Meaningful Use Marks Solid Start for Federal Health IT Efforts
by Steven Findlay
The Medicare and Medicaid electronic health record incentive program now moves into action mode. At last.
The final rules released last week made meaningful accommodations to doctors and hospitals who had complained loudly this past spring about overly burdensome draft rules. Despite some initial grumbling last week, I strongly suspect that doctors, hospitals, IT companies and EHR vendors will get down to the business of figuring out how to make this thing work — for themselves and the nation.
Challenges for Meeting ‘Meaningful Use Of ehr‘
The task is huge, of course. It’s a complex set of rules for everyone to absorb. There are no certified EHRs on the street, for one. The rules for an interim certification process were just released on June 18, and the final technical standards and certification criteria that EHRs must meet were released only last week, at the same time as the “meaningful use” rules that providers must meet. Additions to the HIPAA privacy rule were also released just this month.
And yes, doctors in small practices across the country are only just tuning in to the opportunity, with many still skeptical.
On top of all that, the EHR incentive program is intertwined with the health reform legislation, with providers still attempting to wrap their brains around what the whole ball of wax means for themselves and their patients.
In short, there’s a lot of room for error, delay, frustration, confusion and resistance.
Yet, at the same time, the sheer magnitude of what has happened since February 2009 has propelled a sense of momentum and inevitability around significant change. Health care leaders and rank and file providers alike are beginning to more fully comprehend that it’s different this time. The loud and clear message: Stop being a part of the problem and become a part of the solution.
Rules Advance Consumer-Oriented Health Care
To that end, the meaningful use rules open rich pathways that we, in the consumer and patient advocacy community, warmly embrace. The Obama administration, Congress, the Office of the National Coordinator for Health IT and CMS, and the Health IT Policy and Standards committees got it pretty right. They aimed at things that no one could possibly disagree should be done — things that mattered, would be reasonable with the public and could be significantly impacted by EHRs.
For example, central to much of clinical practice today are prescription drugs. About half of people over age 60 take three or more medications for chronic conditions, while one in 10 take seven or more drugs. When many consumers think of their medical care, they mostly think of the medicines they are taking.
Yet, it has been widely documented for years that doctors don’t accurately track what drugs their patients are taking. That’s poor quality care and dangerous.
The meaningful use rules address this with four prescription drug objectives in the core set of 15 measures doctors must meet. That includes electronic prescribing. In addition, the “menu set” (optional list) contains two other prescription drug measures, including medication reconciliation between care settings.
On top of that, a sizable percentage of the 44 clinical quality measures EHRs must be “enabled” to support more aggressive use of medicines to control a range of chronic illnesses.
The rules attack another embarrassing gap. The vast majority of hospitals and doctors today don’t give their patients a written summary (paper or e-copy) of treatment instructions when they leave the hospital or office despite the fact that research over decades has shown that most people don’t retain much of a doctor’s oral instructions or advice.
The meaningful use rules require that doctors and hospitals provide such summaries within three business days, initially for 50% of office visits or patients. If all goes well, that can be pushed to 80% of patients in 2013 or 2015. To boot, consumers will also be able to access an e-copy of the basic health information (test results, problems lists, medications lists, etc.) that resides in their EHRs.
One final example: For over 20 years, public health leaders and doctors have known that patient-generated advance directives could help families and providers organize the care people want if a life-threatening illness or an accident occurs. Advance directives empower consumers and patients. Yet, no attempt to promote them has succeeded to date. That can now be rectified if hospitals embrace the optional (menu set) meaningful use objective that promotes recording the existence of an advance directive in a person’s EHR. It’s a start.
It’s all a start. And a solid one. HHS has an ambitious goal of 100,000 EHR “adopting” doctors by mid- to late 2012. Let’s hope that goal is reached or exceeded as we wend our way aggressively and urgently to the larger goal: an EHR for every person in the U.S. by the end of 2014.
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