Defining Meaningful Use Criteria
For Electronic Health Records:
An Early Adopter’s Wish List
The Obama administration is com- uling and billing system is also not pops up listing all its known interac-
mitted to transforming healthcare on sufficient. The people writing the tions, many of them will click past it many levels. The underlying assump- checks have specific goals in mind without reading it. If you order a lot
that when defining meaningful use and of Coumadin, you will see this box
i m p l e m e n t i n g want to ensure that the carrots they so often that you may develop “alert electronic health offer result in the actions they desire. fatigue”. Therefore, each physician records (EHRs) The intent is to have the EHRs that needs to determine what decision sup-will result in meet meaningful use criteria—as port items he will actually find useful. improved quality defined by the Office of the National
of care and cost Coordinator for Health Information known drugs that a patient is tak-
savings. To that Technology (ONCHIT)—be certified. ing would be very useful, but it must
end, starting in However, the full certification process
2011 a sliding is long and cumbersome and some of
scale of finan- the requirements may not add value
cial rewards will for oncology-specific EHR systems.
prac- My meaningful use criteria
tices, among others, that demonstrate wish list includes:
“meaningful use” of “certified” elec-
tronic health records. But before we 1. Decision Support
Ideally, EHRs will improve quality patient to have a bad reaction.
we need to give some serious con- of care because they offer important
sideration to just what exactly is information to the doctor at the time
meaningful use, and what will a certi- of patient contact. This is referred to that I believe we will all need in the
fied electronic health record look like? as “decision support” and it is one of future is genetic profiling of diseases
It does make sense to make mean- the criteria being used by ONCHIT not able to memorize which gene pro-
ingful use a requirement for the to aid in its definition of meaning- file goes with which disease, and with
government to give us money, since ful use. Decision support can be which response to treatment. I would
buying an EHR and leaving it in the done well or it can be done badly. love to have the ability to have that
box is not what the government For example, if every time a physi- information at my fingertips real-
intends to pay for. Using a sched- cian orders Coumadin and a large box time when I am discussing therapy
ONCOLOGY BUSINESS REVIEW • ONCBIZ.COM • SEPTEMBER 2009
with a patient. However, I only want I must meet that quality measure, I and be able to customize the elec-the oncology profiles. I do not want will certainly draw a hemoglobin A1c tronic record so that it auto-populates my electronic record to make me pur- on all my patients, but since I do not that summary. Patients definitely chase the genetic decision support for manage their diabetes, it will just add need the information, but an abbre-multiple sclerosis or other non-onco- unnecessary expense and no valuable viated summary pertinent to each logic diseases.
In my opinion, it would have been in medications, and then a more
another meaningful use criterion. better for oncology to have ASCO’s complete summary at the end of treat-I work with problem lists as I think Quality Oncology Practice Initiative ment (or an “episode of care”)—would they are valuable tools. However, the generate quality measures that are better serve their needs. list is not valuable if it consists of meaningful for our own practice
ICD-9 codes that read like this: 174.9. improvement. Furthermore, EHR rion of the Certification Commission Malignancy of the breast, female, site vendors should give us the ability to for Health Information Technology unspecified. What I would rather have delete the measures when they are (CCHIT). It will have to have diagnosis is an ICD-9 code attached to more completed and to add new ones when codes and there will be e-prescribing. information, e.g., 174.9. Breast can- indicated, without billing us for more Immunizations and referral manage-cer, T1, N1, M0, stage II, one of six expensive software.
nodes positive, ER/PR positive, HER
negative, status post AC x four and 3. Health Maintenance
5. Information Exchange
must be able to modify the problem a great function of an EHR. It would wants to import data from another list so that it actually is a meaning- be useful to have flags that come up laboratory, another x-ray facility, or ful clinical tool. Very soon, ICD-10 when people need various screen- other offices, she will either end up codes will be established and while its ings and vaccinations. However, each with scanned documents that are not implementation will be an enormous specialty should be able to adapt searchable, or she’ll have to spend a challenge, this may be an excellent their screenings for their appropri- lot of money with her vendor creat-opportunity to create more sophisti- ate patient population. For example, a ing an interface. (I have learned that cated and customizable problem lists.
reminder of when a patient’s five-year interface is truly a four-letter word colorectal screening with colonoscopy and generally costs $20,000.) Or the
2. Quality Measures
is due will be useful for me, but prob- physician will need to log into a sep-
It comes as no surprise that the peo- ably not for pediatricians. We also arate portal without being able to
ple paying for healthcare would like need to have the ability to run reports import the data, greatly limiting its to know that they are getting qual- on that data so that we can challenge usefulness.
ity care. It, therefore, makes complete insurance companies that downgrade
sense that quality measures should be us based on incorrect data.
measures should be entered automat- 4. Treatment Summaries
ing of lab and x-rays. cont. on pg 10 >>
wasting physicians’ time doing data treatment summaries as meaningful
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Unfortunately, specific measures after every encounter. Ideally, the [email protected] or subscribe
have become part of the meaningful physician should decide what infor- today at: www.oncbiz.com
use criteria. For example, one quality mation goes into the patient summary
The Incredible Elastic Brain:How Neural Stem Cells Expand Our MindsErzsebet Kokovay,Qin and Sally 1New York Neural Stem Cell Institute, 1 Discovery Drive, Rensselaer, NY 12144, USA*Correspondence: DOI 10.1016/j.neuron.2008.10.025Brain development was thought to be largely hardwired and accomplished by birth, and the brain wasthought to have essentially no regenerative capacity. The remarkable di
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