Read the full comment by the Center for American Progress, the Markle Foundation, and the Brookings Institution (pdf)
The $19 billion health information technology investment authorized under the American Recovery and Reinvestment Act’s HITECH program presents a landmark opportunity to catalyze improvement of our nation’s health care system. This key piece of President Barack Obama’s policy agenda encourages doctors and hospitals to embrace health IT solutions in order to strengthen and modernize the infrastructure upon which our health care system runs.
At its core, HITECH rewards not the purchase of health IT but the “meaningful use” of health IT. The vast majority of the $19 billion in HITECH investments go to temporary bonuses paid by Medicare and Medicaid to health care providers who can demonstrate “meaningful use” of “certified electronic health records.” These payments range from $44,000 to $64,000 per physician and up to $11 million per hospital, paid out over five years.
The regulatory definition of “meaningful use” is therefore of paramount importance. On June 16, the Department of Health and Human Services took its first step toward fleshing out “meaningful use” by publishing a proposed draft definition for public comment—articulating not only a proposed initial standard for 2011 but also how this standard would evolve and become more rigorous in 2013 and 2015.
The Center for American Progress has joined the Markle Foundation and the Brookings Institution in formulating and submitting joint comments that have also garnered the support of a wide array of organizations, including the American Academy of Family Physicians, the American Medical Association, Consumers Union, the National Committee for Quality Assurance, the National Partnership for Women and Families, the Pacific Business Group on Health, and many others.
Highlights of our joint comments:
We applaud HHS for laying out an initial definition of “meaningful use” that is firmly rooted in clear, achievable health and cost goals. As opposed to technology-centric objectives, HHS has embraced the notion that the purpose of health IT is to help improve the quality and efficiency of health care, and has framed the 2015 goals of our national health IT investment accordingly, for example by targeting “one million heart attacks and strokes prevented” and a “50 percent reduction in preventable medication errors.” This is exactly the right focus for health IT—improving the health of the nation as opposed to the implementation of technology for technology’s sake.
In the same vein, we also strongly endorse HHS’s declaration that it wants to pay for results—improved health, patient engagement, and better care processes—rather than simply paying for technology. HHS’s proposed definition of “meaningful use” invokes a significant number of the right results-oriented measures of success, such as percentage of patients with controlled hypertension and lipids, percentage of diabetics with controlled HgbA1c, reduced rates of medication errors, and preventable hospitalizations and readmissions after hospital discharge. The draft definition is actually characterized by a profusion of metrics—we recommend looking carefully at each and ensuring that each is a “measure that matters,” with high predictive value in terms of producing results against the big 2015 goals articulated by HHS. We also recommend making a proactive investment in defining and refining optimal “meaningful use” metrics over time.
We are excited by HHS’s proposal to include the provision of electronic personal health information directly to patients as part of the “meaningful use” standard. We believe that HHS can move even further down the road of facilitating patient engagement in their care with the aid of technology, for example by considering notions such as allowing data reported by patients to providers (via home monitoring tools, personal health records, and other means) to help providers satisfy “meaningful use” requirements.
In addition, we endorse HHS’s focus on the use of information to produce results as opposed to articulating “meaningful use” requirements that dictate the utilization of a particular technology or functional feature. There are a few deviations from this principle in the proposed definition which can and should be modified to be consistent with the results orientation of the draft standard in general.
Finally, looking ahead, as the “meaningful use” payments are to be made to meaningful users of “certified EHRs,” we urge HHS to define criteria and certification processes for “certified EHRs” which do not ossify technology in its current state, but rather unlock innovation which is sorely needed. And we emphasize the need to follow up HITECH with broader health reforms—in particular, provider payment reform—in order to provide a permanent, sustainable business case for utilizing health IT to improve the quality and efficiency of health care.
Read the full comment by the Center for American Progress, the Markle Foundation, and the Brookings Institution (pdf)