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Editorials |

It's Time to Meaningfully Use Electronic Health Records: Our Patients Are Demanding It

Richard J. Baron, MD
[+] Article and Author Information

From Greenhouse Internists, Philadelphia, PA 19119.


Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-0731.

Requests for Single Reprints: Richard J. Baron, MD, Greenhouse Internists, 345 East Mt. Airy Avenue, Philadelphia, PA 19119; e-mail, rbaron@greenhouseinternists.com.


Ann Intern Med. 2011;154(10):697-698. doi:10.7326/0003-4819-154-10-201105170-00012
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Two articles in this issue focus on meaningful use incentives to promote adoption of health information technology. Adler-Milstein and colleagues surveyed 175 RHIOs and found deficiencies in the ability of existing RHIOs to support clinicians who are aiming to meet federal meaningful use criteria. Hussain critiques the top-down approach adopted by the meaningful use policy and proposes an alternative one that builds on the needs of providers first. The editorialist discusses the articles' findings and describes the adoption of electronic health records as moving toward “an uncertain but quite promising future.”

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Clarifying a bottom-up strategy for meaningful use policy
Posted on May 25, 2011
Anwar A. Hussain MD, MHA
UHS Hospitals
Conflict of Interest: None Declared

Clarifying a Bottom-Up Strategy for Meaningful Use Policy

In a previous issue Dr. Baron critiques [1] another article [2], and proposes we continue healthcare information technology (HIT) implementation through the "meaningful use" strategy. His editorial's main thrusts are patients are demanding we use HIT, and a top-down strategy will create data standards to ensure interoperability. We respectfully disagree: (a) patients are not demanding HIT per se, but want better and safer care; (b) forcing physicians to use risk-prone HIT will not help patients; (c) patients trust us to analyze clinical interventions in a systematic and informed manner, and most patients are likely unaware that technology can sometimes worsen care; (d) the existing top-down strategy has created the absence of common data standards because vendors resisted standards to ensure purchase of their "suites" of proprietary products; finally (e) Dr. Baron says "our patients increasingly demand that we operate with at least the same level of service as their banks, car rental companies, and online retailer..." This analogy highlights the opposite of its author's claims. Those enterprises designed software from the bottom up to meet their individual needs rather than using software imposed by vendors or government agencies.

Dr. Baron's positive experience with technology is vastly different from that of other providers. Hospitals usually struggle to exchange data because even individual departmental systems do not communicate. Such practical difficulties and the known variability in implementation [3] must be acknowledged within policy. An alternative proposal - a bottom-up strategy -- may clarify misunderstandings. Stage 1 should create robust standards-based interoperability to connect systems (both within and across organizations) and to provide data clinicians need [4]. This strategy creates universal data liquidity, makes products fungible and thus unlocks users from proprietary systems. It also increases vendor competition based on actual benefits [5]. Stage 2 can leverage data liquidity to increase value and sustainability -- focusing, for instance, more on patient safety and security. Doctors expect better usability and clinical process improvements, and hospitals want measurable impact on efficiency and quality. A practical research agenda would and must support implementation of such priorities. Stage 3 would make use of far richer data for public health. Current "meaningful use" strategy is more hopscotch than stepwise, and it should be refined to reflect realities. We all want digital medicine, but the issue is wayfinding. With cost savings and improved outcomes paramount, we want technology to reach its full and sustainable potential as quickly as possible.

Anwar A. Hussain MD, MHA

Ross Koppel, PhD

1. Baron RJ. It's time to meaningfully use electronic health records: our patients are demanding it. Annals of Internal Medicine. 2011; 154: 697-698.

2. Hussain AA. Meaningful use of information technology: a local perspective. Annals of Internal Medicine. 2011; 154: 691-693.

3. Jha AK, DesRoches CM, Campbell EG, Donelan K, Rao SR, Ferris TG et al. Use of electronic health records in US hospitals. New England Journal of Medicine. 2009; 360: 1628-1638.

4. Baron RJ. Meaningful use of health information technology is managing information. JAMA. 2010; 304: 89-90.

5. Mandl KD, Kohane IS. No small change for the health information economy. New England Journal of Medicine. 2009; 369: 1278-1281.

Conflict of Interest:

None declared

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