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More Than Pie in the Sky: Meaningful Use and the Engaged Consumer


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.


More Blog Posts by Molly Mettler

author bio

Molly Mettler is a Senior Vice President for Healthwise and in this position, she advocates for a transformation in the role of the health care consumer from a passive recipient to one who’s stronger, more active, and involved in his or her own care.  She is also a CFAH William Ziff Fellows.

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Comments on this post
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Sarah Jorgenson says
August 5, 2010 at 11:02 AM

I agree that there will be a great deal of benefits for the public with implementing electronic health records. Yet, it will be a very slow process of getting clinics, hospitals, clinicians and the public all on the same page with how to benefit from and use them.

For example, the clinic I used to work for has an E.H.R., which has been an absolutely amazing resource for clinicians and patients. Records are available for patients to request, and forms are in an easy to understand format. However, if patients did not request forms at their visit or immediately following, the clinic policy that was being implemented would allow charging patients $25 for mailing, printing, or faxing physical forms/immunization forms and other paperwork from that visit.

I would be very frustrated if I had forgot to have my doctor fill out the sports physical form at a doctorâ??s visit in July when my child signed up for a sport in September. Patients have to be included in what constitutes â??meaningful useâ?? and made aware of clinic policies surrounding the E.H.R.

Sarah Jorgenson says
August 6, 2010 at 10:08 AM

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