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Brookings Institution scholars give meaningful use good marks, but say it needs more work

Meaningful use has overall been a positive force for digitizing U.S. healthcare, but the EHR incentive program and its federal overseers still must overcome major problems if the promise of health IT is to be fulfilled.

That’s the core message embodied in a succinct Brookings position paper published this week to accompany a health IT forum put on by Brookings’ Engelberg Center that included a speech by ONC chief Karen DeSalvo. View the webcast of the March 4 event here.

Brookings scholars Peter Basch, Christopher Botts and Mark McClellan argue that meaningful use has driven widespread adoption of EHRs, e-prescribing and increased use of health information exchanges.

However, the authors write that despite those successes:

  • Many providers don’t believe that ONC-certified EHRs have reduced their workloads
  • Many providers have criticized meaningful use for relying too much on a general set of mandatory functions and workflow processes that don’t necessarily mesh well with their real-world practices
  • Providers have also complained of excessive costs associated with interoperability

The authors also address other key challenges, some of which were discussed at the Engelberg Center event.

Chief among these is “uniformity of requirements.” Meaningful use and EHR certification have been based around specific sets of measures required of all providers, largely irrespective of specialty. On the plus side, this has provided more certainty to the health IT world, and a degree of standardization, the authors write.

“However, this uniform approach is not always a good for the diverse realities of clinical care, which are likely to benefit from quite different health IT functionalities and tools based on specialty and scope of practice,” the Brookings statement says. “For instance, a provider caring for patients with chronic diseases may require detailed and longitudinal information, while a cosmetic surgeon does not.”

Specific, process-driven measures built into meaningful use have also forced many big healthcare systems to scrap homegrown EHRs that worked fairly well, especially for documentation and coding, for expensive new proprietary EHRs that some providers find hard to use. In addition, the path to stage 3 meaningful use and its emphasis on outcomes is not clear.

The Brookings authors also maintain that meaningful use requirements in EHRs fail to prioritize access to accurate, “actionable” information related to coverage and payment. Meaningful use also has failed so far to provide a route to practical interoperability that actually works, an issue that has drawn widespread attention in recent years well beyond Brookings.

The solutions to these problems may well define the ultimate legacy of meaningful use.