I love a metaphor, and some witty person came up with a good one to explain 'meaningful use' of the Electronic Health Record (EHR). He (she?) displayed a side-by-side picture of a pumpkin and a pumpkin pie, explaining that: a pumpkin is a vegetable; a pumpkin pie is a meaningful use of that vegetable. I wish I had thought of that.
The final rule for Meaningful Use has been announced and that pumpkin pie metaphor keeps on working. In this brave new world of EHRs for everyone:' how did the MU pie get sliced? How's it going to taste to me, the consumer? Can I get it with whipped cream? And, is the pie plate half full, or half empty? It depends on your willingness to celebrate progress while understanding that there is lots more work to be done.
First the good news. Because of focused efforts by a broad coalition of non-profit advocates for patient-centered health care, key consumer benefits have been baked into Meaningful Use.
- You get electronic access to your information. (This is worth a happy little jig in itself. Imagine, your medical record, with test results, problem list, medications, actually gets shared with you.)
- Hospitals must provide you with discharge instructions
- You get an after-visit summary for your office visits.
- You get 'patient-specific education resources' designed to help you become more knowledgeable about your health and healthcare (Information as therapy!)
- Hospitals will record your advance directives for end of life care
- You'll get reminders for preventive and follow-up care
There are system improvements, too, that will benefit patients and families. Hospitals and providers are required to maintain active medication lists and perform medication reconciliation, to help protect you from dangerous drug interactions. You're protected from errors caused by bad penmanship, too, since physicians will use electronic orders to write a prescription. And, because information in the EHR can be shared, there should be improved coordination and communication between doctors and settings.
Is it time to break out the whipped cream? Well, sorta. Maybe. Optimists will see the seeds of a bright new future for patient engagement. At the same time, others can't be blamed for pointing out that the uptake will be slow and fitful. For example, under the final rule, patients have to request a copy of their records (Will hospitals and providers actively promote access to the record, or will it be health care's equivalent of 'Don't ask, don't tell'?) Also, some of the measurements for success are set pretty low (only 10% of patients must be provided with patient-specific education resources; only 20% of patients age 65+ or age 5 and younger must get a reminder for preventive/follow up care). And, not all of the consumer benefits are mandatory. Some vital improvements such as summary care records for care transitions, patient-specific education resources, and recording advance directives can be deferred for two years.
An EHR designed to help patients and families find good care and make the most out of it is what the final rule of Meaningful Use is aiming for. Let's celebrate that. There's reason to be hopeful that we're moving toward a more patient-centered health care system. And that's not pie in the sky.