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The Good, the Bad, and the Meaningful: Has Meaningful Use Provided Sufficient Stimulus to Drive Change?

February 17, 2016 by Louise Sulecki, MBA; member, HIMSS Clinical & Business Intelligence Committee; Systems Analyst, Clinical Systems Office, Cleveland Clinic


I hate writing. But, I love data and I love research. So, when I volunteered to write about meaningful use, I had no idea what to write about, and cursed myself for volunteering.

Here was my starting perspective: Meaningful Use 2015-2017 Modifications, Stage 3 Final Rules, and the 2015 Certification Criteria had recently been published, and my job is specific only to Eligible Hospital (EH) Meaningful Use measures, no EP (Eligible professionals). Then CMS Acting Administrator Andy Slavitt indicated to the audience at the J.P. Morgan Healthcare Conference in January 2016, that Meaningful Use will likely end in 2016.

Louise Sulecki, MBA

So, I hunkered down and started researching the subject. I found that physicians were the most vocal against meaningful use, vendors obviously promoted the benefits of meaningful use and hospitals were fairly non-existent in the conversation. This made sense since physicians were the least likely to benefit from meaningful use. Here are some of the more provoking perspectives as they relate to data and analytics on both sides of the conversation of the current and ongoing meaningfulness of meaningful use.

Critical Viewpoints

Cost and Value:

  • Meaningful Use Stage 3 will require significant investment from an EHR developer community long lampooned for selling products with poor usability and limited functionality, and a maturing health IT market will demand more from its suppliers. (Source: “Can Stage 3 Meaningful Use CEHRT Bring On Big Data Analytics?” HealthITAnalytics. Mar 23, 2015)

Innovation:

Interoperability:

  • Many health IT systems obstruct interoperability through excessive vendor fees or technical limitations that hinder physicians’ ability to meet Stage 2 of the Meaningful Use program. (Source: “AMA to CMS: Critical Changes Needed Before Moving to Meaningful Use Stage 3.” American Medical Association. May 29, 2015)
  • The programs’ requirements divert resources and attention from other efforts to enable interoperability. (Source: “Cancel, Don't Delay, Meaningful Use Stage 3 For Electronic Health Records.” Forbes. Sept 30, 2015)
  • Providers who may have implemented cobbled-together EHR systems that rely on modular components from different developers have been facing interoperability barriers for years, and vendors have not been shy when it comes to ratcheting up fees for providers who wish to exchange health information across different pieces of their infrastructure. (Source: “Can Stage 3 Meaningful Use CEHRT Bring On Big Data Analytics?” HealthITAnalytics. Mar 23, 2015)

Necessity:

  • Meaningful use programs have served their purpose. Stage 3 makes many of the same mistakes as Stage 2, specifically, trying to do too much too soon. Certification is now at the point where it threatens usability, interoperability, and EHR quality, while at the same time diverting research and development resources of health IT developers and providers. (Source: “The Path Forward for Meaningful Use.” Life as a Healthcare CIO; Blog by John Halamka. Nov 11, 2015)

Patient Care:

  • 2014 Medical Economics physician survey regarding EHRs found that nearly half of physicians think that EHRs are making patient care worse, more than 60 percent think that EHRs are hurting care coordination, and an astonishing 70 percent of physicians said that the implementation of their EHR was not worth the time, resources and cost. (Source: “Moving from Meaningless to Meaningful Use.” American Academy of Family Physicians. Jul 7, 2015)

Patient Engagement:

Laundry list: (Source: “Cancel, Don't Delay, Meaningful Use Stage 3 For Electronic Health Records.” Forbes. Sept 30, 2015)

  • Insufficient standards (especially lack of detail);
  • Variation in state privacy laws;
  • Accurately matching patients’ health records (for example, one system many use Social Security Numbers (SSNs) as identifiers, while another may not collect SSNs);
  • Costs (including legal fees); and
  • Need for trust and governance among the entities.

Favorable Viewpoints

Coordination of Care:

  • Leading organizations with the time and budgets to invest in health IT infrastructure are already making strides towards interoperability and the use of big data analytics to drive better outcomes and higher quality care. If Meaningful Use Stage 3 is able to bring those advanced health IT capabilities to more providers in a measured and workable way, the industry may find itself in a very good place by the end of the decade as care coordination, health information exchange, and population health management continue to drive down costs and raise the quality of the patient experience. (Source: “What Does the Stage 3 Meaningful Use Rule Mean for Analytics?” HealthITAnalytics. Mar 23, 2015)

Data Accelerator:

  • The (MU Common Clinical) data set has the potential to be a major accelerator of clinical trials, personalized care strategies, and data-driven accountable care, which are among the most important goals for stakeholders across the healthcare system. (Source: “Can Stage 3 Meaningful Use CEHRT Bring On Big Data Analytics?” HealthITAnalytics. Mar 23, 2015)

Informed Decisions:

  • With more complete patient information, providers improve their ability to make well-informed treatment decisions quickly and safely. (Source: “Benefits of Electronic Health Records (EHRs).” HealthIT.gov. Last updated: Jul 30, 2015)

Outcomes:

  • “Work done in the past was foundational, but the future requires a different approach - outcomes based incentives.” (Source: “A Followup on the MU Path Forward.” Life as a Healthcare CIO; Blog by John Halamka. Nov 18, 2015)

Multiple Examples of Success Stories & Case Studies: (Source: Meaningful Use Data and Case Studies. HealthIT.gov. Last updated: Mar 19, 2013)

  • Examples of improvements due to implementation of Meaningful use are stratified into four categories: Care Coordination, Public and Population Health, Patient and Family Engagement, and Quality Measurement.

One of the most interesting items I came across was the JASON Report on Data for Individual Health. There are eight findings that you can read through, but the one finding that struck me the most was:

There is an explosion of data from many and varied sources. Yet there is little understanding of how to parse, analyze, evaluate, merge, and present these data for individuals and for the health care team. The health data infrastructure currently does not have the capability to make the data accessible in usable form, including the associated meta-data and provenance.

In Summary

I’ve worked with data my whole career and really thought we’d be further along using the power of data. Meaningful use--with all the good, bad and meaningful—needed to happen for the industry to move to the point of data “explosion.” But I agree with Dr. John Halamka and others: We need to retire meaningful use certification and regulation and move on to the next phase. We need to put more effort into learning health-systems as outlined in the JASON report -- where information can be transferred, assessed from one team or community to another, effortlessly and securely. Let’s hope this happens sooner than later.

Has meaningful use sufficiently moved the healthcare to where we need to be to support a value-based system in terms of data and analytics? What do you think will become of meaningful use in 2016 and beyond? What should the future of meaningful use look like? Let’s hear what you think!

Want more information about meaningful use?

Check out these resources:

HIMSS Meaningful Use OneSource

HIMSS Health IT Value Suite | Meaningful Use Fact Finder

Posted Under: Clinical Business Intelligence