Status of Meaningful Use

Implementing electronic health records to improve the quality of care

The federal electronic health record incentive program was finalized in July 2010. As a federal health information technology (HIT) regional extension center, the Regional Extension Assistance Center for HIT (REACH) is working with providers in Minnesota and North Dakota, assisting them in achieving meaningful use.

REACH staff Paul Kleeberg, MD, clinical director, and Sue Severson, program director, discussed the status of meaningful use.

Where are providers in their journey to meaningful use?

Kleeberg: I'm seeing a complete spectrum. I see small docs and family practices that really like the technology and use it to improve care quality. And, I've met a sub-specialist surgeon who declared she'd never use an electronic health record.

Motivations for adoption vary. Some providers see it as a way to improve quality, others see the incentive, while still others see the writing on the wall and believe they will need it to stay in business.

Severson: Health care facilities are extremely practical; they are looking at the nuts and bolts needed to get to meaningful use. Those components will get them started, but we are looking higher, including looking at the National Priority Partnership Goals.

Kleeberg: The greater goal is to leverage health information technology to improve quality, safety, efficiency, and equanimity of care.
So often we take our eye off the ball and look at the dollars or focus on the short term. An effectively utilized record that unifies care across a number of sites so people do not have to re-enter data or duplicate tests and have the information there when a patient shows up at a hospital, will increase quality, increase safety, and decrease costs.

Severson: We want meaningful use to be part of an organization's strategic initiative. If a facility is really motivated byincentives, we try to dig into other motivations. If facilities do not set a foundation, getting to stage 2 and 3 of meaningful use will be a steep climb.

Stage 1 is not enough

Kleeberg: Stage 1 of meaningful use is a low bar. One problem on the problem list and one medication on the medication list is the bare minimum. If providers only meet the minimum, they could record that a patient is a diabetic but miss that the patient has significant vascular complications. That's not quality. Would you willingly give a patient a summary with an incomplete problem list or medication list? As a patient, I consider a complete list along with follow-up instructions to be quality.

Meaningful use criteria are baby steps to bring us to where we want to be. My vision is that one day we will have a system where accessing information is as easy as on the Internet but with significant security protections.

Severson: This is an opportunity to transform care. We are moving into the 21st century with health care. We are moving from this antiquated paper system to an information system that can support the clinical decisions of providers.

More than an IT project

Kleeberg: Those who see meaningful use as a technological fix think of EHR adoption as an IT project. A vendor can provide you with certified technology, but to use it effectively, you and your staff must be involved in the process. Only then will you to get the most out of your investment, improve the quality of your care, and achieve meaningful use.

Severson: Vendors are saying that they have the capabilities. That's much different than clinics and hospitals being able to use those capabilities. That takes a purposeful approach, one with the right workflows,
the right look on screen, and staff who are motivated to enter and extract data because they understand the value to patients.

Meeting stage 1

Severson: There's so much EHR penetration in Minnesota and North Dakota. Many providers who have an EHR think they already have stage 1 meaningful use accomplished or are well on their way. When we dig into the details, it's much more complicated. We've developed a meaningful use assessment so providers can check how ready they are for meaningful use and work on the areas where they find gaps.

Kleeberg: We know that providers are facing multiple quality and reporting efforts—ICD-10, Minnesota Health Care Home certification, as well as PQRI and other forms of data submission. These can be easier with an EHR. Providers should look at meaningful use in tandem with other efforts. There can be a great deal of synergy.

Under its current agreement with the Office of the National Coordinator, REACH is able to offer services to providers at deeply discounted rates for contracts initiated before December 31.

Key Health Alliance is a partnership of Stratis Health, Rural Health Resource Center, and The College of St. Scholastica. REACH is a project federally funded through ONC.