'MEANINGFUL USE' OF HEALTH IT

‘Meaningful use’ of health information technology should be truly meaningful

- 12/13/11 01:52 PM ET

As all parties to the health care system search for ways to rein in costs, the U.S. government is in the process of distributing the first of nearly $30 billion in checks to eligible medical providers. These payouts are part of the Meaningful Use program, which was created under the Health Information Technology for Economic and Clinical Health (HITECH) Act to encourage the adoption and sustained use of electronic health records (EHRs).

If this program works as intended, it has the potential to improve not only patient outcomes and increase coordination among health care professionals, but reduce also skyrocketing health care costs.

But that potential will only be realized if EHRs are adopted and used in an effective and meaningful way. And without the transparency that’s required to measure whether the money is being used for the purpose Congress intended, the Meaningful Use program could end up wasting billions of taxpayer dollars.

So how does it work?

To qualify for the Meaningful Use payments, eligible physicians and hospitals must use a certified EHR platform and attest to having achieved a set of measures over a 90-day reporting period. They must prove that they’ve used their EHR to provide electronic prescriptions, record vital signs, provide patients with a clinical summary of office visits and more.

The problem, however, is a lack of transparency and accountability. The government has no way of verifying that the physicians who claim to have met the Meaningful Use criteria are actually using health information technology in any meaningful way.

Click a box, get a check. Without an audit process in place, it’s almost that easy.

While the HITECH Act has encouraged greater competition in the EHR marketplace, the current lax standards for verifying Meaningful Use could lead to enormous disparities between what physicians and hospitals are able to do with their EHRs and their actual ability to improve patient care.

There are currently 788 certified ambulatory EHR products, but all EHRs are not created equal. The Office of the National Coordinator for Health Information Technology (ONC) and the U.S. Centers for Medicare and Medicaid Services (CMS) should urge EHR vendors to release more performance data so that providers can make informed purchases and invest in systems that will actually improve the quality of patient care and drive down costs.

Providers and their EHR vendors should be required also to submit actual performance data to CMS, as opposed simply to allowing dummy data to qualify a provider for payment. Right now, for example, physicians are only required to try to send vaccination data from their EHR to an immunization registry. It’s only a test of the connection. Even if the test fails, physicians can still check off that box.

CMS should enact a strong enough audit process to ensure that providers have actually done the work necessary to make the use of their EHR meaningful—before taxpayer dollars are distributed.

To increase the integrity of the program and to leverage data that should already be maintained in EHRs, CMS should pursue aggressively a registry-based submission process for provider attestation. Until Meaningful Use performance data can be electronically submitted from a provider’s EHR, attestation unnecessarily remains a subjective and qualitative measure of success. This forces undue stress on providers, creates the need for stringent and costly after-the-fact audits and leaves the full potential of EHRs untapped.

The government needs to take steps now to ensure that Meaningful Use is actually meaningful. This EHR incentive program is critical to improving patient outcomes and it’s a program that we have to get right. It’s not too late to fix it. 

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