Meaningful Use has become a less-meaningful phrase in the USA over the past year or so. Intentionally or no, politicians twist and deform the English language like no others. Their latest target, at least as far as Emergency Department computer systems are concerned, is that phrase: meaningful use.

In this post, I will grossly oversimplify so that you may acquire a basic understanding. As Bacon observed: we are more likely to reach the truth through error than through confusion.

The American Recovery and Reinvestment Act of 2009 (ARRA) contains a vast wealth of provisions to reinvigorate the US economy (no pun intended). Of interest to readers of this site is that the ARRA says that, if you show new meaningful use of electronic medical records, then you can get money from the Federal government. However, this meaningful use only applies to office-based physicians and hospitals, so emergency physicians and Emergency Departments, by themselves, can't get any money. However, in order for hospitals to get the money, the ED and the emergency physicians have to cooperate – which means you have some power over the administration. (Not too much, though – if you're too uncooperative they can fire you or terminate your contract.)

President Obama's signature on the American Recovery and Reinvestment Act
    President Obama's signature on the American Recovery and Reinvestment Act

Here are ARRA Objectives for meaningful use.

   1. Use CPOE
      Measure: CPOE is used for at least 80 percent of all orders
   2. Implement drug-drug, drug-allergy, drug- formulary checks
      Measure: The EP has enabled this functionality
   3. Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT
      Measure: At least 80 percent of all unique patients seen by the EP have at least one entry or an indication of none recorded as structured data.
   4. Generate and transmit permissible prescriptions electronically (eRx).
      Measure: At least 75 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology.
   5. Maintain active medication list.
      Measure: At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient is not currently prescribed any medication) recorded as structured data.
   6. Maintain active medication allergy list.
      Measure: At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient has no medication allergies) recorded as structured data.
   7. Record demographics.
      Measure: At least 80 percent of all unique patients seen by the EP or admitted to the eligible hospital have demographics recorded as structured data
   8. Record and chart changes in vital signs.
      Measure: For at least 80 percent of all unique patients age 2 and over seen by the EP, record blood pressure and BMI; additionally, plot growth chart for children age 2 to 20.
   9. Record smoking status for patients 13 years old or older
      Measure: At least 80 percent of all unique patients 13 years old or older seen by the EP “smoking status” recorded
  10. Incorporate clinical lab-test results into EHR as structured data.
      Measure: At least 50 percent of all clinical lab tests results ordered by the EP or by an authorized provider of the eligible hospital during the EHR reporting period whose results are in either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data.
  11. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach.
      Measure: Generate at least one report listing patients of the EP with a specific condition.
  12. Report ambulatory quality measures to CMS or the States.
      Measure: For 2011, an EP would provide the aggregate numerator and denominator through attestation as discussed in section II.A.3 of this proposed rule. For 2012, an EP would electronically submit the measures are discussed in section II.A.3. of this proposed rule.
  13. Send reminders to patients per patient preference for preventive/ follow-up care
      Measure: Reminder sent to at least 50 percent of all unique patients seen by the EP that are 50 and over
  14. Implement five clinical decision support rules relevant to specialty or high clinical priority, including for diagnostic test ordering, along with the ability to track compliance with those rules
      Measure: Implement five clinical decision support rules relevant to the clinical quality metrics the EP is responsible for as described further in section II.A.3.
  15. Check insurance eligibility electronically from public and private payers
      Measure: Insurance eligibility checked electronically for at least 80 percent of all unique patients seen by the EP
  16. Submit claims electronically to public and private payers.
      Measure: At least 80 percent of all claims filed electronically by the EP.
  17. Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, and allergies) upon request
      Measure: At least 80 percent of all patients who request an electronic copy of their health information are provided it within 48 hours.
  18. Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies)
      Measure: At least 10 percent of all unique patients seen by the EP are provided timely electronic access to their health information
  19. Provide clinical summaries to patients for each office visit.
      Measure: Clinical summaries provided to patients for at least 80 percent of all office visits.
  20. Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically.
      Measure: Performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information.

Having browsed through this list, you might come to a few conclusions, such as:

    * Most of this has little to do with the ED.
    * Given how much of the volume of the hospital passes through the ED, if your hospital is going after ARRA funds, the administration is going to demand that your nurses or physicians are obsessive and compulsive about gathering information on smoking (no big deal) and growth information on all pediatric visits (a bigger deal, because it basically has no relevance to the emergency management of a pediatric patient, and is seldom routinely obtained on ED patients).

But the big one is likely CPOE. What percentage of your hospital's admissions come through the ED? More than 50%? Maybe more like 70%? What percentage of your hospital's outpatient volume comes through the ED? If CPOE is going to be used for 80% of all patients, that mean