Advice From a HIT Man: Take the Meaningful Use Cannoli

In "The Godfather," the character Peter Clemenza reminds us that even in violent, turbulent times, something sweet can be salvaged. As we all assess and improvise after the ICD-10 delay, we can’t ignore the cannoli.

Meaningful Use Stage 2 and the ICD-10 adoption were aligned to create “the perfect storm.” They are now offset by a year. That’s a year for testing, modifying and training. I’ll take that cannolo. But I think there are more pastries to be had.

On March 11, the Health IT Policy Committee adopted the Meaningful Use Stage 3 draft recommendations of the Meaningful Use Workgroup (MUWG), chaired by Dr. Paul Tang and Dr. George Hripcsak. In this adoption, requirements for Stage 3 were reduced from 26 to 19. The reason for the reduction of almost 30% is more significant than the decrease in requirements itself. MUWG made the changes based on the feedback from end-users, thought leaders like Dr. John Halamka.

The committee reaffirmed four areas for emphasis – clinical decision support, patient engagement, care coordination and population management. “Interoperability,” a term of some intensity, confusion and frustration, enjoyed a redefinition as “the exchange of information to improve care.” But most appreciated (here comes the cannoli) were the sensitivity and awareness of the effects meeting MU requirements have on those caring for patients.

“We want to be careful that in the balancing act we weigh the impact to providers, the impact on their workflow,” said Dr. Tang. “We want to reduce the burden on the providers and rely on more mature standards.”

Marc Probst, Vice President and Chief Information Officer for Intermountain Healthcare, echoed Dr. Tang’s awareness:  “[…] it sounds to me like our assumptions are, vendors are just sitting around taking the money and the providers are out there just taking their time off. But we also need to pay attention to the fact that we have an industry out there that right now is pretty much hurting to try and get done what we’ve already put on the table for them to do.”

icd-10-delay-2Judy Faulkner, CEO and founder of Epic Systems, reminded us by the car analogy of having those who provide the care create the standards. Imagine motor vehicles if those writing the standards for driver’s licenses had never driven a car.

“The problem we have here is the people who are making up the rules on what the electronic health records do, are not a group of people who primarily drive the car,” Faulkner said.

The refreshing message of the committee was the design process must be firmly tethered to those who operate the system.

Finally, Dr. Devon Mann warned of the danger of proceeding without assessing the outcomes of MU2, saying the MUWG group needs to engage those living in and applying MU2 before the criteria moves forward.

In validation of Dr. Mann’s comments, on April 14, Dr. Lipika Samal published Meaningful Use And Quality Of Care in JAMA Internal Medicine, which suggested no correlation of Meaningful Use and improved quality measures. Yet even here there is a cannolo: The focus and emphasis of MU3 is on clinical decision support.

As Dr. Tang reminds us, “Clinical decision support is probably the most studied and most written-about function of the EHR, so that’s really the biggest tool we have to improve outcomes in patient health.”

Recently healthcare IT has been trying, exhausting and expensive. But after reading the HIT Policy Committee transcript, one has to smile about the values and realism from those driving the thoughts and direction of healthcare IT.

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