At the request of Neil Calman, I had the opportunity to speak in Albany last week at the New York State AHEC (Area Health Education Center) System Advisory Board meeting on “Health Care Reform & the Health Information Technology Workforce.” The trip was well worthwhile for many reasons, certainly not the least of which being the chance to soak up more wisdom from Neil Calman, MD, CEO of IxAction Alliance member, the Institute for Family Health (IFH).

Neil — a member of the Health Information Technology (HIT) Policy Committee advising HHS on the implementation of HIT provisions in the American Recovery & Reinvestment Act — set up the discussion about the all-important definition of “meaningful use” of electronic health records (which will determine whether physicians are rewarded with incentives for HIT adoption). As others have stated, Neil made clear that “It’s not about the technology.” Rather, he said, “It’s about the handshake between HIT and health care reform.”

Neil then proceeded to give a great example from his own delivery system of the difference between HIT implementation and meaningful use of HIT. When IFH implemented its EHR in 2002, it experienced no improvement in the rate at which its older patients got a pneumonia vaccination. However, IFH added an electronic reminder system to its EHR in November 2003, which produced an immediate and sustained spike in vaccination rates that continues to hover around 80%.

Neil discussed other examples of meaningful use and highlighted that what it’s really about is changing the way clinicians practice. Although many clinicians bemoan the transition from handwritten, paper progress notes to electronic notes available for the patient to review, Neil emphasized that this modern form of documentation can produce important improvements in care delivery. This transparency (an important goal by itself) does much more than just create an environment of participatory medicine for its own sake.

Neil pointed out, “When you change what you write in progress notes,” to make them appropriate for your patients’ consumption, “you drill down further to the real reason” for sub-optimal care. In the past when a patient wasn’t taking a new medicine, an IFH clinician may have just written in the progress notes, “Patient non-compliant.” But such a statement obviously begs the question: Why? So the doctor now will ask, and the answer often provides important direction for improved care delivery: “Patient took first 2 pills and they made him sick.” Now, the clinician and patient know what they need to discuss in order to improve adherence to a medication regimen.

That’s what meaningful use is all about. Taking apart HIT, we’re not just changing the T (technology), but actually fundamentally changing the I (information) in order to improve H (health).

This entry was posted on Wednesday, September 23rd, 2009 at 10:15 am and is filed under Decision Support, EHRs, Inside the Beltway, Participatory Medicine. 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.