Meaningful Use: The Right Path for Health IT?
December 4, 2015
Health information technology (IT) is viewed by many as key to achieving quality improvement, cost reduction, and better health outcomes across populations. To encourage adoption of health IT, the American Recovery and Reinvestment Act of 2009 put incentive dollars on the table for Medicare and Medicaid providers. To earn them, however, providers had to do more than buy an electronic health record (EHR) package—they had to demonstrate their "meaningful use" of it. The process of demonstrating meaningful use was defined by the Centers for Medicare & Medicaid Services (CMS) as a three-stage series of objectives, measures, and clinical quality indicators that becomes more rigorous over time. Under Medicare, providers who cannot or choose not to demonstrate meaningful use begin to face monetary penalties in 2015.
CMS reports that 95 percent of hospitals and 54 percent of eligible professionals have attested to (i.e., met the requirements of) meaningful use. The attestation process has drawn criticism for being burdensome and for taking an all-or-nothing approach (one succeeds or fails; there is no partial credit). The passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) changes the outlook for meaningful use; after 2018, it will be folded into a new merit-based incentive payment system (MIPS). MIPS specifics are not yet available.
Two policy issues have drawn considerable attention in discussions of meaningful use. Interoperability, the ability to exchange clinical data, is the centerpiece of successful health IT deployment—or will be, once achieved. So far, data exchange is hampered, observers say, by different systems, organizations at different stages of technological sophistication, vendors' proprietary concerns, and privacy and confidentiality concerns. Of the nonfederal EHR experts interviewed by the U.S. Government Accountability Office earlier this year, 10 of 18 said that meaningful use requirements forced organizations to shift resources and attention from efforts to achieve interoperability. The Office of the National Coordinator for Health Information Technology has created and continues to refine an interoperability roadmap and standards. Patient engagement is another source of controversy. CMS has retreated to some extent from measures that hold providers accountable for whether their patients access records electronically, but mandates related to timeliness and format are still to be implemented.
This Forum session explored the current state of meaningful use and the prospects for its future. See also our issue brief, which provides more detail on the history, objectives, and policy implications of meaningful use.
Kevin Larsen, MD, FACP (bio)
Medical Director, Meaningful Use, Office of the National Coordinator of Health IT
Lisa Sprague, "Meaningful Use of Health Information Technology: Proving Its Worth?" (Issue Brief No. 856, November 16, 2015).