The Meaning of Meaningful Use

Carrie Vaughan and John Commins, for HealthLeaders Magazine , June 11, 2009
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Healthcare executive and blogger John D. Halamka, MD, says meaningful use will focus on quality and efficiency, and it will require the electronic exchange of quality measures including process and outcome metrics. Halamka, CIO of the Harvard Medical School, says it will require coordination of care through the transmission of clinical summaries, and decision-support-driven medication management with a comprehensive e-prescribing system that includes eligibility, formulary, history, drug interaction, routing, and refills.

The definition of meaningful use will be expanded each year, requiring more features and more data exchange, he says. Initially, the interoperability criteria needed for meaningful use "will include submission of quality datasets, e-prescribing, and clinical summary exchange at a minimum," Halamka says. In the short run, meaningful use could be a combination of products or an EHR lite, Halamka says, adding that a comprehensive EHR will be the best foundation for meaningful use.

How are hospitals preparing?
Eastern Maine has one of its hospitals live on CPOE, with the second coming online later this year. The health system plans to roll out CPOE to its entire organization at a rate of one hospital per year based on its available resources, says Bruno. "But if for some reason there were millions of dollars at stake, we could staff up or hire consultants to help us move more quickly," she says.

Lutheran HealthCare is deploying a computerized physician ordering system for medications, consultations, and documents. The hospital is also implementing a bar-code medication administration system and should have its system up and running by the end of this year. Art concedes he's taking a bit of a gamble on the new system as Lutheran HealthCare works toward meaningful use status. "We as an organization made the decision that these are the features and functions that we need to take care of the patient properly," says Art. "My fear now is that the system that I bought—and these systems are not cheap—won't be certified. And if it's not certified, do I miss out on all the money the government was willing to give me?"

Carrie Vaughan is senior technology editor and John Commins is senior human resources editor for HealthLeaders Media. They may be contacted at and
HIMSS and AHIMA Weigh In
The Healthcare Information and Management Systems Society and the American Health Information Management Association offered their recommendations and definitions for "meaningful use" of electronic health records in April. Both organizations agreed that the Certification Commission for Healthcare Information Technology should be recognized as the certifying body of EHRs and there should be an incremental approach to achieving meaningful use. Initial criteria should be based on what can be reasonably captured with the current technology, and then the measures should be made increasingly stringent as time progresses. Other recommendations include:


  • The electronic exchange of standardized patient data with clinical and administrative stakeholders using the Healthcare Information Technology Standards Panel's interoperability specifications and Integrating the Healthcare Enterprise's frameworks.
  • Clinical decision support that provides clinicians with intelligently filtered patient information and clinical knowledge to enhance patient care.
  • The capabilities to support process and care measurement that drive improvements in patient safety, quality outcomes, and cost reductions.


  • The focus should be on the use of information to improve quality, cost, and performance rather than the technology itself.
  • The measurement and reporting tools should minimize manipulation and mitigate the risk of fraudulent reporting.
  • A transparent process that shows the progress that is being made and helps increase public awareness about the challenges and opportunities of an interconnected healthcare system.

To read the full statement by AHIMA and an outline of the functions HIMSS recommends at each phase of implementation, visit and, respectively.

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