For nearly a year and a half following the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act, the medical community had one question on its mind: What constitutes meaningful use? The HITECH legislation stresses that in order to receive stimulus funding for health IT, providers must prove meaningful use of that technology.
On July 13, 2010, meaningful use was defined—or, rather, the stage 1 requirements for achieving it were spelled out, almost 17 months after the HITECH Act’s enactment. On August 4, Jonathan Teich, MD, PhD, CMIO of Elsevier Health Sciences, led a webinar sponsored by the Healthcare Information and Management Systems Society (HIMSS), parsing meaningful-use requirements as they relate to the stated DHHS goal of improving the safety and quality of care.
“It’s striking a balance between the overall goal, using EHRs to improve quality, while encouraging widespread adoption and avoiding an excessive work burden on physicians. While not fulfilling every quality metric that the policy committee would like, you’re gaining the capability to do that.”
— Jonathan Teich, MD, PhD, CMIO of Elsevier Health Sciences
Teich began with a brief historical overview of the meaningful-use concept. A proposed rule released in January of this year garnered over 2,000 comments, Teich notes, some in support of the rule and most requesting changes. “If I had to summarize the most common comments, number one was the concern that this was an all-or-nothing proposition,” Teich says. “There was a general sense of inflexibility. Because practices are so different, it was difficult to understand how a variety of them would pass this.”
Key Changes in the Final Rule
To address this concern, the final rule, which applies to eligible professionals as well as eligible hospitals and critical-access centers, includes both core tasks—measures that must be fulfilled to qualify a professional or facility as a meaningful user—and menu-set tasks, from which facilities can select measures that most readily apply to them. This, Teich notes, was a direct response to comments about inflexibility; instead of a laundry list of tasks that every user must complete, users now “must do some and can choose from others,” he says.
Thresholds for many of the tasks were also rolled back, making it easier for users to acclimate themselves to new and unfamiliar IT systems. For instance, the proposed rule stated that eligible users would have to transmit 75% of prescriptions electronically, but that number has been reduced to 40%; it also required use of computerized provider order entry (CPOE) 80% of the time. This threshold has been drastically scaled back to include only medication orders, for 30% of patients.
Several calculations have been simplified. In the proposed rule, many calculations were based on the number of encounters; in the final rule, these are based on the number of patients instead. The requirement for manual chart review has also been excised. “All information can now be captured through the electronic health record (EHR) itself,” Teich says.
Because there will be three stages of requirements for meaningful use, Teich says that the philosophy behind the first stage is to be as inclusive as possible. “It’s striking a balance between the overall goal, using EHRs to improve quality, while encouraging widespread adoption and avoiding an excessive work burden on physicians,” he says. “While not fulfilling every quality metric that the policy committee would like, you’re gaining the capability to do that.” He adds that many of the criteria removed from the proposed rule will reappear after 2013, in the following two stages.
Tasks and Measures
That’s not to suggest that stage 1 tasks and objectives won’t be a challenge for first-time users of health IT to meet. Core-task categories, which everyone must manage on a per-patient (not per-encounter) basis in order to qualify as performing meaningful use, include:
- vital signs, body-mass index, and growth;
- problem lists;
- medication lists;
- allergy lists;
- smoking status;
- clinical-encounter summaries;
- health summaries;
- transmission of prescriptions;
- CPOE for medication orders;
- drug–drug and drug–allergy interaction checks;
- tests of ability to exchange clinical information;
- security-risk analysis;
- reporting of quality measures; and
- creating and tracking one clinical decision support rule.
For the last item, Teich