Information Technology Reference
In-Depth Information
(iv) to exchange electronic health information with, and integrate such information
from other sources.” [
2
]
ONC has approved six organizations to do certification testing and 1,426 certified
products are listed on their website. Of these, 924 are “complete EHRs” meaning a
purchase of this system alone provides all the tools to achieve Meaningful Use. The
rest are “modular EHRs” meaning that they can be combined with other modular
components to achieve Meaningful Use. An example of a modular EHR would be a
system for e-prescribing. It would need to be combined with at least one other mod-
ule that could provide the rest of the required functionality. This complexity and
multiplicity of choices creates a problem for prospective purchasers. ONC provides
an online “shopping tool” [
3
] but no real substantive guidance. For providers seek-
ing such advice I offer some suggestions in Resources at the end of the topic.
Meaningful Use
In 2008 DesRoches
et al
published a comprehensive physician EHR adoption survey
and introduced the distinction between “basic” electronic health record systems and
“fully functional” systems. [
4
] Table 1 of the paper
5
describes in detail the differ-
ence between a “passive” electronic replacement for paper charts and a system that
“actively” intervenes to help improve care quality. It provides a useful basis for
understanding the concept of Meaningful Use as defined by ONC.
The American Recovery and Reconstruction Act (ARRA, the “Stimulus”) that is
funding EHR deployment defines Meaningful Use as including three components:
1. The use of a certi fi ed EHR in a meaningful manner.
2. The electronic exchange of health information to improve quality of healthcare.
3. The use of certi fi ed EHR technology to submit clinical quality and other measures.
ONC was charged to define what a certified EHR is and to develop a process for
certifying EHRs. It was also told by Congress to more specifically define and imple-
ment Meaningful Use of those certified EHRs. After much debate and the solicita-
tion of external input, ONC decided to do this in three stages (Fig.
2.1
).
The ARRA program funds adoption by hospitals and community-based “eligible
providers”. Eligible providers are physicians and a list of other licensed health pro-
fessionals. Hospitals and eligible providers each have their own Meaningful Use
standards but we'll only discuss the standards for eligible providers.
At present Stages 1 and 2 have been finalized. As shown in Fig.
2.1
, Stage 1
focuses on data collection and sharing while Stage 2 introduces more advanced uses
of that data to improve clinical processes and decisions. Both stages require the
