EHRs, Meaningful Use Get Spotlight This Week

Janice Simmons, for HealthLeaders Media , May 1, 2009

Hospitals and physicians looking to get a better understanding of what is meant by "meaningful use" of electronic health records (EHRs)—and how they could qualify for health information technology funds under the economic stimulus measure passed in March—got their wishes this week.

Expanded definitions by an industry group, release of a new consensus framework report, and two days of testimony before a federal panel by nearly three dozen experts got the ball rolling.

Under the new stimulus law, Medicare incentive payments can be made up to four years to hospitals and up to five years for physicians who meet "meaningful use" and "meaningful user" criteria of certified EHRs. The Healthcare Information and Management Systems Society (HIMSS), after input from its membership, released new definitions April 27 to specify what is meant by that term.

To be eligible for the incentive payments, the HIMSS definition said that hospitals and physicians must use the technology in a meaningful manner, exchange electronic health information to improve the quality of care, and submit clinical quality measures—and other measures—as selected by the Health and Human Services (HHS) secretary. Also, hospitals and physicians must meet the definition within a specified timeframe, which—as described in the stimulus bill—must be made increasingly stringent over time by the secretary.

On April 30, the Markle Foundation's Connecting for Health Collaborative released several key principles that outline an initial approach to achieving objectives with HIT under the stimulus package. The report containing the principles is supported by a group of individuals representing a diverse group of healthcare, business and consumer groups including the American Academy of Family Physicians, America's Health Insurance Plans, Consumers Union, and the Joint Commission.

"These are the expectations that have to be set from the start—that once you deploy technology, it's too late to start to come up with new and different goals," said Carol Diamond, MD, managing director of the Markle Foundation, about the report containing the principles.

She added that meaningful use is not about using technology for the sake of technology, but instead about improving health. The group agreed on seven principles of meaningful use and qualification and certification of EHRs. Several of these principles are:

  • The overarching nationwide goals of health IT investments are to improve healthcare quality, reduce growth in costs, stimulate innovation, and protect privacy.
  • These goals can be achieved only through effective use of information to support better decision-making and more effective care processes that improve health outcomes and reduce cost growth.
  • Meaningful use should be demonstrable in the first years of implementation (2011-12) without creating undue burden on clinicians and practices.

Also, during mid-week, the National Committee on Vital and Health Statistics heard more than two days from experts about what the definition of "meaningful use" should encompass.

Jonathan Perlin, MD, PhD, with the Hospital Corporation of America, which has 160 hospitals nationwide, told the panel that "it is imperative that we provide clear guidance on the desired outcomes at the end of the defined period."

He agreed with a recent editorial written by David Blumenthal, MD, the new national coordinator for health information technology, in the New England Journal of Medicine, that HIT was improving healthcare and value. "Thus, the desired outcomes of meaningful use must transcend technical specifications and include guidance addressing improvement in safety and quality that are intended."

Farzad Mostashari, MD, assistant commissioner of the Primary Care Information Project, within the New York City Department of Health and Mental Hygiene, said "the transformative potential of health IT is to provide the information necessary for organized care delivery and drive transparency in healthcare outcomes."

The endpoints for meaningful use can include incentive payments tied to measures "that matter and that will sustain improved clinical outcomes," such as blood pressure control, evidence based care (smoking cessation therapy and aspirin use), patient safety, continuity of care, patient satisfaction, and compliance with public health reporting, Mostashari added.

Elliott Fisher, MD, of Dartmouth University, said his personal history in healthcare as a physician, manager, and patient has "lead me to believe that meaningful use of HIT can best be realized through implementing systems that have basic functionalities that facilitate the care of patients by physicians, nurses and other providers," he noted. "These systems need not necessarily be extremely complicated."

Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at

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