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Healthcare IT news While I haven’t been covering health IT issues for very long, it doesn’t take long to find out that one of the hottest topics in health IT today is Meaningful Use. Right near the top of the list of issues in any discussion of meaningful use is frustration with the continuing changes to the criteria for meeting the requirements to demonstrate Meaningful Use. This despite the federal government unveiling its criteria for the meaningful use of electronic health records (EHRs) nine months ago.

When I first started investigating the issue, I wondered what is the controversy all about? How could installing and using EHR not be considered meaningful? However, while it may still be difficult to know what meets the government definition of meaningful use, in the past couple of weeks I have learned what is NOT Meaningful Use.

I interviewed a physician administrator for a medium-sized hospital system in the Seattle, Washington area. The system had a main medical center with a 275-bed hospital, 2,400 employees, six suburban primary care clinics and two urgent care clinics. The system provides care for 15,000 inpatients and 186,000 outpatients a year. Their website touts state-of-the-art cardiac, cancer and surgical services. It boasts about being recognized by HealthGrades as being one of the top 5 percent of hospitals in the country. All of which may be true, so it was that much more shocking to hear about their EHR system.

Apparently, like many hospitals at the time, management decided in 2004 to purchase an EHR for the main campus and its system of satellite clinics. They purchased a system from a well-known vendor. Unfortunately, they did not have an implementation plan. Instead they provided the software package to each of their primary clinics and essentially told them to install it and implement it themselves.

Three years later, when the administrator I was interviewing was brought on board to improve physician services, she found the EHR had not been implemented in a meaningful way. They were still using paper medical records. There was no consistent use of templates for notes or orders. There was no consistent procedure for filling in the data entry fields. The computerized physician order entry (CPOE) was not being used at all. All physician orders were on paper, meaning there were effectively no records of physician orders.

Physicians were frustrated using the system because data entry was so inconsistent most patient records were inaccurate and out of date. The system was capable of telling the doctor when patients had last had their cholesterol tests, or the date of their last mammogram, even display an array of data monitoring points for managing diabetes patients. But because of the haphazard way the system had been implemented, doctors could not trust the information that was entered into the system.

The point is that even the most sophisticated EHR is meaningless unless it has been implemented properly and the data in the database is accurate and up-to-date. This takes careful planning and organizational skills to get buy-in from all the stakeholders.

Even with a well thought out implementation and excellent execution, determining whether a system meets meaningful use criteria has become bogged down in a myriad of technical details.

Dr. Anita Karcz, the chief medical officer of Health Metrics summed it up during the Meaningful Use symposium, last month at the 50th annual HIMSS meeting in Orlando Florida. She said that, in addition to being unnecessarily complex, the information about Meaningful Use has been found to be incomplete, inconsistent and, the most frustrating of all, still undergoing clarifications.

As examples, she cited the many questions about certification of vendor modules blended with modules that have been developed in-house. The rules initially did not allow for such installations in the certification criteria. Other issues have developed over privacy and HIPAA 2.0 and reporting of privacy breaches.

In her Health IT Buzz blog post earlier this month, Dr. Theresa Walunas, Director of Operations Chicago Health Information Technology Regional Extension Center relates a very personal experience illustrating how simple Meaningful Use criteria should be. She tells how a missed order for a daily blood test to monitor warfarin dosing ended up costing her father his spleen.

She then outlines 15 Core and 10 Menu Set Meaningful Use Measures that should define Meaningful Use, noting that had any of eight of them been in place in her father’s case, the error would likely have been avoided.

When you think about it, isn’t that really what the definition of Meaningful Use should be? It seems to me that when a hospital or physician with a properly installed and implemented EHR system can show that the right patients got the right tests and right treatments at the right times, then the criteria for Meaningful Use has been met and the federal grant awarded to such providers will be money well spent.

Michael O’Leary, contributing writer Health Imaging Hub


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