by Vince Kuraitis, Steve Adams, and David C. Kibbe MD, MBA
Over the past several years, many diverse initiatives have arisen offering partial solutions to systemic problems in the U.S. health care non-system.
We see Meaningful Use Criteria recommended by the HIT Policy Committee as a unifying force for these previously disparate initiatives. These initiatives have included:
- Patient Centered Medical Homes (PCMHs)
- Regional Health Information Organizations (RHIOs)/Health Information Exchanges (HIEs)
- Payer Disease/Care Management Programs
- Personal Health Record Platforms — Google Health, Microsoft HealthVault, Dossia, health banks, more to come
- State/Regional Chronic Care Programs (e.g., Colorado, Pennsylvania, Improving Performance in Practice)
- Accountable Care Organizations — the newest model being proposed as part of national reform efforts
Today
While there are some commonalities and overlap, to-date these initiatives have mostly arisen in isolation and are highly fragmented — they’re all over the map. Here’s a graphic representation of the fragmentation that exists today:
Tomorrow
The HIT Policy Committee recently recommended highly detailed Meaningful Use criteria for certified EHRs. Doctors and hospitals who hope to receive HITECH Act stimulus funds will have to demonstrate that they are meeting these criteria; the criteria are not yet finalized.
The Committee website describes the central role of the Meaningful Use criteria:
The focus on meaningful use is a recognition that better health care does not come solely from the adoption of technology itself, but through the exchange and use of health information to best inform clinical decisions at the point of care.
The HIT Policy Committee also is recognizing that there are multiple routes to achieving Meaningful Use beyond the traditional EMR 1.0, e.g., modular Clinical Groupware software.
While some might view the Meaningful Use criteria as limited to the world of health IT — something happening “over there” — we see much more going on. We believe the Meaningful Use criteria are becoming a powerful unifying force across the health system, with potential to converge previously disparate initiatives. Here’s our conceptual representation:
Let’s consider a couple examples to demonstrate how convergence is occurring.
RHIOs were formed primarily with a mission of developing health IT infrastructure for local data exchange; they had little need to think about how care providers, health plans and others would actually use the data.
Patient Centered Medical Homes have been built around seven principles (e.g., physician directed medical practice, care coordination) — none of which directly relate to a need to develop health IT infrastructure; the fact that IT infrastructure is necessary to implement these principles has been assumed but not defined.
RHIOs focused on health IT with little thought about objectives, while PCMHs had grand objectives with little thought about needs for health IT.
All this is changing.
RHIOs are recognizing that achieving meaningful use of data is essential; PCMH initiatives are recognizing the need for a robust IT infrastructure and the need to match their efforts to Meaningful Use criteria.
Here are some broader implications about Meaningful Use criteria becoming a unifying force:
- These diverse initiatives will have more commonalities and will look more and more alike
- Expect previously disconnected regional initiatives to start talking to one another about collaboration.
- A common phrase we are hearing is “We need to do a crosswalk of Meaningful Use criteria with our initiative/organization/application functionality.”
- Vendors must ask: “What are we doing to contribute to Meaningful Use of EHRs”
- Care providers (doctors and hospitals) must ask: “How are vendor offerings helping us to achieve Meaningful Use of EHRs?”
These are positive developments. Meaningful Use criteria are becoming a powerful unifying force toward integrating our fragmented health system.
I agree completely.
The key to making the meaningful use criteria a unifying force will be interoperability standards. Once all of these programs can exchange data, we will have meaningful use and we will have a unified health care system.