Blog roundup: Healthcare IT and Meaningful Use
May 1st, 2009
This week, after the Senate confirmed Governor Kathleen Sebelius (D-KS) as HHS Secretary, HHS announced the establishment of two new health IT committees in the department. Jason Miller of FederalNewsRadio reported:
HHS announced [Wednesday] in the Federal Register that the Health IT policy committee would recommend a policy framework to develop and adopt nationwide infrastructure to permit the electronic exchange of health information.
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The Health IT standards committee would make recommendations around data and technology standards, implementation specifications and certification criteria for the electronic exchange and use of health records.
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Previously, HHS had similar committees addressing policy and standards. But the Recovery Act, which included more than $19 billion for health IT, required HHS establish these new committees with a different makeup.
(See the complete article for more details about membership of the committees.)
The HHS Department’s focus on health IT this week also included a two-day hearing on “Meaninful Use” of Health Information Technology, hosted by the National Committee on Vital and Health Statistics. It’s no surprise, then, that Health IT and the “meaning of meaningful use” have dominated health discussions around the Web this week.
Josh Seidman on the Center for Information Therapy blog highlighted two organization’s issue statements regarding meaningful use:
The [Markle Foundation] statement appropriately highlights patient access to clinically relevant electronic information. It could further by clarifying that such information should be accessible to consumers in a way that they can understand and use it, and also that facilitates action on their part, or as [the Consumer Partnership for eHealth (CPeH)] puts it, “access their personal health information, receive prompts and reminders, and use patient decision support without sacrificing privacy.”
These patient-centered definitions of meaningful use are critically important for ensuring that ARRA HIT provisions actually change how health care is delivered in this country.
For HealthLeaders Media, Janice Simmons highlighted additional definitions released by related organizations:
Under the new stimulus law, Medicare incentive payments can be made up to four years to hospitals and up to five years for physicians who meet “meaningful use” and “meaningful user” criteria of certified EHRs. The Healthcare Information and Management Systems Society (HIMSS), after input from its membership, released new definitions April 27 to specify what is meant by that term. To be eligible for the incentive payments, the HIMSS definition said that hospitals and physicians must use the technology in a meaningful manner, exchange electronic health information to improve the quality of care, and submit clinical quality measures—and other measures—as selected by the Health and Human Services (HHS) secretary.
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Farzad Mostashari, MD, assistant commissioner of the Primary Care Information Project, within the New York City Department of Health and Mental Hygiene, said “the transformative potential of health IT is to provide the information necessary for organized care delivery and drive transparency in healthcare outcomes.” The endpoints for meaningful use can include incentive payments tied to measures “that matter and that will sustain improved clinical outcomes,” such as blood pressure control, evidence based care (smoking cessation therapy and aspirin use), patient safety, continuity of care, patient satisfaction, and compliance with public health reporting, Mostashari added.
Elliott Fisher, MD, of Dartmouth University, said his personal history in healthcare as a physician, manager, and patient has “lead me to believe that meaningful use of HIT can best be realized through implementing systems that have basic functionalities that facilitate the care of patients by physicians, nurses and other providers,” he noted. “These systems need not necessarily be extremely complicated.”
On The Health Care Blog, Adrian Gropper, MD, discussed the issue of regulating “consumer-driven research and advice” when it comes to health data mining:
At the National Committee on Vital and Health Statistics executive subcommittee hearing on “meaningful use” of health information technology, Carolyn Clancy, director of the Agency for Healthcare Research and Quality testified “We haven’t reached a system-based approach where the right thing to do is the easy thing to do.” The meaningful use of health information technology will free patients to organize to accelerate research and deliver advice independent of any particular doctor or health plan. Data mining opportunities traditionally restricted to doctors and health plans as a side-effect of their essential services will now be available to anyone that gains the trust of a patient-consumer including, for example, not-for-profits and Internet social networking groups. Suggesting or confirming “the right thing to do” involves coordinating disparate information that includes mining patient data for decision support (to search and display guidelines), for comparative effectiveness research (to find and group similar cases), for bio-surveillance (to find cases that match a profile) and for informed consent (to quantify the risks of alternative treatments).
On the BNET Healthcare blog, Ken Terry wrote:
The consensus of physician and industry representatives was that meaningful use should include interoperability, the ability to report standard quality measures, and advanced clinical decision-making. The ability of EHRs to communicate with one another still has a long way to go, and so does their ability to report quality measures based on clinical data (as opposed to claims data). But the biggest problem is in the area of clinical decision support (CDS).
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At a recent conference of HIMSS, the association of health IT professionals, CDS experts admitted that the technology needs much more work. Dr. Blackford Middleton of Partners Healthcare in Boston noted that best-practice guidelines need to be integrated into EMRs or “standard web services” that physicians can use at the point of care. Dr. Dean Sittig, a professor of medicine at the University of Medicine and Dentistry of New Jersey, said that CDS should go beyond alerts and reminders; it needs to be woven into EHR templates, default values, order sets, and other parts of the program. That’s all fine—but CDS must also be reliable, so that patients always get the best and safest care.If we are going to make “meaningful use” the bedrock of health IT planning, we better make sure that it is applied only to well-tested components of current EMRs—along with worthy adjuncts such as electronic registries. Otherwise, we may get both more and less than we bargained for.
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