US publishes ‘meaningful use’ criteria

Tags: A EHRs HIS Obama Standards US

05 Jan 2010

The first draft criteria for the federal funding of electronic health records as part of the US' recovery plans have been published.

The eagerly awaited initial eligibility criteria were published at the end of December by The Centres for Medicare and Medicaid Services and the Office of the National Coordinator.

They are set out in a 700-page plan for improving healthcare value and quality by accelerating the use of health IT by doctors and hospitals.

Of particular interest to those hoping to qualify for federal subsidies for EHRs are the first cut of standards governing the ‘meaningful use’ criteria, the benchmark set on eligibility for funding.

US President Barack Obama made healthcare reform a feature of his election campaign and promised that all Americans would have an EHR within five years.

The $19 billion HITECH economic stimulus package included provision for this. Around $1.2 billion has already been released to set up health information technology centres and networks to support adoption and the spread of information.

The new eligibility criteria are the product of almost a year of consultation and lobbying. They set proposed rules for doctors and hospitals to qualify for financial incentives for meeting three stages of progressively more demanding goals for using EHRs.

One proposed usage measure is that at least 80% of patients who request an electronic copy of their health records receive it within 48 hours.

Another governs the use of computerised physician order entry systems in hospitals – long regarded as the holy grail of advanced EHR systems. Here the ambition appears moderate, with the initial proposal suggesting 10% usage after a number of years.

Healthcare officials said their intention is to ensure the meaningful use criteria were consistent for providers who qualified for incentives from Medicare or whose incentive payments will be managed by Medicaid.

Three sets of criteria on ‘meaningful use’ are set to be published over the next three years. The initial set focuses on collecting data electronically, sharing information with other providers and patients, and reporting quality measures to the government.

Stage two, due by the end of 2011, will focus on structured information exchange and continuous quality improvement. While stage three, due by the end of 2013, will focus on decision support for “national high priority conditions” and population health.

Alongside the meaningful use criteria, the ONC also published an accompanying interim final rule on an initial set of standards, implementation specifications, and certification criteria, with a request for comments.

The move is described as “the first step in an incremental approach to adopting standards, implementation specifications, and certification criteria to enhance the interoperability, functionality, utility, and security of health IT and to support its meaningful use.”

Jon Hoeksma

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Readers Comments

Meaningfully useful to whom?

05 Jan 10 03:58

The criteria were released just before the New Year holiday, in association with a telephone conference that was announced only hours before it was to occur. As currently configured, this criteria defines meaningful use for the US Government, but not for the patients whose care is controlled by it, nor for the clinicians who have to use it.

The safety and efficacy of the HIT devices to which the definition is to be applied is not considered in the document. In a search of the document, the words safety and efficacy do not appear except in one phrase involving "patient safety".

These are instruments of patient care. As such, they should be safe and efficacious for patient care and meaningfully useful to the clinicians, enhancing their clinical effectiveness, rather than diminishing it.

Until such is part of the definition and the devices are approved as being safe and efficacious, the US Government will find itself wasting its taxpayers' dollars, not unlike the NHS scenario.

The US should learn from history so as to not repeat it.