Apple Hints At Putting The “Meaningful” Into Meaningful Use

What’s so “meaningful” about Meaningful Use anyway?

The short answer is, “Today, very little. Tomorrow, everything.”

And that is the problem with the meaningful use requirements as they exist.

By its very definition, patient data is information that should have meaning. To be useful, information needs to be in context for the patient and the physicians caring for the patient. It needs to be complete, address the issues relevant to the patient at hand, and be available at the point of care no matter where that might be.

The goal of the meaningful use guidelines as constructed by the Office of the National Coordinator of Health IT under Dr. David Blumenthal addressed these issues in a very well-thought-out way. When Dr. Blumenthal unveiled MU guidelines and deadlines to the University of Pennsylvania medical and health policy community, I was fortunate enough to be in attendance. It made, and to this day makes, sense.

The U.S. operates in a complicated, multi-tiered clinical environment (read: uncoordinated and fragmented). To suggest otherwise, or to create rational pathways that imply point-A-to-point-B symmetries, ignores the realities. Not that the theoreticians do not know this. It’s just that if somebody suggests we better come up with a plan, somebody else is going to respond with a plan.

It may be a very rational plan that makes a lot of sense. In a perfectly rational world.

Crystal-Clear Crystal Ball

The very best minds, by definition, understand the complexities far better than I do. To this day, I believe that the need to come up with a good plan, any plan, soon, to accelerate uptake and interoperability of electronic patient records drove the Meaningful Use guidelines and deadlines the industry is dancing to today. And, I reiterate, it was a good plan. I reviewed the detail of the original proposal the other day. If you want a copy, email me ( and I’ll send it to you.

Even the best minds, with crystal-clear crystal balls, will miscalculate trends – even by a smidgen. The costs are always more than expected; the technical glitches are greater than anticipated; the human factors can never be completely predicted; and the trajectory of technology is usually surprising. We know what happens to a trajectory when it deviates just a smidgen from its expected path somewhere past the point of origin.

Organizations have spent many dollars doing much implementation, often putting into place systems that are already in need of replacement even before the MU guidelines could be met.

The guidelines themselves will certainly be met over time. It’s just that the human factors will change the pace of uptake because younger workers are sympatico and even ahead of where the applications are. Tech is in their DNA. Most notably, with the excitement last week around Apple’s announcement of the iPhone6 and the company’s healthcare strategy, the effect of mobile health on personal responsibility and patient involvement will gallop ahead of the central control model assumed by large implementations of gargantuan software applications within the tentacles of burgeoning healthcare systems.

The Health Information Management Systems Society (HIMSS) is thinking along these lines as it goes to Congress asking it for a change in direction.

In the best of all worlds, the healthcare system will be running to catch up to patients’ demands for interoperability in a few years. And you know how the market responds to consumer demand.


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