From Meaningful Use to Meaningful Outcomes

By Marc Probst, CIO and Vice President, Intermountain Healthcare for (HCI) Healthcare Informatics

The federal government recently announced that its mandate for health information technology will move in a different direction. The change represents a vital opportunity that could lead to dramatic improvements in health care delivery.

Andy Slavitt, Acting Administrator of the U.S. Centers for Medicare and Medicaid Services (CMS), made the announcement on January 11th when he said at the J.P. Morgan Annual Health Care Conference, “The Meaningful Use program as it has existed will now be effectively over and replaced with something better… the focus will move away from rewarding providers for the use of technology and towards the outcome they achieve with their patients… And finally, we are deadly serious about interoperability.”

The distinction that Andy Slavitt makes—between functionality and outcomes—is crucial to the future and extraordinary potential of health IT. So is the need for interoperability.

For six years (until June) I served on the HIT Policy Committee of the Office of the National Coordinator for Health Information Technology (ONC), and we were tasked with, among other things, defining “Meaningful Use”. A crucial question is: Can meaningful use of technology be achieved merely by the adoption of that technology, or does the technology need to improve care to be meaningful? I have long advocated the latter, but at least we have achieved the former on a massive scale. It’s time to declare victory with Meaningful Use and proceed with ensuring that the now widely adopted technology improves the quality and cost of healthcare.

Crucial is interoperability—the ability of different healthcare IT systems to exchange information with each other. Key to interoperability is the adoption of industry-wide national standards that ensure reliable and consistent interchange. Any standards developed must accomplish the following:

•  Correctly match patients’ records regardless of the IT system.
•  Limit access to personal data to authorized personnel regardless of the system.
•  Provide a standard mechanism for placing orders, from lab tests to medications to status reports to oncology findings, among other things.
•  Insist upon standard interfaces connecting the ordering system to individual medical records, regardless of whether the interfaces are connecting with an internal database, an external database, or a patient device, for example.
•  Establish a standard vocabulary to ensure that different systems are speaking the same language—defining conditions similarly—and have standard ways of asking for the same information.

With national standards, healthcare systems can communicate, enabling patients to have access to their records and histories, regardless of where they are being treated or by whom. That would be a huge advance in patient safety, convenience, and efficiency. The standards would also allow the effectiveness of treatments to be tracked more widely; best practices to be refined and applied more broadly, and outcomes to be more rigorously monitored and improved.

CMS’s health IT initiatives should now focus on improving outcomes. Our nation has adopted state-of-market technology in the form of electronic health records (EHRs) as mandated by Meaningful Use, but the technology must become vastly more integrated and not just an electronic filing system.

Healthcare providers need incentives to achieve better outcomes. Those who demonstrate improvement should be rewarded, and those whose outcomes decline should be penalized.

CMS’s enormous clout and resources can have a profound impact on improving outcomes. America’s healthcare consumers deserve it, and healthcare will become more efficient and cost-effective in the process. We must now shift from “meaningful use” to “meaningful outcomes.”