An Update to Meaningful Use

On June 16, I wrote about the release of the draft definition of meaningful use.

Today, at the HIT Policy Committee meeting, the final definition of meaningful use was released and adopted. What was changed?

1. For inpatient CPOE, only 10% of orders must be entered electronically2. For problem lists, ICD9 or SNOMED must be used3. Advanced directives must be recorded4. Smoking status must be recorded5. Quality measures must be reported to CMS6. Clinicians and Hospitals must implement at least one clinical decision rule relevant to a high clinical priority7. Administrative transactions, including eligibility and claims, must be completed electronically

Also, the timing of meaningful use was clarified in this presentation on Slide 12 and 13

Meaningful Use Workgroup recommended use of an 'adoption year'
timeframe (i.e., '2011 measures' applies to first adoption year even if
HIT adopted in 2013; '2013 measures' applies to 3rd adoption year.

clinicians can still receive partial stimulus funds if they implement
2013-2015 instead of 2011-2013, and they can follow the same path as
early adopters instead of an increasingly difficult set of criteria.

The Committee also discussed options for certification which I encourage you to read.

very important meeting today. Now that meaningful use has been defined
and approved, the HIT Standards Committee can complete its initial
standards and certification criteria recommendations, which will be
delivered next Tuesday.

More on meaningful use:

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7 replies »

  1. John,
    I liked the Joint Commission report on BIDMC website (your prior post) in which it complained about problems that your HIT should have solved__but actually appeared to be a result of ill conceived HIT.

  2. As opposed to many colleagues that think that physicians should just practice “the art of medicine as I please”, I am very much for transparency, guideline use and quality control, BUT …
    the above sounds to me like we are confounding means and ends. Other than “Advanced directives must be recorded”, I do not think that any of the above is proven to improve care outcomes – in fact, it sounds like mindless paperwork that physicians will feel harrased to comply with, without ever feeling reasonable motivation (“must implement at least one clinical decision rule relevant to a high clinical priority”). If you want physicians to use guidelines (I am all for it), you have to etxensively teach guideline use during training, or, if you want to speed things up, have great reserves and can face a shit storm, enforce them (e.g. per peer review).
    I am all for EMR (I worked with them since residency in 2000). But it seems that the whole senseless EMR implementation will not remedy the US health care madness, it might rather make things even worse and more costly instead.

  3. For an approximate investment of $35B from the federal government, this level of “Meaningful Use” seems woefully low. I do not believe that the bar should be set so low so as to allow everyone to qualify for reimbursement with little previous effort.

  4. Decision support? Whose decisions and are they accurate for the patients’ unique circumstances?
    This is like the hurry up antibiotics for pneumonia in the ER. Literally thousand of patients with heart failure are being mistreated…those records and stats are not determined by the pre-programmed computers.
    Why did we go to medical school and devote years of life to slave labor as house officers?
    Or, is the decision support for paraprofessionals and chimpanzees?

  5. The definition is rather vague on exchange of patient information. It only mentions “capabilities” to be implemented. The presentation of the HIE Workgroup of the Committee wasn’t very convincing either. There seems still to be a lot of mist as to what HIE networks will aim for and look like, where funding is going to come from, etc. Yesterday, right after the meeting, I posted a blog on that at

  6. Health care in the US is controlled by big businesses only interested in making lots of money for their bottom lines and to hell with stupid US consumers.
    HBOs, insurance companies all those in shiny office buildings who don’t actually treat patients or provide medicins should be eliminated – or at least taxed at 90% to pay for universal health care for all.

  7. One of the key would be to define what is meaningful information to capture..from business and from care perspective. That would help a clearer implemntation.
    The challenge with HIT lies in the very basic fact that it cannot have down time or it must have backup plans; and it is not something that you can fix as you go like most of the non-Health IT tools.
    Those need to be established….otherwise, is is like a professor who used to make org chart and keep on moving his name to different groups and titles to make himself look useful.