“Meaningful Use” Criteria as a Unifying Force

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Over the past several years, many diverse initiatives have arisen offering partial solutions to systemic problems in the U.S. health care non-system.

We see Meaningful Use Criteria recommended by the HIT Policy Committee as a unifying force for these previously disparate initiatives. These initiatives have included:

  • Patient Centered Medical Homes (PCMHs)
  • Regional Health Information Organizations (RHIOs)/Health Information Exchanges (HIEs)
  • Payer Disease/Care Management Programs
  • Personal Health Record Platforms — Google Health, Microsoft HealthVault, Dossia, health banks, more to come
  • State/Regional Chronic Care Programs (e.g., Colorado, Pennsylvania, Improving Performance in Practice)
  • Accountable Care Organizations — the newest model being proposed as part of national reform efforts

Today

While there are some commonalities and overlap, to-date these initiatives have mostly arisen in isolation and are highly fragmented — they’re all over the map. Here’s a graphic representation of the fragmentation that exists today:

MU1

Tomorrow

The HIT Policy Committee recently recommended highly detailed Meaningful Use criteria for certified EHRs.  Doctors and hospitals who hope to receive HITECH Act stimulus funds will have to demonstrate that they are meeting these criteria; the criteria are not yet finalized.

The Committee website describes the central role of the Meaningful Use criteria:

The focus on meaningful use is a recognition that better health care does not come solely from the adoption of technology itself, but through the exchange and use of health information to best inform clinical decisions at the point of care.

The HIT Policy Committee also is recognizing that there are multiple routes to achieving Meaningful Use beyond the traditional EMR 1.0, e.g., modular Clinical Groupware software.

While some might view the Meaningful Use criteria as limited to the world of health IT — something happening “over there” — we see much more going on. We believe the Meaningful Use criteria are becoming a powerful unifying force across the health system, with potential to converge previously disparate initiatives.  Here’s our conceptual representation:

MU2

Let’s consider a couple examples to demonstrate how convergence is occurring.

RHIOs were formed primarily with a mission of developing health IT infrastructure for local data exchange; they had little need to think about how care providers, health plans and others would actually use the data.

Patient Centered Medical Homes have been built around seven principles (e.g., physician directed medical practice, care coordination) — none of which directly relate to a need to develop health IT infrastructure; the fact that IT infrastructure is necessary to implement these principles has been assumed but not defined.

RHIOs focused on health IT with little thought about objectives, while PCMHs had grand objectives with little thought about needs for health IT.

All this is changing.

RHIOs are recognizing that achieving meaningful use of data is essential; PCMH initiatives are recognizing the need for a robust IT infrastructure and the need to match their efforts to Meaningful Use criteria.

Here are some broader implications about Meaningful Use criteria becoming a unifying force:

  • These diverse initiatives will have more commonalities and will look more and more alike
  • Expect previously disconnected regional initiatives to start talking to one another about collaboration.
  • A common phrase we are hearing is “We need to do a crosswalk of Meaningful Use criteria with our initiative/organization/application functionality.”
  • Vendors must ask: “What are we doing to contribute to Meaningful Use of EHRs”
  • Care providers (doctors and hospitals) must ask: “How are vendor offerings helping us to achieve Meaningful Use of EHRs?”

These are positive developments.  Meaningful Use criteria are becoming a powerful unifying force toward integrating our fragmented health system.

Vince Kuraitis JD, MBA is a health care consultant and primary author of the e-CareManagement blog where this post first appeared. David C. Kibbe MD MBA is a Family Physician and Senior Advisor to the American Academy of Family Physicians who consults on healthcare professional and consumer technologies.  Steve Adams is Founder and CEO of RMD Networks, a Denver, Colorado based company.

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Don BerryMarshall MaglothinVince KuraitisR WatkinsCarlos Leyva Recent comment authors
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Don Berry
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Don Berry

This is so backwards. “Meaningful Use” is not an outcome or even a proxy for an outcome. It’s just a marketing point from the HITECH community. You don’t measure the value of IT… except in the direct performance measures of outcome of treatment. Anything else is pure cr*p.

Marshall Maglothin
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Marshall Maglothin

Outstanding, timely and informative information!
The HITECH Grants will produce the most profound advancement in health information, and I believe in ultimately the delivery of personal health care, in mankind’s history. This platform will move us from a fragmented electronic structure for financial transactions to the breath-taking new vista of disease prevention and management.
I encourage all of your HIT readers to be aggressive and involved participants in networking to energize this transformation with the regional organizations which will burst forth in the next 18 months.

Vince Kuraitis
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Alexander and R. Watkins…
Your comments point to the importance of the definitions of “Meaningful Use”. Agreed, there is a danger here.
Best case scenario is that the MU criteria are a good proxy for ways to improve quality of patient care.
Worst case scenario, the MU criteria become an end in and of themselves and/or are a poor proxy for what’s really important to improve quality.
We appreciate the work done by the MU Workgroup and the HIT Policy Committee, and believe they’ve done a good job on initial definitions. Thus, we’re optimistic about the convergence of attention on MU criteria.

R Watkins
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R Watkins

Alexander:
I agree. I would interpret the diagram to mean that all the sub-domains exist to serve
“meaningful use of EHRs.” Where is patient care in this model?

Carlos Leyva
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It turns out that because full compliance with HIPAA’s Privacy and Security Rules is now part of HHS’ meaningful use definition (i.e. ensuring privacy & security is one of the top 5 priorities–full HIPAA compliance by 2011 or potentially no EHR incentives get paid) that you can add regulatory compliance as one of you convergence domains.
There is, in general, a convergence between public policy, law and technology unlike anything we have seen before.

Alexander Saip
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I hope that achieving meaningful use is not going to become a goal on its own, simply creating more workload, which care providers will have to squeeze somehow into their busy schedule. The ultimate objective is to quickly build a view of the patient, relevant to the encounter, using all available information, to ensure the best possible outcome.