Group tackles definition of 'meaningful use' for e-health records

The United States can develop an electronic health record system that could, within the next five years, help prevent a million heart attacks annually and reduce the number of medication errors by 50 percent, a top health official in New York City said on Tuesday.

Farzad Mostashari, assistant commissioner of the New York City Health Department, told a meeting of the Health Information Technology policy committee that electronic health record systems also can reduce hospital re-admissions by half, and provide patients with access to their own medical information as well as health departments nationwide.

All these accomplishments are "achievable goals" and meet the definition of "meaningful use" of electronic health record systems as required by the 2009 American Recovery and Investment Act.

Mostashari is co-chairman of a policy committee working group for HIT, which is charged with defining what the law means by meaningful use of electronic health record systems.

The discussion of meaningful use at the federal advisory committee meeting on Tuesday was the beginning of a historical discussion that would lead to development of a better health care system, said David Blumenthal, national coordinator for health information technology in the Health and Human Services Department. The committee should develop simple, but specific, definitions that will lead to what the law denotes by the meaningful use of electronic health record systems.

Defining the term is not an idle bureaucratic exercise. The law allows the government to give clinicians payments of up to $44,000 each to install an electronic health record system -- if the network is based on a meaningful use on a sliding scale starting in 2011 and ending in 2015. Once the policy committee completes its work, HHS will develop rules that define meaningful use.

Co-chairman Paul Tang said the work group developed a phased approach, allowing health record systems that by 2011 simply capture data in a coded format as meeting the meaningful use definition.

The data would include electronic health records listing medications and drug allergies, vital signs and lab results, said Tang, who is chief medical information officer at the Palo Alto Medical Foundation in California. In 2011, physicians also should be using a computerized order entry system to prescribe drugs and to check for potential adverse interactions.

The working group recommended that by 2013 doctors begin using more sophisticated systems such as computerized clinical decision-support systems for patient care, manage chronic conditions such as diabetes, upload data from patients' in-home medical devices such as glucose monitors, and secure doctor-patient messaging systems.

The incremental steps eventually would create a robust records system by 2015 that improves the quality, safety and efficiency of health care; supports multimedia systems such as X-rays; coordinates individual patient care from multiple providers; and provides patients access to their electronic personal health records, the work group concluded.

Any meaningful use definition must focus on how to effectively integrate the data in the systems rather than the act of capturing it, said Christine Bechtel, vice president of the National Partnership for Women and Families, a Washington-based nonprofit that advocates for quality health care and a member of the HIT work group.

Gail Harrell, another member of the work group who followed health issues as a member of the Florida Legislature, said the group's definitions seem aimed more at generalists and internists rather than medical specialists. She said any definition must include specialists.

The definitions of meaningful use presented at the policy committee meeting did not include any language on the privacy of electronic health records, which Roger Baker, chief information officer of the Veterans Affairs Department, said was a "critical piece" of the discussion. He told the meeting that privacy is key for doctors to adopt the systems and must be part of the five-year plan.