Wednesday, July 14, 2010

Meaningful Use is Here

The Meaningful Use and Standards have finally been issued and I had the fortune of sitting down with Janet Dillione, EVP and GM of Nuance Healthcare to get feedback on the final rules and their impact on the healthcare industry

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These are interesting times with some tremendous emerging technologies that will bring more and more elegant support to clinicians at the time of clinical decision making. Providing clinicians with usable solutions that do not decrease in their efficiency and reduce the time they have available with their patients.

There have already been some useful commentary in the New England Journal of Medicine (NEJM): "The “Meaningful Use” Regulation for Electronic Health Records by David Blumenthal, M.D., M.P.P., and Marilyn Tavenner, R.N., M.H.A. (pdf)". The final regulations provide some level of relaxation of the demands and requirements and the introduction of more choice offering a better balance between the drive towards digitizing clinical medicine with a nod to the existing complex infrastructure that is in place today and would be impossible to achieve without major disruptions to the delivery of healthcare. Overall they appear to have shifted the more demanding elements of meaningful use to later which allows for a slower more acceptable adoption curve

Expanding the choices and reducing the burden makes the move towards meaningful use more achievable by a larger proportion of the already time pressured clinicians. Even though there has been some practical relaxation of the standards the overall drive remains in place and there is a clear push towards the inevitable digitization of clinical care and the improvement in quality of care based on meaningful implementation of electronic medical records. As the NEJM article makes the point
Although the intent of our January proposals has been retained and indeed affirmed through the rule-making process, the final regulation also incorporates significant changes — a response to the comments and experience that diverse stakeholders shared with us. In particular, concerns about the pace and scope of implementation of meaningful use led us to adopt a two-track approach regarding the objectives that allow practices and hospitals to qualify for incentive payments in the first 2 years of the program.

John Halamka posted a brief summary in his posting "Meaningful Use and the Standards are Finalized" which included some links to the original documents. He summarizes
Overall this final rule maintains a balance between the policy objectives sought and the technology changes possible that are achievable now. There will still be 3 stages of meaningful use and later stages will be more demanding. All the original stage 1 requirements will still be part of meaningful use by stage 2

Later he posted an analysis of Final Standards rule here. He details the technical elements and summarized
The major recommendations of the Federal Advisory Committees have all been incorporated, enabling the industry to move forward with enhanced interoperability in a way that is technologically achievable today.

Interesting times and no doubt much more detailed analysis will follow