Posted August 2, 2009 by Lygeia Ricciardi
The definition of “meaningful use” continues to occupy
attention in Washington because of the important role it will play in the
allocation of the stimulus package’s $17 billion dollars geared toward the
adoption of electronic health records (EHRs). To qualify for incentive payments
via the Centers for Medicare and Medicaid Services, health care providers will
have to demonstrate that they are using their EHRs in a “meaningful manner.”
A federal advisory committee called the Health IT Policy Committee has been working to clarify what “meaningful use” will really mean. On July 16th it approved a set of more than two dozen recommended meaningful use objectives. These generally take the form of a single phrase, such as “maintain active medication list,” describing what providers or hospitals must do to be eligible for financial support. Several of the objectives were revised from a previous iteration released in June, which received 720 public comments.
What changed?
Notable changes in the objectives include refinements in the criteria for computerized physician order entry (CPOE), and a tighter timeline by which health care providers are required to be able to give patients access to their own health information via personal health records (PHRs), populated “in real time” with their own health information. (The deadline was moved up by two years – from 2015 to 2013).
So what happens next?
The “objectives” approved by the committee have now been handed off to two
agencies within the Department of Health and Human Services – the Office of the
National Coordinator (for Health IT), and the Centers for Medicare and Medicaid
Services – to be translated into much more technical, specific rules. Drafts of
those rules will be released in December, when the public will again have a
chance to comment on them.
Further
Clarifications are Needed to Make Data “Meaningful” to Patients
In general the supportive stance the committee took on patient access to and engagement with personal health information is very positive. For instance, a stated “care goal” is to “provide patients and families with timely access to data, knowledge, and tools to make informed decisions and to manage their health.” But the next phase of work is where the rubber hits the proverbial road. Based on insights from Project HealthDesign’s first round, there are a couple of key points that still need to be articulated clearly.
Among the objectives are several that have to do with
providing patients access to an electronic copy of their health information
(including lab results, a problem list, medication lists, allergies, etc.).
That’s a great starting point. What’s missing, though, is the stipulation that
such access be in a form that is usable by patients – a computable form consistent
with the Project HealthDesign
vision.
Project HealthDesign envisions
patients in the near future using their health data not just as an end in
itself, but as a starting point. People will be downloading information from
their clinical visits and running it through a variety of tools and
applications to analyze it and mash it up with other kinds of data. For
example, an allergy sufferer could track how her allergy symptoms (as measured
by lung capacity in her doctor’s office) relate to pollen levels (reported by
the national weather service). Merely seeing health data on a screen, or
downloading it in a PDF or other “locked” file format, won’t let patients use
it in many of the ways that are most meaningful to them.
As a related point, many patients will want such novel data relating to their health to flow the opposite way: back to their care team. In its study of observations of daily living (ODLs), Project HealthDesign found that individuals identify a range of types of information that are relevant to them, including sleep patterns and social interactions. Some people choose to keep such information private, but others feel strongly that others – including health care providers, other professionals such as personal trainers, and even family members – need to understand it.
It’s not that providers should necessarily have to worry about the pollen levels in the zip codes where each of their patients live. Rather, providers should have the capacity to incorporate into their EHRs data identified and recorded by individuals as specifically relevant to them and their own health, whether or not it is “traditional health data” such as weight or glucose levels. While the Health IT Policy Committee’s objectives make reference to providers being able to “upload data from [a] home monitoring device,” they do not explicitly address the need to incorporate a wide variety of types of patient generated information into the EHR.
Customization of Care
In general the meaningful use definition process has been very positive from the perspective of strengthening patient engagement. Let’s keep up the good work and make sure its outcomes are as effective as possible by clarifying the points above.
People are different, and the best quality health care needs to be customized to the individual. Many other industries are using information technology to tailor products and services to meet individual needs. In health care, too, technology can enable an unprecedented flow of usable, customizable information–if we make sure the systems we put in place support it.
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