“Meaningful Use” – If You Have to Define It, Is It?

BrianBaum I have a good friend at Duke University
– Dr. Ed Hammond.  (Ed has been involved in advancing electronic
health information for quite some time – probably longer than he'd like
to remember.)  Ed once told me that to get a perspective on how
long we – (our nation) has been assessing the potential of automating
health information you'd have to go back to the introduction of Medicare
in 1965 when President Johnson signed the legislation and officially
enrolled Harry Truman as the first Medicare beneficiary.

A provision of that legislation commissioned
the first study to evaluate the impact on the cost and quality of healthcare
relative to this emerging capability loosely referred to as “information
technology”.  I believe we can all readily admit that much has
changed since 1965, (even if we weren't around in 1965, or aware in
1965.)  For years the debate focused on standards, architecture,
common language, who/how do we pay for this automation, etc – many of
these debates certainly continue today.

The most recent addition to this dialogue
focuses on “meaningful use”.  I saw a press release out of
HHS last week announcing “Process begins to Define Meaningful Use
of Electronic Health Records”.   Now I have to preface my
comments by saying – I am an unwavering advocate of electronic health
information – a strong believer in the value for the individual health
consumer, as well as the greater good of managing health information
across populations.  There can be no doubt of the benefits of efficiently
managing health information with all of the benefits of our ever increasing
powers of information technology.  We can look virtually anywhere
in our lives, our economy to see the impact and benefit.

Now as we enter a period of public
comment on meaningful use – I'm struck by the irony of the very concept. 
Imagine a time long ago when the telephone was first invented. 
Prior to gaining land rights to string phone lines hearings had been
held on “meaningful use” of the telephone.  The debate likely
would have proceeded for years – “who are you going to call”? 
One telephone has no value, the value is in the network – how can we
ensure that a network is ever created?  Of course I'm oversimplifying
the comparison – but you can apply the concept to almost any innovation
– for the most part the innovation succeeds because it provides value,
solves problems, improves life in general.  Once the market validates
an innovation, government may well have a role in regulating to promote
some level of efficiency.  However, the reverse – seems more problematic
– government promulgating meaningful use and then turning it over to
the market to implement.

While I am hopeful that this latest
chapter will produce action, I am most encouraged by the growing recognition
of the role of the patient/consumer in the drive to automate health
information.  No one has more interest in their health history
or health future than the individual health consumer.  Physician
relationships may come and go, payer relationships are certainly transitional
– but the one constant is that most people want to be healthy and want
to live a long and healthy life.  Personal involvement in proactively
managing health is essential to this outcome.  As an industry,
we need to provide the tools and services and access to information
to consumers so that they can effectively manage their health – in collaboration
with all of their clinical resources.  That, I believe is meaningful
use – health information available where and when it can positively
impact the health of an individual and advance the quality of health
across the population.

Earlier this week an organization called
healthdatarights.org issued a “Declaration of Health Data Rights”. 
While the tenets of this declaration would normally be self evident
– I would suggest that this declaration be adopted and endorsed as a
foundation of our national drive to automate health information. 
Actions like this may finally represent the break-through that has eluded
us since those earliest days in 1965.

Brian Baum was the co-founder of
the Health Record Network launched by Duke University in 2003, and most
recently serves as the President of Stayhealthy.

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4 replies »

  1. This is interesting: “No one has more interest in their health history or health future than the individual health consumer. Physician relationships may come and go, payer relationships are certainly transitional – but the one constant is that most people want to be healthy and want to live a long and healthy life.”
    I agree 100%. The problem is that often, individuals are left out of the equation when it comes to these discussions. If the individual doesn’t happen to work in a related field, it is usually late in the decision making process –if at all– that he/she becomes involved.
    I also think that meaningful use had to be defined because of the privacy concerns and the amount of people that could potentially “touch” an individual’s data.

  2. It might help people who are new to the conversation to know that there are over 100 different EMR vendors and until very recently the vendors not only didn’t talk to one another they didn’t even talk to other customers with the same vendor.
    Epic for example (their CEO Judy Faulkner sits on one of the committees that is advising HHS on public policy for health IT) has their EMR at Kasier, Stanford and Palo Alto medical group but you can’t share the records electronically. Just this past year they finally came out with a new module you could install that starts to allow this to happen but it wasn’t built into their system.
    The only reason that the govt is stepping in is because they pay for over 1/2 of all the medical care in the country and the private sector failed for the last 20 plus years to solve this on their own. This isn’t the result of any secret plan to block innovation it is just a change from having the hospitals (the major clients for EMRs) not wanting to share their data.
    The Game changer is that now the vendors realize that it will be the payers of health care not the providers of health care who are their primary client. The loss of income from duplicate tests to a provider is being trumped by the cost to the system.

  3. May be we need to look after democracy here before we tell other countries how to live.
    I’ve had enough of the posturing, lying, propaganda and hypocrisy. It’s time to hold feet to the fire.
    We’re not going to get the obvious, sensible and real solution to US healthcare which is single payer, (No, that doesn’t necessarily exclude private insurance.) combining Medicare, Medicaid, SCHIP, Federal, VA and the military, dumping all the unnecessarily different bureaucracies, and building a realtime medical IT system. The X-factor insurance costs.
    If any of our representatives and senators want to vote against a federally funded public option, how about they give up their federal healthcare. Give them an extra $12,700 a year or so (the average family cover 2008), no tax break, and let them find their own.
    And with ethics oversight to make sure they don’t get deals or care other people can’t.
    Let’s see if they like the insurance company control over their doctor’s choices and their choice of doctors. Let’s see what they call rationing. See how they like having to employ someone to fight their bills for them — god knows they are too incompetent to do it themselves. Let’s see what they think about nationalised health, socalization, and socialized medicine then.
    Below’s what I already sent my senator and rep (Klobuchar/Ellison) with some modification for them. We need a whole load of people to put these shits in a position of shame. We need this to spread exponentially. I’m going to spend the next few hours working the blogs and internet talking about healthcare, and hit all the Senators and as many reps as possible (though most won’t accept non-constituents).
    Help me, please. Hit all blogs, reps, sens, etc.
    I recommend putting this somewhat in your own words.
    Representative/Senator ———,
    I write to you concerning healthcare.
    I understand the inertia impeding the attempt to make healthcare cheaper, more effective and efficient, far less complicated, and universal. Single payer, which would not necessarily mean no private insurance, is the way to go. Adding a publically (federally) funded option is a key if small, and complicating, step on this route.
    In order to avoid any perceived conflict or hypocrisy, I recommend that any senators or representatives voting against a public option renounce their federal healthcare coverage and receive an additional $12,700 per annum (or equivalent, as this was the average health insurance family coverage premium in 2008), no tax breaks (like every other private insuree), and ethics oversight to prevent insurance company favoritism in cost, coverage or service, or federal help in fighting the bills or for care.
    Let’s see who is against a public option then.
    I thank you for your service.
    My name
    One of the Republican “talking points” is to tell anyone that is rich and says that they are willing to pay higher taxes to “Go ahead; pay more taxes. Send a check to the IRS.” Let’s all start hitting these people.
    The young may not think this matters but I have been in the States almost 30 years and healthcare has gone from 8 to 17% GDP of a much bigger GDP per capita. 30 years from now?
    The CBO itself says it is not mostly about the baby boomers but rising health costs.
    Please take time to put this out. Can we make this national?

  4. “That, I believe is meaningful use – health information available where and when it can positively impact the health of an individual and advance the quality of health across the population,” you say.
    Based on this, there are few, if any, commercially available units in the US that will enable meaningfully useful care. The vendors are short changing the docs and the patients.
    CCHIT certification, as configured, is a useless measure of computerrized HIT efficiency.
    Recently, a country in Europe geared up its national HIT system using HIT equipment that has not been in CCHIT’s good graces. This technology may be more meaningfully helpful than the vendor driven inefficently working HIT in the US.