{"id":2230,"date":"2009-05-10T00:20:17","date_gmt":"2009-05-10T05:20:17","guid":{"rendered":"http:\/\/pmedicine.org\/epatients\/?p=2230"},"modified":"2009-05-12T05:56:36","modified_gmt":"2009-05-12T10:56:36","slug":"meaningful-use-a-pivotal-definition-for-new-wave-medical-records-systems","status":"publish","type":"post","link":"https:\/\/participatorymedicine.org\/epatients\/2009\/05\/meaningful-use-a-pivotal-definition-for-new-wave-medical-records-systems.html","title":{"rendered":"“Meaningful Use”: a pivotal definition for new-wave medical records systems"},"content":{"rendered":"
I’ve struggled with what to say about this subject for two weeks, because I want to “get it right” but it’s vast. So I’m giving up any hope of being comprehensive, and I’m just going to say what little I know, and what I think, and let any discussion happen from there. We (the US, and probably the world) are at a pivotal moment in healthcare, a turning point. The direction we choose now can have a lasting effect on how well healthcare works in the coming years \u2013 even for the next decade, I suspect. So as we consider this, I suggest that we think not in 2010 terms, but 2020 terms.<\/p>\n The issue at hand is the definition of “meaningful use.” You’ve probably heard of the $19B in the US \u201cARRA\u201d economic stimulus package that’s set aside to encourage adoption of electronic medical records systems. (A Google search for \u201cHIT stimulus ARRA billion\u201d produces 25,700 hits.) Medical practices that have EMRs and put them to “meaningful use” will get higher reimbursement from the government. <\/p>\n When the stimulus package was passed by Congress, the term “meaningful use” was intentionally left to be clarified later. See David Kibbe’s comment here<\/a> for three items that were specified.<\/i> And here we are: the work is now underway to define and clarify that term. Many meetings are happening in Washington to get this done.<\/p>\n I believe, and many basically agree, that meaningful use should be defined to include full patient access to their data<\/strong> in EMR systems. Here’s why.<\/p>\n First, let’s look at the world for which we’re designing: 2020. The systems we design today will be in use a long time from now, so I suggest we look at the world as it will be in 2020, and how we’ll be using these systems then. What does that world look like?<\/p>\n In this world, what kind of data access do we want? We need to build that into our design choices now. Why? It takes time to plan, design, code, test, install, and train on systems. And once that’s done, the decisions that are made will be with us for a long time – until vendors decide to go through that whole process again. <\/p>\n Sure, a lot of code gets written and updated fast. But if I’ve learned one thing about healthcare IT since I got in the e-patient game, it’s that healthcare systems are big, complex, and slow to change. These are not things that get re-engineered frequently.<\/p>\n Docs\/nurses etc: how old are the systems you use today? Some are new, but many of you are using systems designed in 2000, right?<\/p>\n And here’s where regulatory requirements come in. Some regulatory requirements profoundly affect product design. If a law is passed saying you can get a tax credit for a computer where the “Q” key is colored orange, vendors will offer that, because customers will buy it. Similarly, if a law requires<\/em> that a system have a particular feature, people will only buy that, so vendors put it in the product plan, right from the get-go.<\/p>\n That’s the case with HIPAA<\/a>: many systems are required by the government to be HIPAA compliant. So vendors design accordingly.<\/p>\n And so it is today with the definition of “meaningful use.” Providers will only receive stimulus money if the system they choose meets the definition of meaningful use. So the definition we choose today can have a profound impact on what you can do with your data<\/em> far into the future. <\/p>\n This is our golden moment. It\u2019s not fundamentally hard to give patients access to their data, not any more than it\u2019s hard for banks to give us access to our banking information. It took banks two or three generations to get it right, but the technology exists, and now it\u2019s widespread. Let\u2019s encourage EMR vendors to get it right on the first try, by defining meaningful use to include giving us full access to all our medical data.<\/p>\n A great organization called the Markle Foundation has recently issued a paper that lays out their thoughts on this issue. I like it, and so do the rest of the people on e-patients.net who’ve voiced an opinion in the back room. <\/p>\n","protected":false},"excerpt":{"rendered":" I’ve struggled with what to say about this subject for two weeks, because I want to “get it right” but it’s vast. So I’m giving up any hope of being comprehensive, and I’m just going to say what little I know, and what I think, and let any discussion happen from there. <\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[367,5,59,62,2],"tags":[611,616,646,607,601,382,604,613,606,90,603,610,475,609,612,602,614,617,605,608,615],"coauthors":[],"class_list":["post-2230","post","type-post","status-publish","format-standard","hentry","category-medical-records","category-ptdoc-co-care","category-policy-issues","category-reforming-healthcare","category-trendsprinciples","tag-19b","tag-adoption-records","tag-david-kibbe","tag-design-today","tag-economic-stimulus-package","tag-electronic-medical-records","tag-electronic-medical-records-systems","tag-emr-systems","tag-emrs","tag-google","tag-google-search","tag-issue-at-hand","tag-long-time","tag-many-meetings","tag-medical-practices","tag-medical-records-systems","tag-new-wave","tag-next-decade","tag-pivotal-definition","tag-pivotal-moment","tag-turning-point"],"jetpack_publicize_connections":[],"yoast_head":"\n
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\nThe issue<\/strong><\/p>\n
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\n <\/p>\n\nMy principles<\/strong><\/p>\n\n
proprietary<\/del> captive data.<\/strong> (Edited 11:20am EDT)<\/i> We must put an end to the era where a system provider thinks the data they collect is their property. Lives are at stake.<\/i> Whose data is it, anyway?
Vendors must adapt to a world where they earn their margins by creating on-going value, not by holding data captive. This includes images (CT scans, MRIs, etc, at full diagnostic resolution) as well as lab results and everything else.
Added 11:40am EDT:<\/i> My opinion is that “whose data is it” applies to providers as well as system vendors. If you haven’t yet, consider what happened to Web guru Doc Searls last year<\/a> when he couldn’t share his scan data with another MD.<\/li>\n
Warning: experts on both sides should<\/em> be able to comment on \/ warn the other about apparent errors. Docs must be able to say “Whoops, you overlooked this,” and patients must be able to say “Whoops, you overlooked this.” (See related discussion of “who will vet the vetters” in “Medpedia: who gets to say what info is reliable?”<\/a>)<\/li>\n<\/ul>\n
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\nThese are my personal recommendations, not necessarily those of e-patients.net or the Society for Participatory Medicine. (Hey you out there – what do you think? Participate in the comments! You count!)<\/p>\n\n
Exception: the best minds I know have said doctors need the ability to store private notes, and I can grant that. But I want full access to all my data: all the numbers, all the test results, all the radiology reports, everything.
Added 11:45am:<\/i> Among other things, the records might contain errors<\/a>, and we can help clean them up.<\/li>\n
\n\nMore on that Sunday. <\/del>My post on that is here<\/a>.<\/p>\n