Monday, February 28, 2011

The Age of Meaningful Use

A Message from Dr. David Blumenthal, the National Coordinator for Health Information Technology

February 23, 2011

All of us who are working to achieve adoption and meaningful use of electronic health records (EHR) throughout our health care system know that the journey is a long one. There will be many milestones along the way, each one hard-earned. But I believe that when we look back on the road we traveled, the year 2011 will stand out not merely as one more milestone, but as the time when medical care entered a new era – the age of meaningful use of health information.

On the one hand, this milestone is easy to spot: 2011 is the year it became possible for providers to be meaningful users of EHRs, and to earn a financial reward for this accomplishment.

On the other hand, the real significance of this moment might be easily overlooked. The age of meaningful use is only partly about the use of EHRs and the major financial incentives now available to support this. Even more, this new era creates opportunities to revolutionize the work of health professionals and health care institutions, and to make them and the health care system hugely more effective and efficient.

We have been many years – actually, many decades – in arriving at this threshold. The potential for information technology to support and improve health care was recognized early. Government and private support for development and assessment of health informatics began in the 1960s. Yet, even as computers transformed almost every other sector of the economy, health care (except for billing!) remained mostly paper-based.

In 2009, Congress and the President took a definitive new step when they enacted the Health Information Technology Economic and Clinical Heath Act (HITECH), part of the American Recovery and Reinvestment Act. HITECH authorized up to $27 billion in incentive payments for providers, and $2 billion to build a national infrastructure for the adoption of EHRs. Most importantly, HITECH established the goal of the meaningful use of electronic health records. However cryptic this term may have seemed at first, it holds the key to unlocking the power of information to transform health care for the better.

Put plainly, “meaningful use” is a shorthand for three things:

An incentive program, rewarding not only deployment of EHRs but also their effective use for patient benefit;

A new national infrastructure to support deployment and beneficial use of EHRs; and

A vision for the evolving, dynamic and optimal uses of information to support health and health care improvement – the tip of the spear for an information-powered leap in the quality, safety and effectiveness (including cost effectiveness) of our health care system.

As an incentive program, meaningful use went live in January. That was when registration opened for eligible providers and hospitals to take part in the Medicare and Medicaid incentive payments programs. Surveys in the latter part of 2010 by the American Hospital Association and CDC’s National Center for Health Statistics indicated that 81 percent of hospitals and 41 percent of office-based physicians were already planning to achieve meaningful use and qualify for incentive payments. In January alone, 21,300 providers initiated the registration process.

To create an infrastructure supporting meaningful use, the Office of the National Coordinator for Health Information Technology (ONC) has implemented new programs authorized by HITECH and has pursued longer-standing objectives:

Regional Extension Centers (RECs) – ONC is supporting a system of 62 RECs across the nation. They provide customized, on-the-ground support for providers, especially for smaller primary care practices and for small and rural hospitals. ONC aims for RECs to support 100,000 primary care physicians in achieving meaningful use. As of mid-February, more than 45,000 providers have enrolled for REC assistance.

Workforce Training – Rapid growth in EHR deployment will require HIT specialists. ONC supports a six-month training curriculum at 84 community colleges, most of them offering distance as well as on-campus enrollment. The first “class” of 3,400 will complete the curriculum this spring, and we aim for enrollment of over 10,000 per year in the future.

Certification – A crucial aspect of the meaningful use approach is certification of EHR products to ensure that they support the objectives that providers must achieve to qualify for incentive payments. As of mid-February, there were 350 certified products on the market, including 219 complete EHRs and 131 EHR modules. This is a dramatic increase in both the number and usefulness of EHR systems, compared with pre-HITECH numbers. Altogether, 231 vendors have certified products, and 64 percent are small businesses with less than 50 employees. That means the private sector is rising to the opportunity with a flood of innovative new products that will make EHRs cheaper and more user friendly. Most important, providers can now invest in EHRs with confidence that certified systems will support the required meaningful use objectives.

Interoperability and trust – A key benefit of HIT-assisted health care will be the availability and exchangeability of health data, provided in combination with strong cyber security and strict protection for personal health information. The health care, consumer, and HIT communities are working together with ONC to develop policies and standards for information transfer and exchange of different kinds. ONC is working to fashion a governance structure, standards, protocols and policies to support the Nationwide Health Information Network. Numerous projects will be highlighted at the Healthcare Information and Management Systems Society (HIMSS) conference “Interoperability Showcase” ONC and the HHS Office for Civil Rights are working with other federal agencies to develop privacy and security policies appropriate to the electronic age.

State Health Information Exchange (HIE) programs – ONC supports state-level HIT coordination that enables states and regions to develop solutions that work for their particular circumstances, consistent with broader interoperability standards. So far, 35 states have HIE plans approved for implementation.

Most important is the role of meaningful use as a vision of how information can be brought to bear in new ways for the improvement of health and health care. That vision is a device for defining, encouraging, and supporting the optimal use of information for patient care. It is likewise a device for reaching consensus on specific goals, and the pace at which they should be pursued. Finally it is a device for encouraging development and innovation in the technology itself.

This vision really calls for a new perception of clinical care and what we can do for and with patients. We have been accustomed to thinking of medical information as being statically recorded on paper. Meaningful use challenges us to imagine the way electronic information can “take on life” and serve providers and patients in entirely new ways.

Electronic information, especially standards-based information, can become dynamic, interacting with other information to (for example) generate useful safety alerts, call attention to treatment alternatives, enable instantaneous assessments of quality of care or outcomes for patients, or contribute to public health surveillance. We have never, in the history of medicine, had such tools at our disposal. Meaningful use will help usher them into routine, widespread, and effective use.

For individual providers and patients, these powers will support care that is more reliable, safer, higher quality and lower in costs. For the health care system as a whole, they will enhance total performance and cost effectiveness.

A decade ago, the Institute of Medicine stated in its landmark report that: “Between the health care we have and the care we could have lies not just a gap, but a chasm.” HIT has long been seen as a fundamental enabler for closing that chasm and delivering the care we should have. Meaningful use is vital support for the bridge to a transformed health care system.

We have indeed entered the age of meaningful use – a time of action and transition, a time of opportunity and challenge, and hopefully a time for keeping our eye on the ball. Success is not guaranteed. Hard and focused work has brought us this far, and more of the same lies ahead.

Warmest Regards,

David Blumenthal, MD, MPP
National Coordinator for Health Information Technology

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