At its core, the American Recovery and Reinvestment Act’s HITECH program 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 initial standard for “meaningful use” should focus on uses of health IT that will actually help improve care and accelerate payment reform:
- Tracking key patient-level clinical information in order to give health care providers clear visibility into the health status of their patient populations.
- Applying clinical decision support designed by health care providers to help improve adherence to evidence-based best practices.
- Executing electronic health care transactions (prescriptions, receipt of drug formulary information, eligibility checking, lab results, basic patient summary data exchange) with key stakeholders.
- Reporting a focused set of meaningful care outcomes and evidence-based process metrics (for example, the percentage of patients with hypertension whose blood pressure is under control), which will be required by virtually any conceivable new value-based payment regimes.
The standard for “meaningful use” should be made more stringent over time, as is anticipated in the HITECH Act. The natural extension of this approach to “meaningful use” would be to introduce actual performance against targeted outcomes and process metrics as a key part of the definition of “meaningful use” in years 3 to 5 of the HITECH incentive payments program.
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