Every family has legends that persist the turbulence of truth or memory. My personal favorite is the time my grandmother played golf with Alice Cooper. (“Well,” she corrected. “He prefers to be called Vincent. His name isn’t really Alice, you know.”) Now approaching his mid-sixties, the former Vincent Furnier resides in the fastest-growing age demographic in the world.
Soon after the year 2015, for the first time in history, there will be more people older than 65 than those younger than 5. By the year 2050, in fact, the population ages 65 and over will be more than two and a half times that of the population aged less than 5 — an exact reversal of the situation in 1950, when less than 5 percent of the global total was older than 65 years.
Considering that the human body stops growing between the ages of 20 and 25, this trend indicates that we have succeeded in lengthening the distance between natural mortality and current life expectancy. It also speaks to the importance of well-designed health experiences, since we are increasingly reliant on these services as we get older.
A quick study of electronic health records (EHR) may reveal opportunities for today’s design professionals to drive healthcare transformation. To understand EHR, however, we must first recognize meaningful use.
What Is Meaningful Use?
“Meaningful use” is the term applied to a set of standards defined by the Centers for Medicare & Medicaid Services (CMS). Meaningful use governs the implementation of electronic health records, allowing eligible providers to earn incentive payments by meeting criteria established by the CMS. The intention is to improve health outcomes by increasing the quality, safety and efficiency of care by promoting health IT services.
Medical practices have much to gain by adopting meaningful use. Medicare is reimbursing compliant practices up to $44,000 per physician over five years, with up to $63,750 over six years from Medicaid for meeting requirements. Doctors are required to adopt electronic health systems and achieve meaningful use criteria by October 2014, else they will see reduced payments the following year.
As of this writing, there are two regulations which define the objectives of meaningful use that qualify providers and hospitals for reimbursement:
Incentive Program for Electronic Health Records. Issued by the CMS, these rules define the minimum requirements for providers to adopt EHR technology within their practic to capture, share and advance data relevant to clinical processes.
Standards and Certification Criteria. These rules identify how EHR technology will be certified by the Office of the National Coordinator for Health Information Technology. Eligible healthcare providers — both individual physicians and hospital networks — must be assured that any systems they adopt are compliant with the required functionality.
Stage One of Meaningful Use
To put these in terms more relevant to today’s healthcare consumer, think of meaningful use as occurring in three stages between 2011 and 2016. The first stage, which reached completion at the dawn of 2013, was to ensure that EHR systems were set up to capture health information in a standardized format. With this capability in place, benchmarks can be set to track key clinical conditions and establish reporting criteria for large-scale public health initiatives.
For example — to meet stage one of meaningful use, a practice must be able to enter at least 30 percent of patients’ medication into an online summary dashboard. They must also confirm that they are equipped to enable drug-drug and drug-allergy interaction checks for the length of the reporting period. The practice or hospital must be able to provide a clinical summery for patients upon each office visit, in addition to recording vital signs and smoking status for patients of a certain age.
Stage Two of Meaningful Use
The second stage, which begins in 2014, is to focus on more rigorous procedures for exchanging health information. Where stage one was intended to demonstrate that a practice was capable of accommodating electronic health records, stage two dictates that these activities actually be implemented.
For example, there will be increased requirements for e-prescribing and incorporating lab results into diagnostic reports, as well as the use of computerized order entry for all medications and radiology orders. Practices will also need to examine their options for exchanging data with local hospitals — both in and out of network.
From a technology and user experience standpoint, stage two will be the crucible of proof. Vendors who guaranteed that their systems would meet stage one criteria will now be tasked with delivering actual results. Patients will also need to be educated on the importance of accessing their EHR and ensuring their availability.
According to Jeff Loughlin, project director for the Massachusetts eHealth Collaborative, physicians will bear the onus that medical knowledge is transfered accurately and completely to their patients. “The mentality is that patients think medical records are for medical professionals,” he says.
To Be Continued
In part two of this post, we’ll investigate where today’s user experience professionals can have the most impact on the current healthcare ecosystem. Here’s a hint: it’s in stage three.