WASHINGTON – At a Monday session of the National Health IT and Delivery System Transformation Summit in Washington, Farzad Mostashari, MD, the national coordinator for health IT, made an eloquent and persuasive case for how meaningful use is not just an arbitrary set of requirements the government is asking of providers in exchange for incentives.
Disappointed that he sometimes hears this sentiment, Mostashari outlined how meaningful use tackles what is needed to save lives, prevent patient harm, coordinate care and empower patients.
“I beg of you to take another look,” he told attendees of the conference. “Look at meaningful use not as a distraction or a bureaucratic list of hoops to jump through.”
[See also: Mostashari hails new health IT workforce.]
“Meaningful use is the best-we-could-make-it roadmap to prepare for delivery of higher quality care and mitigating some of the costs toward getting there,” he said. “If it’s a distraction we need to change it and I want to hear from you personally.”
Mostashari explained how “the sum total of meaningful use” is to provide what is needed to make sure fewer people die prematurely for things that could have been prevented.
The need for clinical decision support
Mostashari used the case of controlling blood pressure. “It’s not rocket science,” he said. Controlling blood pressure is possible, but currently the healthcare system is doing it 45 percent of the time.
In addition, when a patient under care for high blood pressure comes to the doctor’s office for a complaint other than blood pressure, those who are found to have uncontrolled blood pressure since their last visit are only given treatment for it currently 5 percent of the time, Mostashari said.
Doctors need clinical decision support and reminders built in to their electronic health record system that will help them control a patient’s blood pressure on every visit, he added.
“We have to stop delivering healthcare the way we sell shoes," he added. "Customers come in to the store and we say how can I help you? Healthcare is more than that. It’s about the sacred, holy bond between patient and provider.”
If a patient doesn’t walk in the door, does the doctor have an obligation to make sure the patient isn’t a stroke waiting to happen? Mostashari, as a physician, believes they do.
Registries are important
He asked the audience, “How many of you get reminders from your vets, dentists and mechanics?” Many raised their hands.
“How many of you get reminders from your doctors who don’t have EHRs?” he asked. No hands were raised.
Registries are important along with electronic health records to help doctors give their patients reminders for care, Mostashari said.
The collection of other data for meaningful use such as BMI, smoking status, lab data and blood pressure are all tools that a healthcare organization needs to succeed. “If you want to do population health management, you need to collect data,” he said.
Patient-centered care is part of MU
Making care more centered on the patient empowers patients to be engaged in their own healthcare. This also helps with disease prevention, Mostashari said. Electronic summaries of a patient’s doctor visit would help the patient understand what the doctor found and the plan of action for care. When a doctor has EHRs, providing patients with this information is all just part of the workflow, he said.
Mostashari said secure messaging and the ability for providers of one patient to share the patient’s information with each other over the Internet would also contribute to reducing medical errors.
[See also: eHealth Initiative issues report on EHRs and care coordination.]
The transformation to EHRs is taking hold
The new federal health IT chief said he is encouraged by many things. From 1989 to 2009, 20 percent of providers adopted EHRs. Since 2009, that adoption percentage has increased an additional 10 percent, to 30 percent.
Some 86 percent of hospitals intend to attain meaningful use, according to Mostashari, “and they are not doing it just because of the money. They are doing it because meaningful use is aligned with what they mean to do,” he said.
Five thousand to 10,000 providers a month are registering for meaningful use, and 6,000 providers are signing up each month for assistance from the regional education center. RECs now have 79,000 providers registered, mostly sole practitioners or small practices, he said.
“It’s hard to do the work, but we have the means, the alignment and the coordination to do it,” he said. “It’s never been a better time.”
Tweaking will be needed
Mostashari said he is pleased that one of the audience members asked about specifics in data collecting, noting there are some aspects that need to be tweaked. “We’ve gone from just talking about it, to actually implementing it,” he said. He promised ongoing “fixes” to technical aspects of data collection that “aren’t working in the real world.”
At a survey conducted of the audience in attendance live before Mostashari’s speech, 59 percent said they are working on starting an accountable care organization.
