Achieving the Health IT Objectives of the American Recovery and Reinvestment Act

A Framework for 'Meaningful Use' and 'Certified or Qualified' EHR
April 30, 2009 | Report, White Paper
Markle Connecting for Health
Markle
Meaningful Use Report Cover

Markle proposes a set of principles for getting health IT right under the American Recovery and Reinvestment Act.


With the American Recovery and Reinvestment Act (ARRA), Congress established new Medicare and Medicaid incentives to stimulate critically needed investments in health information technology (health IT).

The law creates two key concepts to determine whether providers qualify for the health IT incentives: they must make "meaningful use" of IT and use a "qualified or certified EHR" (electronic health record). Besides incentives to providers and hospitals, the law also creates $2 billion in health IT funding administered by the Office of the National Coordinator for Health Information Technology (ONC). A significant amount of this $2 billion should lay important groundwork to help providers use health IT meaningfully toward the goals of improving the nation's health.

Under the auspices of Markle Connecting for Health, the signatories have agreed on the following Seven Principles for Meaningful Use and Qualification or Certification of EHRs:

  1. The overarching nationwide goals of health IT investments are to improve health care quality, reduce growth in costs, stimulate innovation, and protect privacy. The investments should be directed toward achieving clear, specific metrics toward these goals. If the goals and metrics are not clear before technology is commissioned and the incentives are offered, the government will risk wasting valuable resources and losing support from both health care providers and the public for further health IT investments.
  2. These goals can be achieved only through the effective use of information to support better decision-making and more effective care processes that improve health outcomes and reduce cost growth. The goals cannot be achieved through the installation of software or hardware alone. Effective use of information is what enables a consumer to play an active role in maintaining health and getting the best care, prevents a patient from suffering a medical error, helps a clinician prescribe the right treatment at the right time, allows a care team to coordinate care in the most effective and affordable way, and benefits efforts to improve quality, accelerate research, and advance public health. The definition of "meaningful use" should hinge on whether information is being used to deliver care and support processes that improve patient health status and outcomes. The definition should focus on the needs of patients and consumers, not on the mere presence or functions of technology.
  3. Meaningful use should be demonstrable in the first years of implementation (2011-12) without creating undue burden on clinicians and practices. The meaningful use definition must optimize achievability for providers and benefits to patients and consumers. Improving medication management and coordination of care provides early opportunities for such an optimization. Meaningful use should initially rely on standard information types (such as recent medications and laboratory results) that are electronic and already widely adopted—and that can support metrics to improve medication management and coordination of care.
  4. The definition of meaningful use should gradually expand to encompass more ambitious health improvement aims over time. To support meaningful use goals that improve health and reduce the growth of costs, additional data types (e.g., problem lists, allergies, vitals, images, findings, procedures, care plans, hospital discharge summaries, patient registration forms) can become increasingly standardized over time to facilitate a set of defined measurements. The phasing-in of expanded requirements should be well-defined early in the process, so that those building or purchasing systems have a clear and realistic path to achieve meaningful use at each stage.
  5. The definition of "qualified or certified EHR technology" should support the goals of meaningful use, security, and privacy. Processes for certification or qualification will be important to prevent fraud or faulty products (e.g., products that do not sufficiently protect sensitive health information), as well as prevent rewards for superficial or trivial uses of technology. For a technology to be "qualified or certified," it should embed the capability for clinical practices and hospitals to attain meaningful use, and demonstrate their levels of attainment of such use, without undue additional reporting burdens. It should also comply with the technical requirements for privacy and security under the Health Insurance Portability and Accountability Act (HIPAA) and ARRA. Processes for certification or qualification should allow for product and service innovation toward meeting the goals of meaningful use.
  6. Metrics for achieving meaningful use should account for the heterogeneity of the U.S. health sector and allow for a broad range of providers to participate. Medical practices that are capable of installing and supporting a comprehensive EHR should be incentivized under ARRA to do so. However, assuming that only comprehensive EHR systems can achieve the goals of meaningful use might delay progress or lock out other lightweight, network-enabled solutions that may achieve the same goals in the near-term and can provide greater functionality over time. Small practices with less technical support should be able to qualify for incentives by using Internet-enabled technologies that can help them to access and use information to help their patients. By emphasizing rewards for actual use of information, and not the mere purchase of specific hardware or software products, public policy can expand the potential of existing information networks and spur innovation to reach health goals and administrative efficiencies.
  7. Consumers, patients, and their families should benefit from health IT through improved access to personal health information without sacrificing their privacy.1 ARRA clarifies the individual's right to request electronic copies of personal health information from EHRs for storage by information services of the individual's choosing. This should be considered a form of meaningful use toward helping people prevent illness, manage their health-related information and transactions, coordinate care and communicate with clinicians, understand health care costs, and take better care of loved ones.