Wednesday, July 29, 2009

"Meaningful Use:" Meaningful to Whom?

In the States, ARRA has authorized funds to assist organizations implementing EHRs. ARRA requires "Meaningful use." The healthcare Information technology Standards Panel (HITSP) has just defined seven core types of data exchange; prescriptions, lab results, clinical data summaries, biosurveillance data, immunization registries, public health and quality measurement. [Full article here] Clearly a committee was involved--certainly prescription data, clinical summaries and labs would enable healthcare while reducing potential misidentification issues.

But what do immunization registries do for patients or providers? public health data? And biosurveillance is about accessing multiple data sources to identify trends or potential outbreaks; so that means making the electronic record readable for "phishing," not improving the care of the patient. Is that wrong?

The American Health Information Management Association (AHIMA) commented to The National Committee on Vital and Health Statistics on this (April 2009, AHIMA), and had some very interesting points. Sandra Fuller delivered a very thorough discussion of both the product and the process to arrive at "meaningful use." AHIMA felt that public funding should be used to drive improved care as well as the public interest.

To improve care, they spoke of prescriptions, labs and results and discharge data. These are all considered core elements of care-information communication and patient transfer (provider to technician, provider to pharmacist, provider to provider) and areas of greatest risk of error.

The report looked beyond the patient--to both public-health policy and to patient-care policy. To serve public health interests (and after all, this is being publicly funded), AHIMA recommends investment in development of improved reporting methods and systems with coordination through the HIEs being developed (and funded) with other ARRA resources. But, at the end, AHIMA circled back to the patient;

Be relevant to consumers: Taxpayers are funding these investments as a prerequisite to effective health reform. More broadly, this is an extraordinary opportunity to be transparent and to increase public recognition of the challenge and opportunity of an interconnected health system and the progress that is being made.

All in all, a very interesting and valuable report--check it out

Well, the committee got to it and politics seems to have moved things to the, if you will, "right." Immunization records should certainly be part of the patient record, but is it really a priority element for standardization? Discharge summaries fell out, but biosurveillance got in. Should readability by outside agencies be a "core element" of meaningful use? If an EHR is about communicating patient data (and it is usually thought of as an active process, not a passive one), then is anxiety overwhelming the mission? Or is this use of "surveillance" simply a way to get Homeland Security behind the drive for a national standards for data formatting and encoding? After all, the multiple-vendor system has led to a wide variety of proprietary methods that inhibit data communication and portability. And are we still in the times of driving by fear? Thoughts?

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