Monday, 21 December 2015

Meaningful use of electronic medical records

If you want to know if something is serious in health policy, check whether a budget allocation has been reserved for its implementation. Therefore I consider relevant that in 2011, the US federal government started a long term incentive program (until 2020) for the adoption of electronic medical records (EMR). The program is called "Meaningful use" which could be translated as meaningful use of medical records. That is, it encourages not the investment in information systems but its use and is measured by various indicators grouped into 3 stages.

Earlier this year Botta and Cutler published "Meaningful use: floor or ceiling?" an article where the process of encouragement was studied from expert interviews and from data from implementing a survey of American Hospital Association. Well, according to this analysis, the "Computerised Physicians Order Entry" (computerized physician orders) increased their deployment when they were encouraged by the "Meaningful use" program and even went ahead in the use of barcodes for drug delivery, action that was not encouraged by the government program (see figure).

As shown in the graph, in 2011 there was a great impact of "Meaningful use" although it is feared that the concentration of interest from incentivised healthcare providers could be detrimental to other developments and finally end up generating systems that may not be so well balanced. Another discrepancy is the adoption differential between large and small hospitals: the large ones adopt faster. All this follows the expected lines in the world of the organizational behaviour and financial incentives study.

However, the debate over whether the requirements for meaningful use accreditation are "floor or ceiling" provides a fertile discussion in the process of digital transformation of health institutions. Paying for adopting can carry along an inherent conception of ceiling level to be overcome, when in fact it is the first step in obtaining the value sources promised by the health digitization.

For more information on the "Meaningful use" program you may check the website of “Centers for Medicare and Medicaid Services”.

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