THIS JANUARY THE meaningful use program began, and with
it launched a set of measures requiring participating hospitals
and professionals to make their health IT systems a little more
patient friendly. Among the program criteria that participants
must meet are several focused on better engaging patients in
their care by making their health information more accessible
The requirements represent a shift in focus for health IT, which
traditionally has been designed to capture and retrieve data for
providers, not share it with patients.
The meaningful use measures come from the Department of
Health and Human Services, where a patient-centric philosophy has been ingrained in recent work at the Office of the National Coordinator for Health IT. Much of ONC’s patient-centric
work is included in the meaningful use program, which offers
Medicaid and Medicare incentives to professionals and hospitals who use EHRs to meet care objectives.
ONC recognizes that no matter how much money is poured
into health IT, systems designed for providers will have only a
limited potential to improve health processes and outcomes,
says Josh Seidman, director of meaningful use at ONC.
While many agree the work being done by ONC through the
HITECH Act and the meaningful use program has vast potential
to affect the healthcare system, it is still unclear whether these
first patient-centric steps will have a strong impact.
Some patient advocates say that while stage 1 meaningful use
is a start for helping engage patients, ONC and the healthcare
system still have several leaps to make before patients feel the
“I do think...there is some very
tangible impact. But the greater
impact is laying the foundation for
what will come in the future.”
While the healthcare industry has relied heavily on technology
for years, those technologies historically have not interfaced
with the people receiving care.
This disparity disconnects patients from the healthcare system, and it creates a huge challenge in now bringing patients
into the established technological system, says Alison Rein, a
former health consumer advocate at the National Consumers
League and current director with AcademyHealth, a research
and policy advisory group based in Washington, DC.
“There has been a total bifurcation of experience, and we are
starting to recognize that that is not serving our needs or our
interests,” Rein says.
Seidman sees meaningful use as an unprecedented shift in
Characteristics of Patient-Centered Care
PATIENT-CENTRIC HEALTHCARE can be difficult to describe. There is not much evidence to define just what types
of healthcare or health IT systems positively impact patients
and engage them in their care, Rein says.
However, three characteristics of patient-centric care have
emerged. A patient-centered healthcare system gives patients the ability to communicate effectively and immediately
with their providers. It provides patients access to information that is important and useful for them, when they need it.
Finally, patient-centered health IT allows providers to look
holistically at an individual and treat them through the coordination of other providers.
“There are a number of other things you can build onto
that, but we are still at the very, very beginning of what I
imagine will be a huge innovation curve,” Rein says. “At this
point we are not exactly sure what, truly, patient-centered
“I think everybody just agrees that we don’t really have it.”
health IT focus that can help address this disconnect.
“Clearly there is an opportunity here that we have never had,”
Stage 1 Builds a Foundation
Seidman says. “There is a lot of opportunity to ensure that as
providers meaningfully use EHRs, they are using them in a way
that is patient centered.”
The ONC meaningful use initiative is still in its early stages.
The first professionals and hospitals will begin reporting their
measures in April. It will take longer to determine its impact on
Both patient advocates and ONC agree that the patient-centric
elements included in the first stage of the program could improve the way patients interact with their providers and the
healthcare system. But whether these measures went far enough
in requiring providers to engage patients is open to debate.
There are several stages planned for the meaningful use initiative, with each stage expected to increase in difficulty for providers. ONC considers stage 1 merely the start of their efforts to
move American healthcare and healthcare IT toward delivering
“I do think, as with many things in the stage 1 meaningful use
final rule, there is some very tangible impact,” Seidman says.
“But the greater impact is laying the foundation for what will
come in the future.”
The first stage of the program features five outcome priorities,
one of which is “engage patients and families in their health
care.” Within this category are objectives and corresponding
measures, some of which are mandatory and some of which are
optional (see the table on page 22). Each objective has a mea-
surement that defines its successful completion.