HIT

The conversation on healthcare reform clearly hinges on how technology will bring about change, but an even greater discussion still remains. Essentially how can technology be implemented to improve the state of healthcare and be effective, and not just be put in place for technology's sake.

The Markle Foundation (New York) hosted a forum last week to discuss this topic as well as the $19 billion allocated to investments in health information technology IT under the Leaders in healthcare and information technology met with government and policy experts to talk about how these health IT investments can be directed toward improving health care outcomes, protecting patient privacy, and reducing growth in health care costs, laying the groundwork for health reform.

With the American Recovery and Reinvestment Act (ARRA), Congress established new Medicare and Medicaid incentives to stimulate critically needed investments in healthcare information technology (health IT).

The law creates two key concepts to determine whether providers qualify for the health IT incentives: They must make meaningful use of IT and use a qualified or certified EHR (electronic health record).

Besides incentives to providers and hospitals, the law also creates $2 billion in health IT funding administered by the Office of the National Coordinator for Health Information Technology (ONC). A significant amount of this $2 billion should lay important groundwork to help providers use health IT meaningfully toward the goals of improving the nation's health.

"This event was the culmination of two months of conversations Markle has been having with industry leaders and policymakers," Claudia Williams, director of health policy and public affairs at Markle, told Healthcare Infotech Business Report.

The event was a kick-off to the release by Markle Connecting for Health of a new document titled "Achieving the Health Objectives Under ARRA: A Framework for 'Meaningful Use' and 'Certified or Qualified' EHR."

The definition of meaningful use will determine how clinicians and hospitals qualify for the health IT incentives included in the economic stimulus law.

The document was developed with the collaboration of a diverse group of consumer, business, and health organizations.

Under the auspices of Markle Connecting for Health, the signatories have agreed on seven principles for meaningful use and qualification or certification of EHRs:

The investments should be directed toward achieving clear, specific metrics toward these goals. If the goals and metrics are not clear before technology is commissioned and the incentives are offered, the government will risk wasting valuable resources and losing support from both health care providers and the public for further health IT investments.

The goals cannot be achieved through the installation of software or hardware alone. Effective use of information is what enables a consumer to play an active role in maintaining health and getting the best care, prevents a patient from suffering a medical error, helps a clinician prescribe the right treatment at the right time, allows a care team to coordinate care in the most effective and affordable way, and benefits efforts to improve quality, accelerate research, and advance public health.

Meaningful use should be demonstrable in the first years of implementation (2011-12) without creating undue burden on clinicians and practices. The meaningful use definition must optimize achievability for providers and benefits to patients and consumers. Improving medication management and coordination of care provides early opportunities for such an optimization. Meaningful use should initially rely on standard information types (such as recent medications and laboratory results) that are electronic and already widely adopted – and that can support metrics to improve medication management and coordination of care.

To support meaningful use goals that improve health and reduce the growth of costs, additional data types (e.g., problem lists, allergies, vitals, images, findings, procedures, care plans, hospital discharge summaries, patient registration forms) can become increasingly standardized over time to facilitate a set of defined measurements. The phasing-in of expanded requirements should be well-defined early in the process, so that those building or purchasing systems have a clear and realistic path to achieve meaningful use at each stage.

Processes for certification or qualification will be important to prevent fraud or faulty products (e.g., products that do not sufficiently protect sensitive health information), as well as prevent rewards for superficial or trivial uses of technology.

Medical practices that are capable of installing and supporting a comprehensive EHR should be incentivized under ARRA to do so. However, assuming that only comprehensive EHR systems can achieve the goals of meaningful use might delay progress or lock out other lightweight, network-enabled solutions that may achieve the same goals in the near-term and can provide greater functionality over time. Small practices with less technical support should be able to qualify for incentives by using internet-enabled technologies that can help them to access and use information to help their patients.

ARRA clarifies the individual's right to request electronic copies of personal health information from EHRs for storage by information services of the individual's choosing. This should be considered a form of meaningful use toward helping people prevent illness, manage their health-related information and transactions, coordinate care and communicate with clinicians.

"We've got a lot of low-hanging fruit that we can focus on," Williams told HIT. "We also need to keep an open mind. The goal is to help develop an It infrastructure that can be supported throughout and not just several pocket infrastructures."

"Meaningful use is not about technology for the sake of technology," said Carol Diamond, MD, MPH, managing director at the Markle Foundation and chair of the Markle Connecting for Health Initiative. "It's about using that technology to improve health. We must invest this money in ways that support information use to improve quality, slow growth in costs and protect privacy, without creating undue burden on clinicians and practices."

The Markle Foundation's mission is to work to realize the potential of information and information technology to address critical public needs, particularly in the areas of health and national security.