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Owning "Meaningful Use"

May 1, 2009
by Pam Arlotto
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HIMSS announced their recommendations for “meaningful use” this week with a suggested target of 51% and 85% use of CPOE by 2013 and 2015, respectively. AMDIS (the CMIO professional association) will launch the website www.meaningfuluse.org within the week. The hearings have started and the process for defining “meaningful use” will be announced shortly. We are well on our way to meeting the deadline for clarification around the term by December 31, 2009. Yet, defining the term tells us little about “the how” of “meaningful use”.

Early indications indicate that health care will be a very different place when we have “meaningful users”. The degree of change will be exponentially greater than the levels of incremental change we have accomplished to date.

Consider the exchange information electronically across the enterprise, with ambulatory providers and with community collaboratives. Consider the development of new processes for care coordination, closed loop medication administration and outcomes reporting. Consider the clinicial decision support, expanded use of protocols and true evidence based medicine.

Everett Rogers, recognized by many the “guru” of adoption/diffusion research suggest that each organization should design plans for progressive use of technology. Four levels of increased use include:

§ Adoption – Selection of a technology for use by an individual or organization

§ Diffusion – The stage in which the technology spreads to general use and application

§ Integration – Connotes a sense of acceptance and transparency within the user environment

§ Optimization – The technology provides value and return on investment is evident

The final requirements for “meaningful use” will be important for all of us to understand. Yet, in the meantime, given the level of change anticipated, I recommend that each organization develop its own definition of “meaningful use”—one that senior leadership owns and is accountable for. This definition should be accompanied by a plan to move the organization through the various stages of adoption, diffusion, integration and optimization. Knowing where you stand today, will make a hugh difference in identifying and closing the gaps between where you are and the final legislation.



I'd suggest not trying to analyze now. Focus on your own organization, where are you now, what would be "meaningful use" for your clinicians, what gaps do you have to close, what is realistic in the next few years, what is the cost benefit and what are the "politics of this much change". Once you have focused internally, you will be more prepared when the preening is over and the definition is finalized.

Before there can be meaningful use, there has to be first use. I've been working with some office-based practices, trying to build their comfort to the level of any automated systems.

While I recognize this may not be practical for vendors, I have a few steps that I use to increase comfort zones. First, I tell the clinicians that regardless of what they've heard, they personally don't need electronic medical records. Computers need electronic medical records.

They need information better presented, as well as better means of entering information.
In a few tests, I'm starting that with paper emulating what a good automated system would do. Literally, I take my personal physician's chart notes and give him back the sort of organized material that an information system would produce. His comfort level is improving.

Meanwhile, I've also been accepted, in that practice, as the Bringer of Paper to the Nurses. Those pieces of paper are organized to match a nursing workflow, and be readable.
If I know there will need to be a PBM preauthorization, the forms are there.

Let's start in the comfort zone, at least in the small practice, and grow from there.
Eventually, we'll have enough advocates. It's a different problem than large institutions.

Yes, I agree that remote hosting makes the most sense. I would caution, however, that once the commitment is made, the system has to be reliable. As I put it in Microsoft terms, you don't want a Blue Screen of Death to be literal.

What this may well mean is that the office must have backup power, and multiple links to one or more hosting centers. Sometimes, there are surprisingly cheap ways to get the alternate path, perhaps without the same performance.

As you state, HCBerkowitz, before meaningful use, there has to be use, and before use, there has to be adoption. HITECH seems to necessitate skipping a few of those critical steps.

I would imagine it's hard for HIT professional to analyze and reconcile all the definitions being thrown around. It seems to be a point of pride right now for each industry organization to take its own crack at a definition. When a definition is put out for comment, we'll really see the preening begin.