Industry Spotlight: Industry Weighs in on Definition of Meaningful Use

By: Carrie Vaughan, Technology Editor for HealthLeaders Media

Healthcare providers are antsy to start working toward becoming "meaningful users" of electronic health record technology so that they can claim some of the American Recovery and Reinvestment Act's financial incentives when they become available in fiscal year 2011 and 2012. While providers wait for the government's definition of "meaningful use" of EHR technology, which ultimately is the only definition that matters, they did receive some guidance this past week as just about every association and industry group released their own definition of what meaningful use should include. Here's a breakdown of those recommendations.

CHIME: The College of Healthcare Information Management Executives says that meaningful use should focus on the use of quality metrics and outcomes regardless of the technology in place, a phased approach should be used to encourage adoption, the industry should explore alternative ways to connectivity in the short term that can lead to participation in a health information exchange, and the industry should consider alternative ways to exchange health data other than the continuity of care document—at least initially—because some organizations may not have the capability to immediately deploy the CCD.

AHIMA: The American Health Information Management Association says the most crucial element of meaningful use is the widespread adoption of certified EHRs and that the expectations are applied uniformly across all industry segments and not vary by payer, patient, or provider. AHIMA recommends the focus should be on the end goals to improve quality, cost and health system performance not the technology itself; the initial criteria should be based on what is achievable with the current technology with the measures becoming more strict in the next several years; the certifying body should be the Certification Commission for Healthcare Information Technology; it should be measured and reported in a way that minimizes manipulation; and it should be relevant to consumers.

AMIA: The American Medical Informatics Association recommends that meaningful use should focus on process and care improvements over time, include EHR functionality and capability, and establish approaches to measure meaningful use. The AMIA notes that EHRs have the potential to support and enhance clinical care and decision-making, but simply implementing an EHR does not mean that the organization will effectively use the system or achieve the desirable patient outcomes and changes to clinical processes.

ANI: The Alliance for Nursing Informatics says meaningful use should include patient-centered documentation—initially focusing on patient summary data—that can enhance cross continuum communication and improve safety, quality, and processes of care delivery; collect standardized clinical performance measures as a byproduct of care delivery and clinician documentation; use processes and infrastructure defined by HITSP—initially focusing on a subset of existing NQF-endorsed measures—to submit quality measures; use existing initiatives such as HITSP and IHE to guide standards use within all systems that record, transmit, collect, and share information for care delivery; and expand the definition of "meaningful user" to include registered nurses and advanced practice registered nurses.

HIMSS: The Health Information Management Systems Society recommends that CCHIT be the certifying body of EHRs; using an incremental approach to adopt metrics that can be reasonably captured and reported beginning in fiscal years 2011 and 2012, and then made increasingly stringent using intervals of not less than two years; bridging the existing gaps in interoperability of health information by creating new standards and implementation guides in coordination with HITSP and IHE; and reconciling the gap between "certified EHR technologies," "best of breed," and "open source" technologies.

The types of features and functions HIMSS recommends in phase one for hospitals are:

• Major ancillary department information systems (lab, pharmacy, and radiology) and a clinical data repository that are interfaced with the patient accounting system.
• Discrete clinical observations electronically entered and available to clinicians throughout the organization. Physician documentation is desirable, but optional.
• A combination of compliance metrics and National Quality Forum-endorsed quality measures that align with national quality and performance goals. The hospital's EHR must be able to capture and report relevant statistics without manual intervention. For example, baseline reporting of percentage of medical orders entered electronically into the EHR by physicians; re-admissions within 24 hours of discharge; duplicate diagnostic test orders; and present-on-admission tests compliance.
• The electronic exchange of health information via scanned documents, text documents, or XML transactions.

Phase one recommendations for physicians include:

• An EHR infrastructure that has clinical data display and computerized practitioner order entry, with independent licensed practitioners entering the order.
• Electronic prescribing technology to transmit prescriptions to pharmacies.
• A sub-set of existing National Quality Forum-endorsed measures that align with national quality and performance goals. For example, baseline reporting of medical orders entered electronically by physicians; Agency for Health Research & Quality quality outcomes; National Priorities Partnership goals, convened by National Quality Forum; adverse drug events; and percentage of prescriptions electronically sent to the pharmacy.

The Markle Foundation recommends seven principles for meaningful use and qualification of certified EHRs in the report, Achieving the Health IT Objectives of the American Recovery and Reinvestment Act.

1. The overarching goals of health IT investments should improve healthcare quality, reduce growth in costs, stimulate innovation, and protect privacy. "If the goals and metrics are not clear before technology is commissioned and the incentives are offered, the government will risk wasting valuable resources and losing support from both healthcare providers and the public for further health IT investments," the report says.
2. The definition should focus on the needs of patients and consumers, not on the mere presence or functions of technology. The end goals cannot be achieved through the installation of software or hardware alone, so it is essential that the information is being used to deliver care and support processes that improve patient health status and outcomes.
3. The definition should be demonstrable in the first years of implementation without creating undue burden on clinicians and practices. For example, improving medication management and coordination of care is an early opportunity to achieve meaningful use. It should initially rely on standard information types such as recent medications and laboratory results that are electronic and already widely adopted.
4. The definition should gradually expand to encompass more ambitious health improvement aims over time.
5. The definition of "qualified or certified EHR technology" should support the goals of meaningful use, security, and privacy. For a technology to be certified, it should embed the capability for clinical practices and hospitals to attain meaningful use without undue additional reporting burdens.
6. Metrics for achieving meaningful use should enable a broad range of providers to participate. The definition should reward the actual use of information and not the mere purchase of specific hardware or software products.
7. Consumers, patients, and their families should benefit from health IT through improved access to personal health information without sacrificing their privacy.

There are a few key areas that the industry agrees on. Namely, that the focus of "meaningful use" should be on the desired outcome, which is improving quality of care, reducing costs, and making care delivery more efficient, not the technology itself. In addition, the definition should encourage the widespread adoption of EHRs by using an incremental approach that requires more stringent criteria as time progresses.

Now providers must wait and see if the government takes the industry's recommendation and defines meaningful use in a way that a large number of hospitals and physicians can achieve with the technology that is currently available.

Carrie Vaughan is a senior editor with HealthLeaders magazine. She can be reached at .cvaughan@healthleadersmedia.com