What is Meaningful Use?

The definition of "Meaningful Use" in ARRA is one of the most critical decision points of the new administration's healthcare IT efforts. That definition will influence the types of products that will be implemented in clinician offices and the types of standards used for healthcare exchange to qualify for stimulus dollars.

For example, if meaningful use is defined as e-prescribing, then standalone products such as Dr. First's Rcopia could be used as part of a clinician's office compliance in lieu of a complete EHR.

If meaningful use is defined as the basics of ordering/viewing labs, then products like 4medica could constitute meaningful use.

If meaningful use requires sophisticated quality measurement, decision support, and workflow redesign to enhance efficiency, then a CCHIT certified comprehensive EHR may be required.

My prediction of meaningful use is that it will focus on quality and efficiency. It will require electronic exchange of quality measures including process and outcome metrics. It will require coordination of care through the transmission of clinical summaries. It will require decision support driven medication management with comprehensive eRx implementation (eligibility, formulary, history, drug/drug interaction, routing, refills).

Each year, the definition of meaningful use will be expanded, setting the bar higher and requiring more features and more data exchange.

Thus, in the short term, meaningful use may be a combination of products or an EHR lite. However, over the longer term, a comprehensive EHR will be the best foundation for meaningful use.

The definition of "certified" is also important. Today, CCHIT includes those criteria that make an EHR capable of supporting an optimal set of functionality. If certification is redefined as a baseline set of functionality, then more basic EHR lites may meet the definition of "certified". If certification is based on the criteria as written today and the likely evolving criteria for usability and interoperability, then a comprehensive EHR will be the best foundation.

There are many stakeholders on both sides of this discussion. Small clinician offices with few resources want stand alone e-prescribing and lightweight EHRs to get them started on e-health. Hospitals, larger practices, population health experts, and researchers favor a more comprehensive EHR.

As background, here's the HIMSS strawman proposal for meaningful use.

The next few months will settle this question once and for all. If you have an opinion about meaningful use, I expect the first recommendations to come from the new HIT Policy Committee and possibly NCVHS, an existing FACA advising HHS. Participation in any call for public comment will be the best opportunity to contribute your opinion.