Meaningful Use: A springboard for innovation

Meaningful Use has given the healthcare industry more than a gentle nudge toward adopting electronic health records and other health information technology. And future stages of the program will challenge organizations to go even further. But some organizations are using Meaningful Use as a starting point--going beyond the individual requirements and collecting their incentive paychecks.

At last week's Institute for Health Technology Transformation (iHT2) summit in Ft. Lauderdale, panelists Doris Crain, vice president and CIO of Broward Health; Jeanette Schreiber, medical affairs and chief legal officer of UCF Collect of Medicine and the chair of the Central Florida RHIO; Garett Trumpower, RN, vice president of strategy and consulting at Medseek; and Shane Hade, CEO of Avhealio talked about how organizations are using Meaningful Use as a springboard for innovation.

Moderated by FierceHealthIT, panelists discussed innovative uses of health data, engaging patients in their own health data, trends in patient portals and mobile technology, using Meaningful Use incentives to fund new programs, and more. Some highlights from the discussion follow.

FHIT: How does Meaningful Use help--or hinder--innovation?

Crain: At Broward health we don't really think of Meaningful Use as Meaningful Use. We were doing Meaningful Use before there was such a thing. It was the right thing to do for patients, the community, for the physicians and really for the IT staff.

Innovation is about bringing value; it's not about inventing something new, necessarily, but it's about finding a new way to measure the value within the value. When we forced--and we did force--the nurses to begin doing documentation in the EMR over the course of time they really saw value in what we had done. 

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Trumpower: One of the biggest hindrances is the checkbox strategy: You check the box and move on.

That is what about 50 percent of the organizations we work with are doing. It would behoove all of us to figure out how to go to the next level of innovation. Organizations are looking at disease management and using technology to move from a fee-for-service world into at-risk contracts.

Hade: In Stage 2, it's going to be a whole different ballgame. In Stage 2 you actually have to do something with the data. You have to actually have to increase your patient engagement and coordinate care and manage people's care.

FHIT: There's a massive amount of data coming out of EMRs and from other sources such as home monitoring devices. How does data drive innovation?

Trumpower: Organizations have been using data for many, many years; they might have used it for direct mail lists or to improve quality. What I'm starting to see is organizations looking at data not only to predict propensities for disease state but also how to direct care. A great example is an organization in Michigan that looks at the data of who's showing up in their ERs versus who's really a candidate for ambulatory or urgent care center. And how do we message that to those patients? We use socioeconomic data, media data, whether they have broadband or mobile access at home, what they're using to get information. We use that data to really target them, to educate them on the use of ambulatory versus ERs.

Schreiber: At the Central Florida RHIO, we're adding providers and physicians to the two systems that we have and in the course of this we're realizing that we have such a rich database that we're looking at bringing in payers to add other dimensions. There are so many uses for that data that we're preparing for both through governance and all the provisions for modeling the data and also the technology. That involves everything from public health monitoring, identifying new illnesses using this data, looking at drug interactions. There are ways to use the data for fraud and abuse identification. Some of our physician providers want our help getting them set up so that they can use their data and tools to establish the medical home model. You can use the data and information, ultimately, to manage care across provider lines.

Crain: We're more focused on using the data that's being generated in managing some of the core measures for the Joint Commission. It's driven by the nurses. Their assessment route generates a plan that our predictive modeling tool uses to mine the data and remind them to do things like administering aspirin. It even predicts the people who may be at risk for falls. It also helps us with value-based purchasing, because one of the things that, as a public facility, we're very concerned about is more money being taken away. So we are using the tool to get our arms around quality improvement.

FHIT: What kind of results are you seeing from those efforts?

Crain: Our quality department produces a dashboard with the help of IT. Every month we report it to the board. In the beginning it wasn't exactly a color that you would like to see. But it is now moving from lots of red to mostly green and some yellow. We've seen a huge change in people not just using the data but putting a plan around how to improve the care.  I don't know that they would ever have been able to do it without the EMR.

FHIT: One of the big initiatives in Meaningful Use Stage 2 is getting data into patients' hands, and one way organization do that is through patients portals. What's new and what's next in this space?

Trumpower: I've always looked at meaningful use of patient portals as one, how are they going to use it and, two, how will they know about it? If you build it, they will not come. Access and knowing that it exists are critical. Organizations are looking at search engine optimization strategies, they are looking at very specific social media strategies, they're using predictive analytics to understand who in our marketplace will actually use this. The other piece is does it take action? Having the data there is having the data there. It's what you do with the data that makes it meaningful.

FHIT: How can health information exchange promote patient engagement?

Schreiber: There are a number of HIEs around the country that have already put in portals. Just think about what that can enable. Imagine that you only need to go to one place to communicate with and get information from all the whole range of providers and physicians that you deal with. We're talking to some folks who are interested in bringing in the home monitoring programs and then there's discussion about the wellness component. There's a belief that people will put their wellness data into the HIE and use it to monitor and motivated people can use that for education and other types of motivational tools.

FHIT: Reaching patients who are already engaged and motivated is one thing; how are we getting patients with chronic conditions and those who are not as motivated to participate?

Trumpower: There's a lot of hubbub right now with Meaningful Use Stage 2—it's is not just about having the data there but adoption of it: 10 percent have to actually look at the portal discharge records. That's a pretty high number. A lot of people say that will never make it to final ruling. I say it doesn't matter; you want to get the adoption for strategic reasons. In many cases, the CMO is taking charge of this and there's heavy physician involvement on the front end—if it comes from the physician you get better adoption from the group that the data says doesn't participate.

Crain: Broward Health is going to have an interesting challenge with that. Most of our patients are underserved or uninsured so they don't have a smart phone, they don't have the computer at home and they don't have the interest. Frankly, when we do our portal later on this year we'll target our employees. We have our own health plan and the majority of our employees come to our facilities, so I think they'll be a perfect target audience. But the majority of the people we serve probably will not enjoy the portal.

Hade: Mobile technology is going to have a game-changing effect on the delivery of care. The reality is, people that are going to use it oftentimes have good care already or they take pretty good care of themselves already. But the chronic disease management is another aspect. The portal, to me, is like an HIE for the individual. The data is already there. So what can you do to make it easier to use it?

Almost everybody carries a phone with them. And the smart phone and tablets have eclipsed computers—that's just reality. Deploying mobile technologies plus push technologies will then present the opportunity to be more proactive. Whether it works remains to be seen but it can absolutely prove benefit. It's been proven to work with chronic disease management, diabetes care and medication adherence.

Crain: Broward Health is going to have an interesting challenge with that. Most of our patients are underserved or uninsured so they don't have a smart phone, they don't have the computer at home and they don't have the interest. Frankly, when we do our portal later on this year we'll target our employees. We have our own health plan and the majority of our employees come to our facilities, so I think they'll be a perfect target audience. But the majority of the people we serve probably will not enjoy the portal.

We hope to use some of the $14 million we've received from Meaningful Use and the expected $30 million through the stages and provide the patients who have chronic disease who don't have the computer or smartphone with some sort of device so they can better care for themselves.

Editor's note: Some responses have been edited for length and clarity.                                        

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