The Many Meaningful Uses of Health Information Technology
Emily Hogin and Jodi G. Daniel, J.D., M.P.H. | May 18, 2011
ONC’s core mission includes promoting the meaningful use of health information technology nationwide. By one definition, “meaningful users” are those who qualify to receive funding under the Medicare and Medicaid Electronic Health Records Incentive Programs under the HITECH provisions of the 2009 American Recovery and Reinvestment Act. This funding goes to health care providers who adopt certified electronic health records and use them in specific ways to improve patients’ health, increase transparency and efficiency, and engage patients and caregivers.
According to a March 2011 Health Affairs article co-authored by Brian K. Bruen and Leighton Ku, along with ONC’s own Melinda Beeuwkes Buntin and Matthew Burke, more than four in five office-based physicians and virtually all acute-care hospitals could be eligible for the Medicare/Medicaid incentives. But the incentives do not apply to everyone. The Health Affairs article acknowledges that under the HITECH Act, many pediatricians, obstetrician-gynecologists, and mental health providers will not be eligible for the incentive payments. The same is true for long-term and post-acute care providers.
For ONC, the fact that not all providers are eligible for payments under HITECH is a reminder that meaningful use is not only a financial incentive program; it is also a goal. Meaningful use is the idea that all of our nation’s health care system will benefit from an IT infrastructure in which electronic health information can be collected, exchanged, and innovatively deployed to improve the safety, quality, and cost effectiveness of American health care. ONC has several programs and resources to help providers and hospitals that do not happen to be eligible for incentive payments nevertheless use health IT to improve their patients’ care.
Pediatricians and Obstetricians-Gynecologists
Pediatricians and obstetrician-gynecologists are critical to the future of health information exchange as they care for patients at the moment when a life-long electronic health record would ideally begin. So far, 9,156 pediatricians and 5,894 obstetrician-gynecologists nationwide have already registered with one of ONC’s 62 Regional Extension Centers for help in making the transition to robust electronic health records. ONC is also participating in an effort led by the Agency for Healthcare Research and Quality and the Centers for Medicare & Medicaid Services to develop a model electronic health record for children enrolled in Medicaid or CHIP. The model would allow health care providers and IT vendors to ensure safe, effective, and reliable care through the use of health IT.
In New York City, for example, ONC’s Regional Extension Center has worked to help pediatricians deploy electronic health records that improve patient care by flagging age-appropriate tests, generating completed school forms, and submitting data to the Citywide Immunization System. This latter function, in particular, plays a critical role in protecting and improving regional population health. In addition, ONC’s Beacon Community in Cincinnati, OH was awarded $13 million in part to work with pediatricians to improve care coordination for children with asthma.
Mental Health and Behavioral Health Providers
ONC programs and resources are also helping mental and behavioral health care providers make effective use of health IT. ONC’s Regional Extension Center in Ohio, for example, is assisting the Ohio Department of Mental Health to identify and customize electronic health record products that meet the needs of the local mental health/behavioral health provider community and their patients. ONC’s Beacon Community in Southern Piedmont, NC will use electronic health records to help doctors in screening for mental health illnesses so their patients can get the care they need. The State Alliance for e-Health has assembled teams in North Carolina, Virginia, the Virgin Islands, Massachusetts, New Hampshire, New Jersey, and Vermont to identify the challenges of including behavioral health in health information exchange and to develop plans for addressing those challenges.
Telehealth is expanding across the United States as a way of addressing health care shortages in underserved areas, but that expansion is sometimes inhibited by providers’ out-of-state medical licenses. ONC has partnered with the State Alliance for e-Health to simplify the process and time involved in obtaining medical licenses in multiple states. Recommendations included adopting a uniform application with state specific addendums and using a centralized credentials verification service. To date, 22 states are in some stage of adopting Federation of State Medical Board’s Uniform Application. In addition, 14state medical boards require and 63 state boards accept the use of the Federation Credential Verification Service.
Post-Acute and Long-Term Care Providers
Post-acute and long-term care providers stand to benefit enormously from effectively using electronic health records to reduce errors, increase efficiency, and improve care coordination. ONC has devoted significant resources to this end.
ONC’s State Health Information Exchange (HIE) Challenge grant program, for example, awarded $6.8 million in Colorado, Massachusetts, Oklahoma, and Maryland for work in improving long-term and post-acute care transitions. This money is being used to identify data that will be used to help develop strategies to improve long-term and post-acute care transitions and implement pilot programs to test health information exchange.
The Southern Piedmont Beacon Community is also working to use electronic health records to reduce errors in transfers between nursing homes and hospitals. The Western New York Beacon Community has prioritized adding home health organizations and nursing homes to the region’s health information exchange, and the Keystone Beacon Community in Pennsylvania has launched community working groups with home health organizations and skilled nursing facilities to examine their potential for expanding use of health IT.
The State Alliance for e-Health has assembled teams in Alaska, Arkansas, Colorado, Indiana, Michigan, North Dakota, Rhode Island, and Washington to identify challenges of including long term/post acute care in health information exchange and to develop plans for addressing those challenges.
Of course, consumers can also use health IT in meaningful ways that enable them to play a more central role in maintaining good health. For instance, health IT can strengthen consumers’ communications with their care team, enable access to information about personal health, and provide tools and services that support them in making sound choices including those related to diet, exercise, and taking medications. The State HIE Challenge grantees are helping individuals and families use personal health records to partner with their doctors and improve their own health. These personal health records can encourage consumers to take preventative measures that both improve health and lower costs.
Perhaps the most important part of achieving meaningful use of health IT is recognizing that the concept is not about specific labels or programs, but is really about getting each potential user of health IT – whether a large hospital, a small pediatric practice, a nursing home, a mental health provider, or a consumer – to think innovatively about how to employ electronic health information to improve care and outcomes.
Do you have ideas on how you can use health IT meaningfully? ONC wants to hear from you on how to make our regulations, vendor certification, standards and other programs relevant for all – please share your comments below.