COMMENTARY

The 3 Key Parts of EHR Meaningful Use -- Prescribing, Sharing, and Measuring Quality

Ileana L. Piña, MD

Disclosures

November 17, 2010

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Hi, I'm Ileana Piña and this is my blog. I am happy to be here at the American Heart Association National Sessions in Chicago where there's a lot of activity, and it's a wonderful meeting.

Today I want to talk to you about the electronic health record and meaningful use. I'm hearing a lot of conversations and concerns about having an electronic health record. President Obama declared early in his administration that, by 2014, hospitals and physicians' offices should have an electronic health record. As a matter of fact, the budget has set aside monies to pay physicians in order to be able to get the electronic health record. Of course, if that's not done, it also comes with a price of penalties. But today I really want to talk about meaningful use.

Meaningful use may be a blur, but it has 3 very distinct entities. If anyone wants to read a wonderful article about it, I point you to Dr. Jha's article.[1] He's from the Harvard School of Public Health. The article can be found in the October 20th issue of JAMA, called "Meaningful Use of Electronic Health Records."

There are 3 items that constitute the true definition of meaningful use. One of them is electronic prescribing. Many of the pharmacies around the country are now set to do e-health prescribing, or electronic health prescribing. The second one is that the electronic health record should be shared as a point of information among clinicians, so that information crosses boundary lines -- a problem that we all have about communicating with each other. And the third is that it's served to look at quality measures.

The uptake has been slow, and Dr. Jha states that only about 10% of hospitals and 20% of physicians had any kind of electronic health system when the president announced his intentions. The growth has been very slow: 2%-3% per year. Some hospital systems now have physicians working for them, and it may be easier for these systems to incorporate the electronic health record in their offices.

There are other requirements that are not necessarily under the meaningful use definition. They include a full set of demographics, so that patients' age, weight, race, and gender are clearly placed in the electronic health record. Dr. Jha also talks about smoking status and having a problem list. We have a little too much to ask already for detailed history and physicals, but the reason for this at the end will be to allow us to have some decision support built into the electronic health records, which will help clinicians stick to the guidelines, look at the performance measures, and see where the data are to make good decisions for their patients.

This decision support is also scary. It's a new way that we will have to learn to practice medicine, but I think we realize that if things don't change, it's not going to be a good tomorrow.

I thank you. This is Ileana Piña signing off.

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