Markle gives sound advice on “Meaningful Use of Health IT” to policy makers (again)

The Markle Foundation has been giving some very reasonable advice on the use of IT and technology in general for the healthcare industry. Their most important advice, if heeded by lawmakers, would put to effective use the billions of dollars that have been earmarked for healthcare IT in the ARRA stimulus bill.

I loved what they said in their letter to Frizzera (CMS), Blumenthal (ONCHIT), and Orszag (OMB).

On page 3:

In setting metrics, HHS should resist the temptation to impose too many prescriptive technology requirements. The most constructive part of the rule will define what needs to be achieved as opposed to precisely how systems must behave to achieve it….The requirements should not require a narrow process or deployment of a particular tool. Rather, technology and care redesign innovations should be encouraged to engage consumers more fully in planning and managing their care through a variety of approaches.

On page 4:

The approach to standards must enable a wide array of providers with varying levels of IT adoption and support, from sophisticated integrated delivery systems to the physician in solo practice, to achieve the goals of Meaningful Use. Technology or standards requirements that are unnecessarily complex, or that fail to take into account the diverse needs of a wide spectrum of health care providers, can have the unintended consequence of narrowing participation. Care must be taken to avoid stifling alternatives or innovations that would otherwise propel more widespread adoption of health IT to improve health care quality and costeffectiveness.

These direct statements take into account the mistakes made in the past by folks (like CCHIT and others) who believe that features and functions in software create better outcomes. We all know that people and process which the right selection of a wide variety of technologies (and no specific product or vendor) create better outcomes.

It’s great to see that influential voices like Markle are making the arguments clearly and in an easy to understand manner. Those of us in the healthcare IT sector of the industry should use materials from Markle to make our cases as well. Everyone is focused and listening and now is the time to make sure we don’t repeat the mistakes of the past and push specific vendors and technologies or products into legislation or rule-making.

In an associated document entitled “Demonstrating Meaningful Use of Health IT for 2011 and Beyond” Markle advises the following foundational principles:

  • Prioritize “measures that matter” for health improvement—measures that demonstrate improved health outcomes and greater cost-effectiveness.
  • Be operationally feasible for 2011 and beyond for a broad range of providers, vendors and the Centers for Medicare and Medicaid Services (CMS).
  • Leverage existing quality reporting efforts if they meet these criteria and work in alignment toward meaningful use goals.
  • Implement processes that will proactively improve data quality and data integrity over time.
  • Minimize unnecessary burden and cost by enabling reporting of “measures that matter” as a byproduct of using qualified health information technology. Providers should be able to easily submit data to demonstrate meaningful use without significant additional overhead and effort.
  • Give providers timely access to the quality and cost information they need to improve care. Demonstrating meaningful use should help providers and patients improve health and health outcomes, and not just be a time-consuming administrative data reporting or documentation exercise.

Later on page 7 they make a great point (the emphasis on compliance exercise is mine):

Systems must be able to support providers’ needs for information to meet meaningful use goals. The underlying objective is to put useful information into the hands of providers and patients to improve care, and not to create a compliance exercise.

I’m hoping that Dr. Blumenthal will give Markle’s recommendations due attention.

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5 thoughts on “Markle gives sound advice on “Meaningful Use of Health IT” to policy makers (again)

  1. There are many good points here. Defining what needs to be achieved as opposed to dictating how has long been a recipe for systems engineering success. Markle's comments about “engaging consumers” should be strengthened to “including consumers” when considering any new technology. This is not customarily done.

    For example, human-centered design principles are being used to devise new interfaces for mechanisms such as infusion pumps. This is so providers can better understand what the mechanism is doing and what it has done in the relevant past which would include operations, maintenance and calibration. What designers fail to consider is that the patient and the patient's family will spend far more time with that equipment. When its alarm goes off, a patient's response may range from annoyance to panic. It may take some time for a provider to appear to reset the machine. In the meantime, the patient and their family are helpless.

    So in the foundational principles, measures that matter must include those that matter to patients as well as providers and payors. Consumers should also have timely access to quality and cost information if market forces are to be allowed to improve the system.

    The comment about being able to easily submit data, speaks to product design. I have observed that providers are changing the ways they work to match what their software will support. This may be a good thing if the goal is to extinguish unfavorable procedures. However, it seems just as risky for software designers to constrain the practice of medical expertise as it is to dictate the technical solution from above. Meaningful Use of Health IT has to be based on consumer and provider needs and must support the collaborative activities they perform to achieve favorable outcomes.

    1. Thank you, Steven, for the kind words. It seems like you have a good deal of experience here — would you like to create a guest article on human centered design in healthcare and have it published here?

      1. I would be glad for the opportunity, Shahid. If you have guidelines for guest articles, please let me know what they are. I will begin to put materials together.

  2. Thank you, Steven, for the kind words. It seems like you have a good deal of experience here — would you like to create a guest article on human centered design in healthcare and have it published here?

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