How About “Meaningful Exchange”?

At last, we have received from Mt. Olympus those much awaited writings….the definition of “meaningful use”!


I understand how we got here. I could put myself in the shoes of government  decision-makers at every step of the way and see myself doing the same thing. “Step in and help … EMR adoption is too slow and costs are rising too high … the free market isn’t working, so step in.” I get that.

“Make the definitions hard and truly meaningful so that after we are thrown out of office, the social benefit of this program of ours will outlast the pure stimulus effect and create real social change in the health care market.” I get that too.

“Let hospital-owned practices into the mix. Even though we know they have the money, we want their leadership. Also, lots of docs are affiliated with hospitals.” This one was tough for me even though I have a lot of hospital clients that own practices and are growing that business.

“Delay a little to see if we can get more people to our higher standard.” Okay.

“Delay a little more and signal that maybe the standards won’t be so high … otherwise maybe no one will be a meaningful user.” Okay. Okay.

Now we have the goods. We’ve increased the cost of health care in the following ways:

  • We spent billions on attaining meaningless meaningful use.
  • We cause vertical integration between hospitals and doctors, giving hospitals more pricing power and more influence over doctors’ referral patterns.
  • We got thousands of doctors onto software-based, isolated EMR packages that are systematically not connected to one another and left doctors with no meaningful incentive to work on the interconnection problem themselves.


Bitch, bitch, bitch – why am I complaining? It’s not like the PRIVATE sector did such a terrific job all these years connecting health care! If it had, the government wouldn’t be in here like this. So what now? The private sector had better step up! The fact that meaningful use might be meaningless may actually be a blessing of sorts. There is still room for the private sector to step in and starting MEANINGFULLY exchanging health care information. This administration may be activist, but they are NOT stupid. IF the private sector starts moving health care information around in a way that is safe and starts sowing the seeds of differential payment for differential quality, I am SURE that the government will let it happen.

Okay Payers!

Okay Hospitals!

Okay docs!


Or is it? You tell me—what do you think?

Jonathan Bush co-founded athenahealth, a leading provider of internet-based business services to physicians since 1997. Prior to joining athenahealth, he served as an EMT for the City of New Orleans, was trained as a medic in the U.S. Army, and worked as a management consultant with Booz Allen & Hamilton. He obtained a Bachelor of Arts in the College of Social Studies from Wesleyan University and an M.B.A. from Harvard Business School.

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8 replies »

  1. I am quite sure that what we all want, and are advocating for, is “Meaningful Outcomes” for patients.
    If we focus on the “Meaningful Outccomes” then we know that the “Meaningful Use” will be guaranteed.
    What they did get right was in using the word “Meaningful”.
    But I also agree with Leonard in that we have to start with what we can.
    The EHR Guy 🙂 Again!

  2. Man am I disappointed with some efforts to improve what doctors do in their office. I’ve practiced for over 18 year in a middle-lower middle class populations. We use PA’s and NA’s and have a non-obstetrical family practice. No one has even threatened to sue me, and aside from getting a little overworked at times my practice has been a joy. My office can comfortably see twenty to twenty five patients a day per physician/PA team. I see about one to two asthmatics a day.
    Now I’m introduced to an office audit that literally is medical baby food. Its safe to say that no effectively functioning family physician had anything to do with it. There was talk about having one person in the practice handling asthma, having weekly or monthly meetings about the asthma patients, and formal and scrupulous interfacing with community agencies and specialist. Welcome to medical care reform American style that smells like medical care reform 1970. These people are clueless.
    My tool kit for asthmatics begins with a good patient rapport, accessory with a PEF meter, a pulse oximeter, home and office flow charts and referrals when goals are not being met. The pulse oximeter is actually more useful for chronic bronchitis patients. The interactions vary with blood tests, reviews of medications(routine on every patient every visit asthma or no), exam with a good forced exhalation, check about allergens. It take about 15 minutes and I can’t remember when I had to admit a asthmatic patient to the hospital.
    “Asthma specialists” in the practice, get real. You simply establish a good rapport and use the most effective tools repeatedly. A weekly meeting, do you know how much that costs(5 doctors and 5 pa’s over $1000)? Sandwich or no sandwich these meetings are time waster and stress inducers

  3. Big plane. Not enough power for load. Stall, spin , crash, burn on takeoff.
    It looked impressive at the gate. Sold alot of seats. Glad you missed your fright?

  4. I agree that it is at least a start and that you do have to start somewhere. It is too easy to try and tackle the whole thing in one go. Takeing it step by set is a good way to start.
    Looking forward to seeing what happens next.

  5. Strangely, I agree with Brian, Leonard… and propensity too. Somehow, a concern for patient safety must be injected into this process.
    I would just hope that all those amassing “priceless assets” keep in mind that those assets do not belong to those amassing them anymore than the contents of safety deposit boxes belong to the bank.

  6. There is too much emphasis on “meaningful”, “use”, “exchange”, “efficiency”, and “e-patients” using unusable devices of unproven safety, and not enough emphasis on “care”, “patient”, “nursing”, “cognition”, “safety”, “efficacy”, “accountability”, “functionality”, and “usability” as a determination as to whether any of the said devices are any damn good, before wasting $ billions. Pathetic.

  7. Yep. I agree that there’s been perhaps too much emphasis on “use” and not enough on “exchange”, but we have to start where we have to start. There is no “exchange” without electronic data.
    I wouldn’t hold my breath for industry to start exchanging what they’ll soon realize is a priceless asset that the gov’t has just required them to create. Perhaps we’ll see a “meaningful exchange” in our future?

  8. I like the fact that even though you stand to benefit hugely from this program, you are still willing to criticize it. It is rather astounding how we have to drag the healthcare industry kicking and screaming into the 21st century. I actually do not think that meaningful use will be meaningless – unless few achieve it…
    Without critical mass (particularly in small practices and rural and underserved areas) the goals of actually improving the quality of care and lowering costs will not be realized.