Meaningful Meaningful Use

A little while ago, I wrote about the experience of a patient, Fred Holliday, whose wife Regina Holliday stimulated a discussion about patient access to recorded health information. Fred Holliday died on June 17, 2009 .

On June 16, 2009, the HIT Policy Committee produced its first recommendations of what Meaningful Use should be. I of course am looking at the proposal from the perspective of patient and family involvement in care, and I think in many ways it is impressive.

It’s useful to think about the HIT Policy Committee recommendation in the context of what the law as written says, which is as follows (page 355-356):

‘(2) MEANINGFUL EHR USER.— ‘‘(A) IN GENERAL.—For purposes of paragraph (1), an eligible professional shall be treated as a meaningful EHR user for an EHR reporting period for a payment year (or, for purposes of subsection (a)(7), for an EHR reporting period under such subsection for a year) if each of the following requirements is met: ‘‘(i) MEANINGFUL USE OF CERTIFIED EHR TECHNOLOGY.—The eligible professional demonstrates to the satisfaction of the Secretary, in accordance with subparagraph (C)(i), that during such period the profes- sional is using certified EHR technology in a meaning- ful manner, which shall include the use of electronic prescribing as determined to be appropriate by the Secretary. ‘‘(ii) INFORMATIONEXCHANGE.—The eligible profes- sional demonstrates to the satisfaction of the Secretary, in accordance with subparagraph (C)(i), that during such period such certified EHR technology is connected in a manner that provides, in accordance with law and standards applicable to the exchange of information, for the electronic exchange of health information to improve the quality of health care, such as pro- moting care coordination. ‘‘(iii) REPORTING ON MEASURES USINGE HR.—Subject to subparagraph (B)(ii) and using such certified EHR technology, the eligible professional submits information for such period, in a form and manner specified by the Secretary, on such clinical quality measures and such other measures as selected by the Secretary under subparagraph (B)(i).

That’s the complete definition in the law.

With that in mind, the thinking of the HIT Policy Committee is inclusive of a policy priority they call “Engage patients and families,” with a fairly reasonable (based on what I know the technology can do) set of objectives and measures for 2011-2015. The way I interpret the thinking in this set, it is that in 2011, patients will begin to read their records online, in 2013 they will begin to write their records online, including via secure messaging with their providers, and in 2015, there will be full real-time access to a personal health record populated with their data.

The measures in 2011 include the use of an after visit summary, which I’ve written about previously, and is relatively easy to measure (and produce, in my opinion).

I think the measures are a nice compromise between what leading edge health care systems can do today versus where all health care systems should be in the future. I’ll also say that this component of meaningful use is likely to help all of the other components be more successful, because they will cause health care systems and providers to see the impact of what they do, through patient reaction. To the patients out there, what do you think?


Ted, I'm so glad to hear that your assessment of this is positive. It's such a vast subject, with so many interlocking aspects, that it's been hard for me to know what to think – especially since my career has always involved revolutions that move much faster than this subject seems to.

I have to say it's been sobering to realize how little the industry will be able to deliver in the next few years. The last I heard, the 2011 standard will be that I'll be able to read online these items:

1. My condition list

2. My allergies

3. My medications

4. Lab results

Is that the current thinking?

It happens to be what PatientSite has offered for almost a decade, but from what I hear it'll be a big step forward for a lot of providers.


Well said, and I might say that the experience with PatientSite has really helped in getting things this far. In addition to the things you mention, I think "clinical summaries for patients for each encounter" would be very powerful. (My work/writing about the After Visit Summary is here) The criteria seem to be specific enough (% patients receiving one), yet also general to allow innovation. So for example, a provider might decide to include all clinical information, including physician progress notes, on an After Visit Summary. This could be a breakthrough for patient and family involvement in care.

What we don't know is if these will be the final criteria, as commentary such as this imply that changes or modifications should be watched closely, and if there are things about the criteria that are supported, that commentary would probably be useful, too.


Are the four items I mentioned indeed what's planned for 2011, or are you saying there may be changes?

There's such a continuous blitz of tweets and posts about all this – most of it naturally coming from people who are in the biz so their day job includes keeping up on this. Where's a good place to watch for updates, for those of us who aren't?

Dave, I think there may be changes, from my read of the article I mentioned above.

The question about "where to get updates" is a good one. I don't know, other than "ambiently," some HIT Policy Committee members, notably Neil Calman, MD, are on Twitter, so perhaps you might follow them and/or ask them what the best ways to keep abreast of things are,


[…] there will be full real-time access to a personal health record populated with their data” by Ted Eytan (26 June 2009). At the same time (22 June 2009) the discussion on ownership started (see also here […]

Ted Eytan, MD