Obama’s administration took the first important step in health care reform this week. They put up a proposed definition of meaningful use for ARRA (The American Recovery and Reinvestment Act of 2009). There are two key documents to review: a preamble which is excellent and calls out all the key issues that need to be addressed; and a matrix which reviews the planned requirements for meaningful use for the key areas identified for improvement. These are:
- Improve Quality, safety, efficiency, and reduce health disparities. – Read Overtreated to learn why this is key
- Engage patients and families – Without this, we cannot solve the fundamental cost problems we face
- Improve Care Coordination – It will be amazing to see care coordination come into the 21st century
- Improve population and public health – They are correctly focusing on measuring what works and who is doing it
- Ensure adequate privacy and security protections for personal health data – I believe consumers should control who sees what of their personal health data and am excited to see this supported.
I’m really delighted. This document isn’t perfect in my opinion. In particular, it calls for EHR’s to “provide patients with electronic copy of – or electronic access to – clinical information (including lab results, problem list, medication list, allergies) per patient preference (e.g through PHR). This allows the bad “old days” of tethered PHR’s to continue where as you switch doctors because of changes in your location, insurer, job, or just need a better doctor, or you want to include other doctors in complex care, or want outside or second opinions about your data, you cannot get it because not everyone is using the same EHR. It is key that the patients control their PHR’s and that they can transfer or download or copy this data in as computable a form as is available in the EHR into their PHR of choice.
But overall the committee that produced this document is to be congratulated. Kudo’s and congratulations to the members of the HIT Policy Committee and a special thanks to David Blumenthal. And while there are features in the matrix that aren’t called for until 2013 that I’d like to see in 2011, again, it is an excellent document.
The preamble does an excellent job calling out why we need this and what we need to improve. Don’t change a word of it please!!
Adam Bosworth's Weblog 
More background on how the meaningful use progress has been made can be found at http://ixcenterblog.org/archives/714, where you can read about the work of the Consumer Partnership for eHealth.
Some additional suggestions for how to improve the patient-centered nature of the draft definition issues by ONC (for more detail see http://ixcenterblog.org/archives/718):
* Certainly, some of the elements should be moved up — earlier in the timeline (e.g., secure messaging, patient access to self-management tools & decision support, and electronic reporting on experience of care).
* The access to electronic information needs to be “timely” (a word that should be added); timely applies both to the speed at which it is made available and the ability to get information targeted to the consumer’s particular moment in care.
* Incorporation of data generated by the consumers themselves beyond just what can be uploaded from electronic monitoring devices (per the 2013 criterion).
* There should be more attention to consumer information tools (beyond just narrowly definted personal health records) and more clarity around the kinds of tools that consumers need — not just self-management tools but also decision support tools and tools that facilitate effective & efficient communication to improve the infrastructure for participatory medicine.
Meaningful Use is great, and like you said, this is something to be happy about. Making information available when needed is critical, and even more so for patient care data. I like the five key points you mentioned, these should keep things in track.
One of the big challenges that meaningful use participants face is the integration with others and the ability to properly share that clinical information to make it all happen.
That is good information, much appreciated.,