Sunday, May 17, 2009

Meaningful Use

I work in Health Information Technology (HIT) and am working on a Masters in Medical Informatics (MMI) degree at Northwestern University. One of the hot topics in HIT is the American Recovery and Reinvestment Act (ARRA) The act will reimburse hospitals and other providers for the “meaningful use” of HIT. But the act doesn’t fully define the term.

ARRA defines “meaningful use” as:

  1. ePrescribing
  2. participation in an HIE
  3. submission of quality measures

This is ok, but what does it really mean.

ePrescribing is well understood. When ePrescribing is implemented, your doctor no longer hand writes a paper prescription that you carry to your pharmacist. The prescription is entered into a computer system and it is electronically transmitted to a pharmacy that you select. Hopefully, the bottle of pills will be waiting for you to pick up when you get there. The advantages of this are that no one has to try to read the Doctor’s handwriting, unless, the doctor still writes out the order and has a nurse or a clerk enter the data for them. If the doctor is using Computerized Physician Order Entry (CPOE), they enter the order directly into the computer. Another advantage is that we can compare this prescription with your current medical conditions and other prescriptions that you are taking and a Decision Support System will flag any potential adverse drug event (ADE) that might occur. With CPOE, the physician is alerted when the order is entered. In the old paper based system, your pharmacist might catch the error and would have to phone the physician to get the prescription changed.

The second component of meaningful use is participation in a Health Information Exchange (HIE). What is a Health Information Exchange? An HIE is a network of Hospitals and other providers that will electronically exchange clinical information about patients. The idea is that if you go to see Dr. Smith, his office will be able to electronically retrieve information about your past treatments other doctors and hospitals in the region. The problem is that HIEs do not exist. Well, ok. There are some things out there that are called HIEs, but they are few and far between. CCHIT just published their certification criteria for HIEs last fall but many of the HIEs that are operational may not meet these criteria. The hope is that states and regions will build HIEs so that providers can participate in them.

The third component is the submission of quality measures. We still do not know what quality measures will be reported and to whom. When providers have EMRs in place, it should be fairly straightforward to collect these quality measures and to electronically transmit them to the appropriate agency. This is just the reporting of quality measures; there are no targets….yet. Expect to see quality defined as a measure of outcome, and not as a measure of effort. In other words, just giving the patient an aspirin should not be considered a measure of quality. Similarly, you shouldn’t get quality points for giving the patient the same “quit smoking” pamphlet that they have been getting for years. A better measure of quality might be “has the patient stopped smoking?” Many other industries have adopted quality measures that relate directly to the quality of the product and to customer satisfaction with a product or service.

So, when will we know what meaningful use means? National Coordinator for Health IT David Blumenthal said: “We hope to provide a direction and some specifications in the late spring, early summer.” He did not specify which year :-)

What’s the rush? Well we need to begin deploying these systems soon, because meaningful use must be achieved by 2012 in order for providers to get the full incentive money. Note that this refers to the federal fiscal year, so this really means October 1, 2011. These systems are complex and the timing is fairly tight.

Last month, the National Committee on Vital Health Statistics (NCVHS) met to discuss meaningful use. The meeting agenda and presentations can be found at the following link.

One thing we can expect is that meaningful use will be a target that will change every year. Expect the bar to be raised each year. For example, once everyone has ePrescribing implemented I would expect to see the addition of Decision Support to check for drug interactions and to look for cheaper alternatives.

The HIT Standards Committee met on Friday, 5/15. There is a nice summary of the meeting on John Halamka's blog:

That's enough of that. The Red Wings begin the conference finals this afternoon. Go Wings!

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