Health IT: Puzzling Out the Meaning Behind “Meaningful Use”

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One of ARRA’s long-term goals is to push America’s health care providers to use electronic health records (EHR) and other health information technology (health IT).

The carrot that ARRA has in hand, of course, is money. But despite the incentivizing dollars, providers have been reluctant to rush out and buy technology (not to mention the training and other administrative costs). Why? Because they’re going to have to eventually demonstrate that their expenditures meet the definition of “meaningful use,” that the Recovery Act requires. This is very tricky, since nobody has really defined meaningful use.

(We can empathize: As we’ve tried to understand what meaningful use is, we sometimes find ourselves spinning in the Land of Meaningless Tautology. That is to say, we begin to feel as though “meaningful use” is generally defined as “use that’s meaningful.”)

The Office of the National Coordinator for Health IT  published a first stage set of meaningful use criteria in late 2009, though the final rulemaking is pending. Stage 2 and Stage 3 criteria have yet to be released. The three criteria stages will become effective in 2011, 2013 and 2015 respectively.

John Lynn of the EMR and EHR blog recently linked to a relatively simplified 12-page matrix and a list of 25 objectives for meeting the first stage meaningful use threshold. As you can see, the objectives range from things like tracking patient medications and providing patients access to their health information to more esoteric items like the capability to provide” electronic syndromic surveillance data” to public agencies.

That last one might not be 100% clear to laymen (goodness knows it’s not clear to us), but generally speaking all the objectives seem straightforward enough.

However, Lynn points out a further hitch:

It’s one thing to have nice lists of meaningful use objectives. Then, people can look them over and try and guess what CMS might do with those objectives, but it’s a very different thing to have details about what will really need to be done to meet those objectives.

So the problem is really two-fold. Providers aren’t sure exactly what they need to do AND they aren’t exactly sure how they’re going to prove they’re doing it.

These questions will no doubt be sorted out in due time, and we’re sympathetic with the men and women trying to put a definition to meaningful use. On the one hand, if the definition is too loose, there’s a real risk that stimulus dollars might be wasted. On the other hand, if the definition is too prescriptive, then good and sensible EHR uses might never have the chance to see the light of day.

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