Meaningful use: Start small, think big

Between 13 percent and 35 percent of physicians would not meet the current definition of an "eligible provider" (EP) under the proposed meaningful use rules now being finalized by government health IT policymakers.

That’s largely due to their association with academic medical centers or because they practice in a space where they may rely on computer systems provided by hospitals already covered by the terms of the Act.

There are other hurdles. For instance, the considerable time it will take to launch Regional Extension Centers – so vital to helping small practices adopt EMRs – may hinder the overall rate of health IT adoption.

The risk is that complications like these, especially towards small providers, may further advance a world of health IT "haves" and have- nots" in the provider world and thus compromise HITECH’s overall objectives.

The full potential of EMRs for improving patient safety, coordinating care, treating chronic illnesses and decreasing healthcare costs will only met if information is widely exchanged across care teams.

But has the meaningful use bar been set too low when only one test is required to demonstrate electronic data exchange between unaffiliated organizations?

This requirement can be met through local, regional or state exchanges, so it is not entirely dependent on activity underway to fund and foster state-level HIE.

Clearly there are some gaps in the Centers for Medicare and Medicaid Services’ Notice of Proposed Rulemaking (NPRM) on meaningful use. But it’s important to remember that meaningful use is not about health IT adoption, it’s about using IT to improve healthcare delivery and population health.

We are frequently reminded by technology innovators and leaders to start small and think big. In the current deliberations on meaningful use, has the right balance been struck on this wise principle?

-- Fernandes is vice president and healthcare industry ambassador for Initiate Systems Inc.