AMDIS/HIMSS: Meaningful Use as a teaching tool

NEW ORLEANS—The point of Meaningful Use is to learn, said Seth Foldy, MD, MPH, senior advisor for Centers for Disease Control and Prevention's Office of Surveillance, Epidemiology and Laboratory Services, speaking during the Physicians’ IT Symposium during the Health Information and Management Systems Society’s (HIMSS) annual convention. The symposium is co-hosted by the Association of Medical Directors of Information Systems (AMDIS).

By 2020, 90 percent of clinical decisions will be supported by accurate, timely and up-to-date clinical information and will reflect the best available evidence, he said.  

“We’re learning to implement learning and how to implement liquidity of information.” We can’t learn from what’s not captured but right now, “we’re obsessed with meeting benchmarks and getting incentive dollars. Getting information into the EHR is one of the hardest things we have to do.”

To make EHRs learning-friendly, information must be visible at the clinician-system interface, he said. Learning about the patient via Meaningful Use requires three steps.

1. Data capture at the practice. This includes vital signs, basic demographics, family history, advance directives and smoking behavior and has expanded in recent years to structured lab results, text-searchable progress notes and improved problem and allergy lists.
2. Data from other providers. The average primary care physician’s Medicare patients are have 229 other doctors involved in treatment, according to an Institute of Medicine report. One-quarter of patients said that their physician had to reorder tests to have accurate information for diagnosis.
3. Learning from the patient. Patient-contributed information and ability for patients to request changes are being considered for Meaningful Use Stage 3.

Learning needs Interoperability which needs shared vocabularies and format standards. Learning needs information exchange which needs interoperability, shared secure transport protocols and sustainable business case and trust fabric. Learning needs usability which needs user-oriented design and objective-oriented design.

Foldy discussed three layers for information exchange: secure transports, data exchange format and content/vocabulary.

Better data leads to better information management which leads to better intervention which leads to reduced disease and injury. This flow will improve performance, Foldy said.

“The focus today is input, but the focus will as soon as possible be on outcomes.”

Let process improvement drive information systems, not other way around, he said. Focus on the front end, such as how do you capture data and how might patients contribute electronically? How will you accomplish interoperability and exchange?

He encouraged the audience to share existing evidence. “Don’t re-invent existing evidence and tools and share the lessons you learn. There’s no need to keep reinventing the wheel.” He also told the audience not to go it alone but partner with regional efforts including public health.