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The American Hospital Association (AHA) has sent a letter to David Blumenthal, M.D., M.P.P., National Coordinator for Health Information Technology (HIT), regarding the draft definition of "meaningful use" as applied to the Recovery Act reimbursement incentives from Medicare and Medicaid for implementation of health information technology by physician and hospital providers. (See DM 9401) The possible final definition of this term has caused much speculation in the health care industry.

The letter explains the AHA's concern about the first draft definition by the Health IT Policy Committee. While the AHA strongly supports the use of HIT as a means of improving the efficiency and quality of the health care system, the AHA notes that hospitals "want to adopt [Electronic Health Records] EHRs, but the cost of purchasing and maintaining clinical HIT systems is a significant impediment. The definition of "meaningful use" is critical because hospitals need financial assistance to expand HIT use, and want to avoid the Medicare payment penalties that begin in 2015 if they are not 'meaningful users.'"

The AHA recommends a practical and operationally oriented approach that supports clinicians and hospitals in the delivery of safe, high quality care. This approach, the AHA says, should stage objectives in an order that leads to the effective implementation of EHRs, and begin at a level that is achievable for the majority of hospitals. This includes a "meaningful use" adoption timeline that "begins with fewer functional requirements and extends the transition to a fully functional EHR beyond 2015." Computerized Provider Order Entry (CPOE) of all orders, clinical documentation of patient demographics, problem lists, and medication lists, etc., should not be required until 2015 or beyond, because CPOE implementation is dependent on other EHR components that require significant cultural changes and costs, the AHA points out.

The AHA suggests the definition of meaningful use in 2011 "should first aim to get the majority of hospitals up and running with the basic components of an EHR system that can be built upon." The letter says the AHA agrees with the committee that clinical documentation of patient demographics, problem lists and medication lists are appropriate functions for 2011. The letter proposes the other electronic functions for 2011 should include: discharge summaries; and results viewing for lab reports, radiology reports, and diagnostic tests.

The letter also proposes that the decision support tools to provide drug allergy and drug-to-drug alerts--proposed for 2011--be functions added in 2013 instead, along with other functions including nursing documentation and assessments; electronic access by pharmacists to formularies; medication bar coding; implementing drug-drug, drug-allergy, and drug-formulary checks; maintaining active medication lists; and maintaining active medication allergy lists.

The AHA concludes the letter by noting that the expected release of a final definition will be past the 2010 budget cycle for most hospitals. This, the AHA says, makes the definition proposed for 2011 unmanageable. "A rush to implement the draft definition, combined with the lack of capital and personnel," the letter states, "could result in many hospitals choosing not to, or being unable to, participate in the incentive program. For those that do, this aggressive schedule could threaten patient safety and quality of care as hospitals are forced to shift to a mere technical implementation of technology rather than the more methodical process of implementing HIT system changes along with care process and cultural changes needed for a successful HIT adoption and use."

Based on the letter from the AHA to David Blumenthal.

Link: http://www.aha.org/aha/letter/2009/090626-cl-hit-meaningful-use.pdf


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