Matthew Holt

Meaningful meaning? (with UPDATE)

6a00d8341c909d53ef0105371fd47b970b-320wiThe first draft of “meaningful use” came out early yesterday, and I was struck by two things. First, probably influenced by the NCVHS recommendations and the Consumer Partnership for e-Health (See Update), the work-group included a lot of consumer-facing aspects in the concept of meaningful use. Here’s the full draft. Comments are being accepted now (but hurry as they’re going to come back with version two in a month, you have 9 days!).

But in terms of getting consumer activities into the 2011 definition the “Objectives” suggest that meaningful use includes:

  • Providing patients with electronic copy of or electronic access to clinical information (labs, medication list, allergies, medical “problem” list)
  • Providing access to patient specific educational sources
  • Providing clinical summaries for patients at each encounter

Metrics would include the percentage of patients with

  • electronic access to personal health information
  • access to patient-specific educational resources
  • and percentage of encounters where clinical summary provided

The objectives and measurements get even more comprehensive by 2013 and 2015 including adding patient-physician communication, and including data from electronic devices in the home, and more personalized self-management tools. So overall this is, compared to where the standard EHR industry has been, fairly ambitious. Think back to two or four years ago and see exactly how few of those were in place then compared to now, and you’ll see how fast change will have to happen.

The second thought I had is that the major EMR vendors, (well Epic at least), can already provide all of what’s being talked about being necessary by 2011, and most of 2013’s requirements. But if we really are going to attach devices to the data systems and also engage patients with meaningful management tools, those vendors and their clients are really going to have to open up to the Health 2.0 world.

And funnily enough a group that includes David Kibbe & Clay Christensen, led by Isaac S. Kohane and Kenneth Mandl from Children’s Hospital Boston have today come out with recommendations for how to build a platform for plug & play applications to accomplish these goals using the iPhone App store as one potential model, and encouraging everyone to open their APIs Web 2.0 style.

That would achieve the ability to provide meaning in that meaningful use in a few short years—in fact many of these applications are already being developed and used. The question of course is, can the CCHIT certified EMRs interoperate with these platforms, and if not, will their use be meaningful. And again if not, will the vendors and the providers who’ve spent millions of dollars on them demand a downgrading of the new meaningful use metrics—locking them into the 2011 standards.

All will be watched very closely, but there’s no question that on health IT we have the potential for a great leap forward. Something that is looking very elusive for health reform in general.

UPDATE: My friend and colleague Josh Seidman from the Center for Information Therapy has written to correctly chastise me for not reading the blog post where already he gave his view on meaningful use, and more importantly for my missing completely the role of the Consumer Partnership for e-Health (supported by Markle) in the process–several of whose recommendations were incorporated pretty much wholesale into the workgroup’s current version. Josh also wrote a description of the process which I engaged in with the Consumer Partnership for e-Health earlier this month. It’s important to realize that beyond those of us ranting on the sidelines, consumers have real advocates like Josh and his team working on their health information needs in DC.

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JohnaposatDavid AhernJosh SeidmanJen McCabe Gorman Recent comment authors
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If you want to streamline your the process for Social Security Disability try getting a representative. Usually Social Security or your representative will collect all medical records for you in your claim.


insurers have near ludicrous caps on this service. Who’s going to pay for all the time docs will spend answering patient questions (whether they arrive in Health 2.0 style via a txt message or email or IM or via old-skool means like a face to face visit or Pony Express)? can u explain more

David Ahern
David Ahern

I applaud the work of the Health IT Policy Committee and, like Matthew, am frankly pleasantly suprised by the intial language and framework for definition in the preliminary recommendations. Clearly, as Joshua notes, considerable work from the individuals and organizations he mentions have influenced the perspective of the committee to emphasize the consumer and patient-centeredness of “meaningingful use” out of the gate. I’m also heartened by the inclusion of quality metrics, albeit in 2011, that support a shift to population health. I would also argue all stakeholders and certainly patients be made aware of this information about quality as part… Read more »

Josh Seidman

Matthew, I appreciate your UPDATE. We also should add that there are many excellent members of the HIT Policy Committee and its MU Workgroup who have demonstrated great leadership on this issue, including Christine Bechtel (National Partnership for Women & Families), Neil Calman (Institute for Family Health), Deven McGraw (Center for Democracy & Technology), David Lansky (Pacific Business Group on Health) and workgroup co-chairs Paul Tang (Palo Alto Medical Foundation) and Farzad Mostashari (New York City Department of Health), among others. They have been strong voices for consumer access to health information. There also is still a long way to… Read more »

Jen McCabe Gorman
Jen McCabe Gorman

All this meaningful use discussion and transfer of info from docs to patients to payors etc. won’t mean a thing if we don’t begin to, as Steve Beller points out, provide decision support tools and services. We can start by paying providers for time spent on patient education. Many insurers have near ludicrous caps on this service. Who’s going to pay for all the time docs will spend answering patient questions (whether they arrive in Health 2.0 style via a txt message or email or IM or via old-skool means like a face to face visit or Pony Express)? Whenever… Read more »

Steve Beller, PhD

I like Joshua’s additions. One of the essential element missing from every meaningful use definition I’ve read to date, however, is a requirement for “patient-centered cognitive support.” Following is a 1,000 word response I just submitted to the HHS HIT Policy Committee’s request for comments on a definition … Proposed definition: Using Health IT to increase care value (effectiveness and efficiency) by providing ever-better patient-centered cognitive support. As discussed in a recent report by the National Research Council of the National Academies, patient-centered cognitive support (PCCS) is a computerized process that improves decision making by fostering profound understanding through use… Read more »

Joshua Seidman

Regarding your first observation about the consumer-facing side of the draft meaningful use definition, many of the elements derive directly from the recommendations of the Consumer Partnership for eHealth. For background, see
And, for some recommended improvements to ensure stronger attention to consumer access to meaningful, useful information, see