Meaningful Use and Justice

As part of the 2009 economic stimulus bill, Congress passed the Health Information Technology for Economic and Clinical Health (HITECH) Act. Among other things, this act sought to increase the adoption of Electronic Health Records (EHRs) by providing financial incentives to adopters of certified EHRs who met certain benchmarks by a certain timeline. These benchmarks are known as “Meaningful Use.” To receive the financial incentives — up to $63,750 over six years beginning in 2011 — “providers” must attest to compliance with Meaningful Use. That this is a much larger task than originally assumed was demonstrated by the decision last month of the Center for Medicare & Medicaid Services to push back the timeline for reaching compliance with Stage 2 of Meaningful Use, acknowledging problems with the implementation of the required technology.

Last week a report on the progress of Meaningful Use showed that practices which serve primarily minority populations, and practices in areas with the highest levels of poverty, were least likely to have attested to Meaningful Use — and thus least likely to receive any financial incentives.

The cost for startup of an EHR is substantial– estimated to be at least $40,000 to $100,000 per provider. The cost for training, upkeep, upgrades, etc., are never-ending. The time involved in learning and maintaining such systems is also significant.

Areas with higher minority populations and higher rates of poverty are some of the most medically underserved areas as well. There is less money flowing than in more affluent areas, and there is less flexible time in the schedule, as there are fewer physicians seeing greater numbers of patients.

Therefore it appears that one of the unintended consequences of the Meaningful Use program is that those practices that have the least resources to spend on an EHR are the least likely to receive any financial stimulus, while those practices that have the resources to pour into purchasing and upgrading EHRs and training people to use them are more likely to receive financial aid. Those that need it the most don’t get it.

The Federal Government is pushing hard for EHRs (next year, Medicare will start penalizing physicians who don’t use them). It has set up a benchmark program that financially rewards those who are most financially well off, thus increasing existing disparities. It should restructure this program in such a way that it at least does not tend to increase disparities.


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Maybe you would be interested in my issue paper: Meaningful Use in Corrections: Unknown Opportunities