First coined by the US Centers for Medicare and Medicaid in 2009 as the Stimulus Bill was being passed in an attempt to jump start the American economy, the term, title and description "Meaningful Use" describes a set of rules and objectives to be met during the implementation of electronic health records (EHRs).
Meaningful Use Rules include concepts such as improving care coordination, ensuring privacy and security of patients' records, and making sure patients have access to those digital records.
If providers can show that they have achieved those criteria, they may be partially reimbursed for implementing EHRs.
However, while meaningful use rules seem to be mostly common sense and patient-centered, many providers object to being held to the Meaningful Use Rules despite the reimbursement they may become eligible to receive.
The Grand Goal - Developing EHRs Across the United States
Records and management of every almost every aspect of our lives are collected, stored and disseminated electronically. From the check-out at the supermarket, to our children's school records; from email correspondence, to making an appointment with your hairdresser; from banking and financial transactions, to the stoplights at every intersection - they are all managed electronically, and have been for a decade or two.
But not healthcare.
Despite believing itself to be so advanced, the United States is the only industrialized nation in the world that doesn't manage all individuals' healthcare using digital means. Most health record keeping in the United States is archaic at best, and dangerous at worst.
With too few exceptions, doctors, hospitals, testing labs, pharmacies and other health-related provider systems have been driven by paper records, stored on shelves and in boxes, individual to each provider. Each provider works in his or her own little silo, not sharing with the others except by fax transmission or postal mail. Prescriptions are written on little tablets. Appointment notes are scribbled on three layered paper copies, the data to be input later by a clerk who has learned about healthcare data management.
So the grand goal for electronic health records, first defined during the Economic Stimulus, is to transfer all patients' records into digital files, that each doctor share those files (which, when put together, create a patient's total record) and then be used by all that patient's doctors. By creating one comprehensive record for each patient, all that one patient's doctors can view the same information, can see what other doctors are recommending for that patient, and then can allow that patient to see and engage with those records, too.
To further the goal, and to be sure most providers would make the effort to reach the goal, in 2009 a carrot was held out to them: If they implement EHRs, then they can receive partial reimbursement once they've proved they have met a certain set of criteria; the Meaningful Use Rules.
What the Meaningful Use Rules Require from Providers
There is a list of 25 objectives those providers must meet to prove they have achieved meaningful use, and therefore be reimbursed the amounts they can earn. In general, they address the content of the records to be sure all a patient's information is included. Further, they begin to standardize the information so that an electronic record for one patient contains the same, and the same amount of information as that of another patient.
All 25 objectives speak to one or more of the following:
- Improving quality, safety and efficiency
- Improving care coordination
- Ensuring Privacy and Security
- Improving Public and Population Health
- Engaging Patients and Families
(A master list of all the meaningful use concepts and objectives can be found on the government's Health IT website.)
Over time, the Meaningful Use Rules have been refined in stages, and will probably continue to be refined. For example, for the objective that insists a patient have access to his EHR, the Stage 1 rule specified that more than 50 percent of all patients who request an electronic copy of their health information had to be provided with it within 3 business days.
The Stage 2 requirement, announced in August 2012, steps that up to require inclusion of doctors' notes, imaging and results, family history, and other aspects of patients' care in certain percentages of their records.
Americans have to wonder how there could possibly be an argument with any of those objections, especially when providers will be paid to make sure they are met. Yet there are loud objections from frustrated providers.
Many providers have resisted implementation of EHRs in general, and are frustrated by meaningful use in particular. Their specific complaints include such points as: they don't like changing what they have always done, they don't like the expense of implementation or maintenance, they don't like taking extra time to enter information into patients' records, and they don't like having to share records with their patients.
There may be other aspects they don't like, too. For example, they may not like the fact that another doctor can view (and perhaps second guess) recommendations they have made to their patients. They may also not like that patients may be able to see some of the derogatory things written about those patients in their notes. And they certainly don't like the fact that digital records live on in many places where they have been backed up - and can't be changed or erased if and when problems occur later.
Why Meaningful Use Is Important to Patients
There are so many reasons why the complete implementation of EHRs is important to patient care. They have been outlined previously.
But implementation of EHRs, and Meaningful Use Rules, aren't exactly the same thing. Having a record is one thing; but a record that has real information, available in real time to all parties (including patients), with relevant information that can be used for that patient's care, is far more useful. It's like the difference between shack and a home. A shack may provide some protection from the elements, but a home is full of everything that supports living.
What Can Patients Do to Further Implementation of Meaningful Use?
There are a few steps we patients can take to encourage our providers to continue implementation of digital records, filling those records with relevant and useful information, and then sharing the complete record with us.
- With each visit to your doctor, ask whether you have access to your personal EHR yet. If you do, then congratulate your doctor for being proactive and in-touch. If you don't, then politely mention how important that is to you (gentle nagging won't hurt.)
- If you must see a new doctor, ask whether the doctor has implemented EHRs yet, and whether you'll have access to your records. If not, then consider making an appointment with a different doctor - and make sure the one who doesn't offer access knows why you decided against seeing him or her.
- If you have an accessible patient record, use it. Access it. Ask questions about it. Thank the doctors who use it. Encourage them and show your appreciation as much as possible.