The State of Meaningful Use

Is it possible that the State Department is technologically bolder than the HIT Policy Committee?  On Tuesday, that committee convened by the Office of the National Coordinator as required by the American Recovery and Reinvestment Act released some initial recommendations on the definition of meaningful use of HIT.  Then yesterday the New York Times in an above the front page fold article reported that the State Department recognized an internet blogging service could change history–right now.

Compare that report about the State Department to the HIT Policy Committee’s recommended vision for the role of patients and families.  The committee envisions that someone would eventually “provide access for all patients” to populated personal health records and some self-management tools by 2015–about six years from now.  It’s not that this vision is bad; it’s just so underwhelming.  Let’s see–the State Department thinks that the Iranian people might be using Twitter today to regain control of their nation–and in our multi-billion dollar ultimate vision for the patient’s role with health information technology we’re still talking about “providing” a couple of interesting tools to patients by 2015.  Is it me, or are we possibly missing a powerful health reform player here–the consumer?

So, as you can see, I listened to this meeting on “meaningful use” and came away with some distinctly mixed impressions.

First the good news–the committee’s Meaningful Use Workgroup has clearly developed the beginnings of a thoughtful, far-reaching, impressive definition.  They’ve nicely captured the point that this effort is not a software implementation exercise but rather part of the journey toward transformed health care–so far so good.

They have a solid vision of a trajectory of transformation that starts with improved clinical data capture and culminates with hoped for improved health and health care outcomes.  They note that the definition will change and flex along that trajectory toward improved health care.  They emphasize the important role for health information technology in collecting race, ethnicity and language data in the drive toward closing health care disparities.   They integrate a focus on the role of health information in improving population health monitoring.  That’s all terrific.  And they begin to include some specifics about the kinds of health care performance and outcome measures that we expect electronic health records to construct–that all seems fine–great, actually.

But then I started wondering whether the committee’s approach might be too narrowly focused.  There’s that limited consumer role I mentioned and that unfortunate comparison with the State department’s insight about the public’s current embrace of information technology.

But that’s not the only problem.  One wonders if they are working hard enough to connect to other existing efforts to transform health care.  The definition rightly focuses tightly on the information–but their entire transformation vision seems to as well.  The recommendations imply that with the right amount of meaningfully used information technology–we’ll all step nicely along that curving trajectory to improved care.

But, of course, information is only a piece of the puzzle.  The information needs to get in the hands of the public and the health professionals so they can use it to improve.  Where’s the emphasis on public reporting of these measures?

And we will not be able to magically get practices to improve simply with better information. How does this vision and definition coordinate with other federal and private efforts to support practice redesign?

And the definition doesn’t link back to the existing public-private measurement enterprise very well.  They mention the National Priorities Partners and some about the National Quality Forum.  But they do not clearly build off the existing large body of consensus work on measurement and reporting. Instead, it at times sounds like they’re attempting to create everything anew here.  That would probably be a mistake.

Basically, the committee is off to a nice start–but definitely still has some work to do.  I worry that they might be too mired in a sort of HIT 1.0 mindset–while the rest of the world is bravely marching into a networked, empowered, user demanding 2.0 future where widely available sources of information can and will be used to promote, drive and help sustain the transformation we need.

Michael W. Painter, J.D., M.D., is a physician, attorney, health care policy advocate, and 2003-2004 Robert Wood Johnson Health Policy Fellow. He is currently senior program officer and a senior member of the RWJF Quality/Equality Team.