Picturing Meaningful Use

Note: This is a guest post from Lygeia Ricciardi ( @Lygeia ). Ted and I have had the pleasure of collaborating for some time through the Clinovations collaborative here in DC, and we share a lot of the same interest and passion around putting consumers/patients/citizens at the epicenter of health care change.




I made this “wordle” from the text of the Meaningful Use final rule as printed in the Federal Register July 28, 2010. Note that I didn’t include the text in tables, because it didn’t transfer easily into the wordle program… but I did get the rest of the 273 pages. After I did it I searched to see if anyone else had done something similar. Indeed I saw that David Harlow at HealthBlawg made a wordle of the proposed (as opposed to final) Meaningful Use Rules back in January–it looks pretty similar.

What’s a Wordle?
A wordle is a “word cloud” generated from a block of text. It makes the words that are used most often appear largest. You can make your own Wordle at http://www.wordle.net/

What’s Meaningful Use?
The Meaningful Use Rule spells out the details for how eligible hospitals and health care providers can qualify for incentives to use electronic health records (EHRs). Up to $27 billion is available—an amount that far dwarfs any other public investment in health IT in the US to date. The idea behind the Rule is to encourage the use of technology in ways that genuinely improve health, not just to acquire tools for the sake of having them.

What does it mean?
Well, not surprisingly “EHR,” “incentive,” and “payment” feature prominently. As do Medicaid and Medicare (the incentives are only for providers who treat patients via those programs). It’s worth noting that the word “patient” is a bit harder to find – there it is in green on the bottom right. One of the most important challenges in implementing Meaningful Use, in my opinion, will be finding ways to make it meaningful for patients. What do you think?

From Superstars to Jane and Joe–Engaging Consumers in Health IT

Note: This is a guest post from fellow innovative Washingtonian and health communications professional Lygeia Ricciardi ( @lygeia ). I’ve had the pleasure of collaborating with her for some time through the Clinovations collaborative here in DC, and we share a lot of the same interest and passion around putting consumers/patients/citizens at the epicenter of health care.

If you care about health IT, you’ve probably heard of “ePatient” Dave DeBronkart ( @epatientdave ) and Regina Holliday ( @reginaholliday ). Both have risen to relative stardom telling their personal stories of how poor policies and technologies dangerously block the delivery of good quality healthcare. They have helped articulate what’s wrong with the system and steps we can take to fix it—infusing “business as usual” with the spark of personal passion through major media outlets and government hearings.

But the “patient perspective” is too often absent from important discussions. As we prepare to spend billions of dollars rolling out health IT through the HITECH funds in the Stimulus Package, we need a whole army of Daves and Reginas. Too bad they are so hard to find… or are they?

As Dave has pointed out, “we are all patients.” Indeed. Scratch the surface of almost any life in the US (including yours?) and you’ll find stories of how health and healthcare could be better with the right information and tools. There are thousands of other Jane and Joe consumers who can help shape the future of health–if we can tap their input appropriately.

Different Kinds of Engagement Are Needed

The need for consumer input is not unique to health IT, but it’s an area that has strong potential to reshape healthcare more broadly in the near term. “Consumer engagement” is often used as a catchall phrase, but unpacking it reveals several different roles:

From Superstars to Jane and Joe

“Superstars” like Regina and Dave shock the system out of complacency. They get get broad media coverage and participate in high profile meetings, hearings, and conferences. Qualifications include an unusually compelling personal story, a flair for communicating (whether through words, paint, or Seinfeld clips), and the motivation to undertake a personal crusade for change.

Equally important are the “Implementors” who weigh in on the sometimes bewilderingly complex details of developing tools, networks, and the policies that govern them. A great example of an Implementor is Dan Teitz, an HIV/AIDS expert who has tirelessly shaped statewide health IT policies and outreach materials in New York—and encouraged a broad network of other consumers to do the same. Implementors like Dan are invaluable in the governance of hospital networks, regional, and statewide HIE networks, as well as in reviewing products and policies for PHR, EHR, and online health service developers.

The broad base of the consumer engagement pyramid is the general public—“Jane and Joe Consumer.” The ultimate goal is to engage them (us!) better in personal health and healthcare through information and communication. Engagement of the general public is essential, and we haven’t yet figured out how to do it effectively.

(To wit, only 7% of Americans have a personal health record.)

Roadblocks Consumer Superstars and Implementors Face

Broad public engagement is the topic of another post (or several)–for now let’s focus on Superstars and Implementors—both of which pave the way for Jane and Joe. So why aren’t there more people like Dave, Regina, and Dan? Time, money, and specialized knowledge.

Other health IT stakeholder groups, (eg providers, payers, and IT companies) have financial incentives to pay lobbyists and other staff to advocate for them. They stand to gain major government funding or profits from health IT implementations that go their way.  But who pays consumers? In many cases, no one. It’s that familiar healthcare problem of misaligned incentives.

Sure, consumer organizations (such as the Consumer Partnership for eHealth) have begun to get some traction when it comes to shifting major debates such as the implementation of “meaningful use,” but in general consumer groups report that they are under-funded and unable to dedicate the time and other resources necessary to track and participate substantively in health IT debates and implementation.

Part of the problem is that the rest of the healthcare establishment isn’t yet used to inviting consumer participation. Those who do seek consumer input for conferences or testimonies in Washington often don’t want anyone “too professional.” They seek a fresh story—some as yet “undiscovered” patient who can capture media attention anew. But is that really necessary for an Implementor, and how many consumers will make the effort and foot the bill to tell their stories, particularly if they will  enjoy only a limited shelf life?

Potential Solutions

The first step is for all health IT stakeholders to understand that consumer engagement is essential on several levels. Next, consumer organizations and foundations should better coordinate and leverage their resources to support consumer “Superstars” and “Implementors” in the following ways:

Funding — Fund travel expenses and provide basic stipends for the time consumers put into shaping the health IT landscape.

Knowledge – Develop and disseminate basic materials about health IT, not for the general public, but explicitly for those who want to participate more in depth.

Networks – Develop networks to support consumers engaged consumers, who may benefit from each other’s experience, especially as Implementors.