Meaningful Use: A Highly Useful Construct for Informatics

Whatever does happen with the ARRA/HITECH programs in the long run, one value to come out of the entire process is the construct of "meaningful use." In the next month or two, we will hear how meaningful use is operationalized in its first (2011) stage. Two more stages will follow in 2013 and 2015, and later in this decade we will know if the meaningful use of the electronic health record (EHR) has improved healthcare and people's health.

But I must give credit to whoever "invented" the construct of meaningful use. It is a brilliant way to think about the implementation of health information technology. I would also argue that it drives home the distinction between informatics and information technology (IT) that I have written about elsewhere, with the former focused on the goal of making "meaningful use" of the technology of the latter.

I have been asking around to see to whom we can attribute the invention of meaningful use. I will stand corrected if I find out the term was used before this, but it appears that it was first coined in a bill introduced in the 2007-2008 Congress, H.R. 6898: Health-e Information Technology Act of 2008. The bill was never passed but proposed the idea of "incentive payments to physicians and inpatient hospitals that meaningfully use a certified health information technology system." HR 6898 was introduced by Pete Stark, and has much verbiage from what eventually went into ARRA/HITECH. (Given the meaning that Stark’s name has in other contexts, it is indeed interesting that he could have been associated with the origination of the term!)

The idea behind meaningful use is simple: The goal is not to merely put computers and EHRs in physician's offices and in hospitals, but rather to make sure that they are implemented in ways that improve individual and population health. As HITECH has been operationalized, there are five underlying goals for meaningful use:

1. Improve quality, safety and efficiency
2. Engage patients in their care
3. Increase coordination of care
4. Improve the health status of the population
5. Ensure privacy and security

Every specific criteria that HITECH requires physicians and/or hospitals to do in order to get EHR adoption incentive funds must be tied back to one of these goals. For example, they must implement decision support rules, which are tied back to the goal of improving quality, safety, and/or efficiency of care. Likewise, they must provide care summaries in the patient's format of choice, tying back to the goal of engaging patients in their care. In the matrix of proposed criteria for meaningful use accompanying the Notice of Proposed Rule-Making (NPRM), every last criteria is tied back to one of the five goals listed above.

The definition is further modified that certified EHR technology be used, and that these certified EHRs be connected for health information exchange and able to submit information on quality measures, but that is just a modifier to the core construct. In the weeks and months ahead, we will see meaningful use operationalized, but I hope that we do not lose sight of how excellent of a construct it is for thinking about the value of HIT.

ONC-Funded Scholarship Program for OHSU Biomedical Informatics Graduate Program Open for Applications

Applications are now being accepted for scholarship funding from the Office of the National Coordinator for Health IT (ONC) to study in the Oregon Health & Science University (OHSU) biomedical informatics graduate program. This funding comes from the ONC's University-Based Training Program, and is part of their Health IT Workforce Development Program that aims to rapidly expand the workforce through predominantly short-term educational opportunities. In the case of OHSU, this will involve tuition scholarships for 135 students in our Graduate Certificate program and 13 students in our Master of Biomedical Informatics (MBI) program over the next three years. The latter will also receive a stipend and student health insurance while enrolled in the program. Enrollment for both programs will begin in Fall 2009.

Despite this funding, very little else about OHSU's larger informatics programs will change. The ONC scholarships add funding for a large number of students as well as some additional academic requirements centered around six health IT job roles. Each of these job roles has requirements for additional courses that either already exist or will shortly be added to the curriculum. Students not funded by the ONC scholarships will still be able to study in the program as they always have. For more information, click on the "ad" to the right or go directly to www.ohsuscholarships.info.

More details about the program are available on the OHSU Department of Medical Informatics and Clinical Epidemiology (DMICE) Web site. To qualify for funding, students must be US citizens or permanent residents; must not have been enrolled in an informatics educational program on December 17, 2009 or earlier; must commit to study in one of six ONC-designated job roles; and must commit to completing the Graduate Certificate program in one year or the MBI program full-time and on-campus over 1 1/2 years.

The OHSU Biomedical Informatics Graduate Program offers a variety of certificates and degrees in three tracks: clinical informatics (CI), bioinformatics and computational biology (BCB), and health information management (HIM). The CI and HIM tracks are focused on the healthcare and public health arenas, while the BCB track is focused on translational bioinformatics and personalized medicine. The ONC funding is limited to the CI and HIM tracks.

The certificate and degree programs are implemented on a building-block model, where courses at any level can be carried to programs at higher levels. The most basic program is the Graduate Certificate program, which is offered for the CI and HIM tracks. (The HIM Graduate Certificate is CAHIIM-accredited and allows graduates to sit for the examination for the RHIA credential.) OHSU offers two master's degree programs which differ only in the culminating project being a thesis (Master of Science) or a capstone or internship (MBI). The master's degree programs are offered for the CI and BCB tracks (although HIM Graduate Certificate graduates can easily move into the CI master's programs). OHSU's PhD program is offered for the CI and BCB tracks. All CI and HIM track programs up to and including the master's degree programs are available both on-campus and via distance learning. The BCB track and PhD program are only available on the OHSU campus.

The introductory course in the CI track (BMI 510 - Introduction to Biomedical and Health Informatics) was also adapted to be the original course in the AMIA 10x10 ("ten by ten") program, which aims to education 10,000 professionals in informatics by the year 2010. It has been the most subscribed course in the 10x10 program, and about 15% of graduates have gone on to further study in the OHSU Biomedical Informatics Graduate Program.

Why study biomedical informatics at OHSU? We have a long-standing program that is one of largest in active enrollment as well as alumni. Our 230+ alumni have taken a variety of jobs in healthcare organizations, academia, industry, government, and other settings. We also have a full-time faculty who are not only passionate about teaching but also accomplished researchers and thought leaders in the field. Finally, our program is a real graduate program and not a continuing education program.

Explaining the HITECH Workforce Development Program

The word is slowly getting out on the Office of the National Coordinator for Health IT (ONC) HITECH Workforce Development Program. Naturally I am interested in the word getting out, since Oregon Health & Science University (OHSU) is playing a major role in the program.

One of the most enjoyable interchanges so far has been with Anthony Guerra, Editor of the healthSystemCIO.com site. It began when I took exception to a posting of his wondering whether the ONC workforce funding might be "fast and loose spending of taxpayer money." I expressed my disagreement, which led him to interview me for his site. He prefaced the interview with a posting explaining its context. The full interview, which includes about 20 minutes of audio, provided me the opportunity to defend the program, at least what we at OHSU plan to do with our funding (described in an earlier posting in this blog).

While the OHSU press release has been replicated all over the Internet (as all press releases are), a few publications have actually written their own stories. One is Healthcare IT News.

The American Medical Informatics Association (AMIA) is also working on a press release touting all of the HITECH funding that its members have received.

And of course, ONC has something to say itself about the workforce funding.

Not related to the workforce funding, I was also recently a HIMSS featured member in their HIMSS Insider e-newsletter.