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.