The 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.
Categories: Matthew Holt