Health Care Stakeholders Struggle to Define 'Meaningful Use'

Health care stakeholders are scrambling to help the federal government define key health information technology terms used in the American Recovery and Reinvestment Act of 2009, or ARRA, with a special focus on what constitutes "meaningful use" of health IT.

The distribution of $17 billion in incentive payments to America's health care institutions and physicians hangs in the balance, because after the language is finalized, health care providers must follow the government's blueprint to qualify for health IT funding.

The Academy recently joined more than 70 other organizations in signing a consensus statement (22-page PDF; About PDFs) drafted by the Markle Foundation's Connecting for Health collaborative. The statement, which was released April 30 in Washington, addresses how to meet the health IT objectives set forth in the ARRA.

The statement outlines seven key principles related to investments made in health IT and includes clarification of such issues as

The consensus statement proposes the following definition for meaningful use of health IT systems: "Demonstrates that the provider makes use of, and the patient has access to, clinically relevant electronic information about the patient to improve patient outcomes and health status, improve the delivery of care, and control the growth of costs."

The Markle statement also proposes initial meaningful use requirements -- which would be in place from 2011 to 2012 -- that read, "Demonstrates that the provider makes use of, and the patient has access to, clinically relevant electronic information about the patient to improve medication management and coordination of care."

Steven Waldren, M.D., director of the AAFP's Center for Health IT, participated in a panel discussion at the Markle meeting. He told AAFP News Now that although the definition of meaningful use likely would expand in time to encompass more ambitious health improvements, the AAFP wouldn't want to see a "bait and switch" operation that changed health IT criteria midstream.

"Physicians need to know upfront the eligibility rules that pertain to the bucket of money available in this stimulus package," he said. "HHS must not raise the bar two years into a five-year program and render some previously eligible physicians ineligible."

Waldren also expressed concern about overly rigorous electronic health record, or EHR, certification requirements that could lead to reduced health IT innovation in the marketplace. "Future products may not have legacy functionality," he said. "Will we really want the same EHRs we're using today five years from now in a potentially reformed health care system?"

On April 29, the Washington-based National Committee on Vital and Health Statistics, or NCVHS, heard advice from physician executives on how to proceed with defining the concept of meaningful use.

AAFP Board Chair Jim King, M.D., of Selmer, Tenn., provided a written statement to NCVHS, an advisory body that reports to HHS, in which he pointed out that physicians must meet HHS criteria by 2011 to receive the maximum incentive and by 2014 to receive any incentive.

"This is a very short time frame for the selection, implementation and use of an electronic health record, especially since the definitions of 'meaningful use' and 'qualified system' are yet to be defined," wrote King. "It can take a practice anywhere from one year to five years to select and implement an EHR."

Terry McGeeney, M.D., M.B.A., president and CEO of TransforMED LLC, a wholly owned subsidiary of the AAFP, spoke at the NCVHS meeting. He told the committee that meaningful use should not dictate or mandate a comprehensive EHR. Instead, the definition should focus on the functionality and capabilities required by practices to provide high-quality, efficient health care to patients.

"The options for practices to identify and acquire 'a la carte' solutions should be the rule, not the exception," said McGeeney.