Core competencies of meaningful use for people, organizations, and systems

As an educator, I often think of competencies, which are the knowledge, skills, and attitudes we hope that students obtain from the education we deliver. As I think about competencies related to meaningful use (MU), I see that there are competencies not only that people must have, but also organizations and even the information systems they are deploying. The final MU rules make it clear that there are a number of competencies that people, organizations, and systems must have to succeed with the HITECH agenda.

The list of MU criteria and what must be done to implement them are a veritable textbook of clinical informatics. They also include some additional competencies from other sub-areas of biomedical and health informatics as well.

Clearly the major competency area for MU is clinical informatics. Individuals, their organizations, and their information systems must have a thorough understanding of most of the tenets of clinical informatics. A list of what competencies are needed and why includes the following:

• Clinical data, e.g., demographics, vital signs, problem lists, medications, structured data, advance directives
• Clinical decision support - rules, drug-drug and related checks, medication reconciliation
• Computerized provider order entry
• Health information exchange
• Privacy and security
• Healthcare quality
• Organizational and project management
• Standards and interoperability - e.g., HL7, ICD-9, SNOMED, LOINC, CCR/CCD, etc.

Of course, MU is not limited to clinical informatics. People, organizations, and systems must understand elements of public health informatics, since of the "menu" criteria must include the exchange of information with state or local public health agencies. Likewise, these entities must have competence in consumer health informatics, understanding the ramifications of the requirements to provide patients with summaries of their care and, in the long run, exchange information with personally controlled health records.

There are more competencies that one must have across for all uses of health information technology and the even-larger field of biomedical and health informatics. Nonetheless, competency in MU is something that all people, organizations, and systems that deal with health must know about. Many must master it, not only to achieve the short-term objectives and funding of HITECH, but also to provide a patient-centered, evidence-based, and cost-effective healthcare system for the 21st century.