Mostashari: Make EHR Use More Meaningful

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Meaningful Use is more than just meeting a minimum set of requirements to earn extra money from the Medicare and Medicaid programs. Instead, it is meant to incentivize improvements in quality of care and overall health status while lowering costs, with the help of electronic health records (EHRs), according to national health IT coordinator Dr. Farzad Mostashari.

"Meaningful use is a tool," Mostashari explained at last week's College of Healthcare Information Management Executives (CHIME) CIO Forum in Indian Wells, Calif. "You can do it in a 'check the box' way and get the [bonus] check, and that would have been an inept use of that tool," he told this 20th annual meeting of influential healthcare CIOs.

"Make it meaningful," Mostashari said. "You need to use it to get to population health management, patient engagement, and health information exchange."

As an example of EHR use that is not meaningful, Mostashari recalled his previous job running the Primary Care Information Project for the New York City Department of Health and Mental Hygiene.

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Though the department collected quality data from primary care clinics in underserved parts of the city through an EHR program Mostashari spearheaded, the national coordinator noted that blood pressure at one point was kept in 136 different places. It was difficult if not impossible to manage populations when physicians kept creating new variables in the system to fit their own personal workflows, he said.

Physicians and organizations need to standardize how they store and process data, according to Mostashari, or HIE and population health management will not work. He praised EHR vendors for participating in conversations about standards and making the decision to "lay down their weapons" as federal officials developed the Stage 2 rules for Meaningful Use.

He also explained the importance of prospective rather than retrospective analytics with an anecdote from his time in New York. Mostashari talked about visiting a storefront clinic in Harlem and asking a primary care physician how many patients had received flu shots. The physician told him that "almost all" of her patients had gotten the annual vaccination, but a review of the EHR showed that the actual number was 17%.

The local physician told Mostashari that maybe there was a problem with the data in the EHR, so the two of them started looking at individual cases, and the clinic doctor made excuse after excuse. "Well, that one just came in for a [prescription] refill," was one reason, Mostashari said. It still was an opportunity to administer the shot.

"After the eighth one, she said, 'Can I send him a letter?'" said Mostashari. Yes, the EHR could in fact automatically generate reminder letters for preventive care by pulling up all patients in certain risk categories. "That was the 'aha' moment for that physician, according to Mostashari.

Prospective analytics shifts population health review from the after-the-fact "wagging finger" to a proactive exercise that can prevent adverse events, the coordinator said. "That's a meaningful use."

InformationWeek Healthcare brought together eight top IT execs to discuss BYOD, Meaningful Use, accountable care, and other contentious issues. Also in the new, all-digital CIO Roundtable issue: Why use IT systems to help cut medical costs if physicians ignore the cost of the care they provide? (Free with registration.)