Posts Tagged ‘health IT’

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

May 17, 2010

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.

The Health IT Challenge

April 21, 2010

Jed Seltzer, executive director of the New Jersey Health Information Technology Commission, says when it comes to developing health information exchanges getting all the stakeholders on the same page is at least as daunting a task as solving the purely technological issues.

These exchanges are the building blocks of what will become a national system for exchanging patient data in real time between providers. Seltzer explains what he works on every day in New Jersey, “Trying to get 30,000 doctors and 73 hospitals to even think about digitizing their records and then getting them to do it in a way that is ‘meaningful use’ and then getting it interoperable. That is such a tough haul in terms of education and outreach.”

With that in mind – and with $20 billion stimulus dollars going to health IT– we were intrigued by a note we spotted over the weekend about how little the public even knows about the potential uses of health IT. This is an important question, because the public’s input is key to engaging people in the development of a “meaningful use” definition. This definition will help providers decide what technologies they should adopt and how that technology needs to be used in order to meet federal requirements and, more importantly, in order to best serve patients nationally.

Jeff Rowe, the post’s author, wrote,

In short, it seems safe to assume that while health care stakeholders and observers are more than familiar with the HIT landscape, much of the general public still is not.

While it is certainly true that stakeholders will be more informed than the general public regarding health IT, we wonder if Rowe is overestimating the level of understanding on the part of insiders. If this kind of technology follows the path of many before it, we suspect that many engaged stakeholders are still in the dark regarding its complexities, its benefits, and its risks.

We’re going to be following the development of these exchanges in the states and look forward to seeing the ways they tackle the enormous technological and managerial challenges.

The long view

April 8, 2010
“I worry that the long-term investment programs will be looked at negatively because they aren’t generating jobs right away.”
– Darrene Hackler

When the stimulus act was being debated, there was a great deal of emphasis on so-called “shovel ready” projects. But there are some elements in the program that have a somewhat longer-term focus – like broadband, health IT, the “smart grid” and high speed rail.

Their emphasis is less on creating jobs now, and more on building for the future. As a result, these programs will depend on continued focus from state and local governments, the federal government and  the private sector, long after the stimulus is a distant memory, says Darrene Hackler, senior fellow at the Information Technology and Innovation Foundation and an associate professor at George Mason University.

Some of the lessons to be learned about these longer-range projects emanate from broadband, which is out of the gate earlier than others because it doesn’t rely as much on federal planning and standard setting.

Darrene Hackler

One thing that state and local governments can learn from the broadband experience, says Hackler, is the value of getting collaborations going and a vision set out even before the federal government has all its ducks in a row. “When the funding came down for broadband, there were states and local governments that were ahead of the game,” she says. “They were prepared to respond to the grant proposals more quickly. They had already had community meetings, developed partnerships with private and non-profit sectors, and done technology planning assessments. That’s been a big advantage.”

Long-term projects also face a profound need for the development of good metrics. With many private companies involved, there’s a great deal of proprietary data, as well as information that may involve privacy issues.  But that can’t stand in the way of “being able to measure the effects,” says Hackler. The National Telecommunications and Information Administration, which handles part of the broadband effort, is currently developing ways to allow managers, leaders and the academic community to track usage and trends through broadband mapping grants, without jeopardizing proprietary data.

It’s also important to look at what could have been done better with broadband. Hackler believes that the broadband grant stream was not set up in a way that encouraged the collaboration of agencies. There was the Agriculture funding stream (administered by the Rural Utility Service) and the one from the Commerce Department (out of the National Telecommunications and Information Administration). “Why did we divide it?” asks Hackler.

She also believes there should have been more collaboration with the Department of Education, since the anchor tenants for broadband will be schools, universities and libraries. Greater collaboration with the Department of Labor would have provided better grounding for training workers with the necessary IT skills for high growth and emerging industry sectors.

Meanwhile, Hackler has one big fear.  “I worry that the long-term investment programs will be looked at negatively because they aren’t generating jobs right away. These programs are about building a foundation for job creation. If they don’t create lots of jobs immediately, they shouldn’t be thought of as failures, but as a down-payment for the future.”

For more on broadband, Hackler’s report, “Sustaining Jobs After the Stimulus: Building on Broadband,” came out yesterday. It was published by the CGI Initiative for Collaborative Government.