“Meaningful use” and what it means to physicians

The Obama administration’s massive stimulus package (known as ARRA) contains a section pertaining to the adoption of electronic health records (known as HITECH), and earmarks substantial money (up to $44K per physician over the next 5 years) for physicians who can demonstrate “meaningful use of certified EHRs.” Defining what exactly is meant by “meaningful use” has been the focus of intensive debate as the newly-created government bodies charged with oversight of this have begun deliberation. The exact definition of “meaningful use” should be hammered out by the end of 2009, with incentives beginning to become available to physicians in the subsequent years.

 

“Certification” has similarly been a subject of much debate. Traditionally, CCHIT has been the sole certifying body for EHRs, emerging as a non-profit agency spun off from a government-industry collaborative. Many have assumed that CCHIT will remain as the going-forward certification body, but others have questioned this and propose that alternatives to certification are appropriate. They argue that, besides the $30K certification price tag, CCHIT developed its criteria in an era when large, self-contained client/server EHR systems were emerging, and that such criteria lose relevance in a web-based, distributed, cloud-oriented environment – such as the one that Practice Fusion has emerged in. CCHIT wants to modernize its criteria, but it may lag behind technological innovation.

 

Regardless of how certification will emerge, it is clear that “certified EHR” and “meaningful use” will be closely linked. In order to qualify for “meaningful use,” an EHR should be able to do the following:

1.     Electronic prescribing, both out-bound e-prescribing of new, de novo prescriptions, as well as responding to prescription refill requests originated by pharmacies

2.     Achieve interoperability, meaning that summary data (diagnoses, medications, allergies, etc.) can be easily exchanged with others using different EHRs. There is a standard type of document, called a Continuity of Care Document (CCD) which needs to be able to be created and exported, as well as imported.

3.     Generate quality reporting and metrics. The criteria set has yet to be determined, but is likely to be either the HEDIS set of metrics (used by insurers in the private domain) or the larger PQRI set (used by Medicare, and which encompasses the HEDIS criteria plus many more)

4.     Point of care decision support. This will be a technology that evolves, starting with simple things like prompting for wellness and chronic-disease management prompts, but evolving into presenting physicians with evidence-based guidelines for the diagnosis at-hand.

5.     Routine, secure, electronic communications between patients and caregivers. This can include prevention and screening reminders, and numerous other ways of supporting patients in their own management of their own health.

 

The specifics of all of this, of course, will be hammered out in the debate process this year. Practice Fusion is keeping a very close eye on all of this, and is rapidly building features in each of these categories. Our goal is to offer physicians a robust EHR that is not only free to use, but also will qualify everyone for “meaningful use” as this definition becomes clearer. Whether CCHIT remains the sole certifying channel, or whether it becomes one of several avenues towards certification, Practice Fusion intends to achieve “certification” as ultimately is defined by HITECH.

 

Robert Rowley, MD

Chief Medical Officer

Practice Fusion, Inc.

Follow us on Twitter: #practicefusion

Comments

[Jacob]

Wow, this is eerily close to what I was thinking about this very morning. I knew PF had plans to add e-prescribing, and I was wondering exactly what features were required for CCHIT certification. I'd planned to look it up, but hadn't gotten around to it. You've saved me a bit of research!

[Michael Planchart]

Why should an EHR be free to use?

There must be some revenue to sustain a company and further development.

The solution must have its value.

I don't believe the barrier to introduce a product in the market is based on its cost.

Thanks

[Robert Rowley, MD]

Michael - the question of the strategic value of implementing our SaaS-based EHR free of charge to participating physicians (subsidized by alternative revenue streams) is a worthwhile question, though probably a bit off-topic for this particular post. We might want to create a blog post about that in the future here - however, you can see a more in-depth article about our experience and vision here: http://www.thehealthcareblog.com/the_health_care_blog/2009/02/freenomics-and-healthcare-it.html