The latest inside-the-Beltway, HIT version of “exciting” debate is now raging: What will constitute “meaningful use” for providers to qualify for HIT implementation incentives from the stimulus bill? The Center for Information Therapy (IxCenter) background on it can be found here.

Everybody, including new National HIT Coordinator David Blumenthal, has been talking about how the way in which “meaningful use” is defined by HHS will be a critical piece in determining how well it stimulates improved health care and greater systemic efficiency.

The National Committee on Vital & Health Statistics held a two-day hearing on the subject this week, causing many organizations to issue statements, including ones from the Consumer Partnership for eHealth (CPeH) and the Markle Foundation, to which the IxCenter signed on to both.

CPeH’s statement focuses on the key point that, “A fully patient-centered health care system will exhibit the following characteristics, all of which must be enabled and supported by the effective, meaningful use of HIT to improve patient outcomes:”

• Care is comprehensive, coordinated, personalized and planned
• Patients and their caregivers are full partners in their care, assisted with management of chronic illnesses and health care decision making
• Transitions between settings of care are smooth, safe, effective and efficient
• Patients can get care when and where they need it
• Patients’ experience of care is routinely assessed and improved
• Care is connected to and integrates community resources
• Continuous quality improvement and the elimination of disparities are a top priority

Moreover, the CPeH statement gets specific about how to leverage the “meaningful use” definition to drive a patient-centered delivery system. “Incentives must create a pathway toward this patient-centered system, beginning with rewarding the currently achievable goals such as effective medication management, improved coordination of care, and safer transitions between settings, while building steadily toward the achievement of every characteristic of the patient-centered system we all seek.  Essential mileposts include:

• Increasingly ambitious health improvement aims over time.
• The ability of consumers, patients, and their families to access their personal health information, receive prompts and reminders, and use patient decision support without sacrificing privacy.
• Flexible requirements that enable a broad range of providers and patients to benefit from new technologies.
• The ability of systems to capture both clinical and patient experience data to support more rigorous and robust quality measurement and improvement.

Markle’s key “Seven Principles for Meaningful Use and Qualification or Certification of EHRs” are as follows:

1. The overarching nationwide goals of health IT investments are to improve health care quality, reduce growth in costs, stimulate innovation, and protect privacy.
2. These goals can be achieved only through the effective use of information to support better decision-making and more effective care processes that improve health outcomes and reduce cost growth.
3. Meaningful use should be demonstrable in the first years of implementation (2011-12) without creating undue burden on clinicians and practices.
4. The definition of meaningful use 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.
6. Metrics for achieving meaningful use should account for the heterogeneity of the U.S. health sector and allow for a broad range of providers to participate.
7. Consumers, patients, and their families should benefit from health IT through improved access to personal health information without sacrificing their privacy.

To me, this seventh principle is where the rubber meets the road sky. As the Markle goes on to say about it, “ARRA clarifies the individual‘s right to request electronic copies of personal health information from EHRs for storage by information services of the individual‘s choosing. This should be considered a form of meaningful use toward helping people prevent illness, manage their health-related information and transactions, coordinate care and communicate with clinicians, understand health care costs, and take better care of loved ones.”

The Markle 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 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.

This entry was posted on Thursday, April 30th, 2009 at 8:14 pm and is filed under Inside the Beltway. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.