Defining - and implementing - meaningful use has the potential to dramatically impact the use of electronic health records in the US. At this early stage, it is critical ask if the end goals are being served by the approach. This paper introduces the concept and considers how to implement such significant change in the context of the American health care system. Written for a course on Quality and Performance Measurement for Brandeis University.

1. Jodi
Sperber
Quality
and
Performance
Measurement
in
Health
Care
March
31,
2010
Meaningful
Use:
Will
the
end
result
be
meaningful?
With
the
cost
of
health
care
in
the
United
States
continuously
increasing,
significant
efforts
are
being
made
to
make
systemic
improvements
that
save
on
cost
without
negatively
impacting
quality
of
care.
Moreover,
the
true
goal
is
to
contain
spending
while
at
the
same
time
making
improvements
to
quality.
This
endeavor
has
numerous
components
to
be
considered,
given
the
complexity
of
the
American
health
care
system.
Over
the
past
10
years,
health
information
technology
has
increasingly
been
viewed
as
a
vital
factor
in
health
reform
efforts.
To
this
end,
the
American
Recovery
and
Reinvestment
Act
(ARRA)
of
2009,
commonly
known
as
the
stimulus
bill,
included
a
provision
called
the
Health
Information
Technology
for
Economic
and
Clinical
Health
(HITECH)
Act.
Provisions
of
this
act
involve
a
number
of
regulations
and
programs
aimed
to
support
the
improvement
of
health
care
systems
and,
ultimately,
help
to
increase
the
health
of
Americans
(Blumenthal,
2010;
Centers
for
Medicare
and
Medicaid,
2006;
Glaser,
2010;
Halamka,
2010b).
Of
primary
interest
within
HITECH
is
the
development
and
utilization
of
electronic
health
records
(EHRs)
as
a
normative
part
of
the
American
health
care
experience.
As
a
part
of
this
effort,
the
federal
government
is
interested
in
boosting
the
use
of
Page 1

2. Jodi
Sperber
Quality
and
Performance
Measurement
in
Health
Care
March
31,
2010
EHRs
among
providers
receiving
payments
from
Medicare
and
Medicaid
in
ways
that
are
considered
to
be
“meaningful.”
How
meaningful
use
gets
defined
is
of
great
significance,
as
new
financial
incentives
rest
upon
providers
and
hospitals
meeting
minimum
standards
set
forth.
As
of
this
paper’s
writing,
no
final
decisions
have
been
issued
–
the
initial
proposed
rule
of
meaningful
use
was
issued
in
December
2009,
and
public
comments
on
the
proposed
rule
were
accepted
until
March
15
(Department
of
Health
&
Human
Services,
2009;
HHS
Press
Office,
2009).
These
comments
are
currently
under
review.
For
the
purposes
of
studying
meaningful
use
in
more
detail,
it
is
worth
taking
a
moment
to
delineate
electronic
medical
records
(EMR)
and
EHRs,
two
terms
that
are
often
conflated.
Though
frequently
used
interchangeably
they
are,
technically,
distinct.
As
defined
by
the
recently
disbanded
National
Alliance
for
Health
Information
Technology
(NAHIT),
EMRs
refer
to
the
“electronic
record
of
health-­‐
related
information
on
an
individual
that
is
created,
gathered,
managed,
and
consulted
by
licensed
clinicians
and
staff
from
a
single
organization
who
are
involved
in
the
individual's
health
and
care.”
EHRs
refer
to
the
“aggregate
electronic
record
of
health-­‐related
information
on
an
individual
that
is
created
and
gathered
cumulatively
across
more
than
one
health
care
organization
and
is
managed
and
consulted
by
licensed
clinicians
and
staff
involved
in
the
individual's
health
and
care”
(Neal,
2008).
Page 2

3. Jodi
Sperber
Quality
and
Performance
Measurement
in
Health
Care
March
31,
2010
Therefore,
while
an
EMR
may
be
very
useful
for
capturing
and
organizing
information
within
a
single
practice
or
for
a
single
patient,
an
EHR
can
be
utilized
to
compare
commonalities
and
difference
across
populations,
making
it
a
more
robust
mechanism
to
spot
trends,
highlight
outliers,
and
support
evidence
based
treatment.
Using
these
definitions,
an
EHR
can
be
viewed
as
an
EMR
with
the
capability
of
integrating
into
multiple
systems,
making
it
a
much
more
powerful
tool
for
measuring
quality.
Thus,
the
federal
government
is
interested
in
incentivizing
practitioners
who
meet
EHR
standards
aimed
at
improving
quality
for
patients
even
as
they
move
around
within
the
larger
health
care
system.
Despite
both
private
and
public
actions
to
date,
and
consensus
that
the
use
of
health
information
technology
will
likely
lead
to
more
efficient,
safer,
and
higher-­‐quality
care,
the
adoption
of
EHRs
in
the
US
has
been
slow.
Lethargy
in
EHR
adoption
has
been
a
topic
of
discussion
amongst
researchers,
health
providers,
consumers,
and
policy
makers
for
some
time.
At
present,
less
than
20%
of
physicians
currently
use
an
electronic
records
system.
Such
systems
are
generally
found
in
larger
care
settings
including
hospitals
and
large
practices,
while
smaller
practices
rarely
have
such
systems
in
place
(DesRoches,
et
al.,
2008;
Jha,
et
al.,
2009;
Jha,
et
al.,
2006).
Within
the
federal
government,
IT
modernization
efforts
are
an
integral
part
of
the
Health
Information
Technology
Framework.
The
US
Department
of
Health
and
Human
Services
listed
health
information
technology
as
a
priority
for
quality
Page 3

4. Jodi
Sperber
Quality
and
Performance
Measurement
in
Health
Care
March
31,
2010
measurement
and
data
collection,
indicating
that
interoperable
electronic
records
should
be
available
“to
patients
and
their
doctors
anytime,
anywhere”
(Centers
for
Medicare
and
Medicaid,
2006).
To
both
ease
and
encourage
the
transition
to
EHRs,
the
proposed
meaningful
use
definitions
and
goals
for
EHRs
are
broken
into
three
separate
stages,
scheduled
to
be
rolled
out
in
sequence
between
2011
and
2015.
Each
stage
builds
upon
the
previous,
with
financial
incentives
available
at
each
new
stage.
Stage
1,
which
begins
in
2011,
focuses
primarily
on
basic
EHR
capabilities,
naming
25
modules
for
eligible
professionals
(EPs)
and
23
modules
for
eligible
hospitals
that
must
be
met
to
be
deemed
a
meaningful
EHR
user.
Stage
2
expands
Stage
1
criteria
in
the
areas
of
disease
management,
clinical
decision
support,
medication
management,
support
for
patient
access
to
their
health
information,
transitions
in
care,
quality
measurement
and
research,
and
bi-­‐directional
communication
with
public
health
agencies.
Stage
3
focuses
on
achieving
improvements
in
quality,
safety
and
efficiency,
focusing
on
decision
support
for
national
high
priority
conditions,
patient
access
to
self
management
tools,
access
to
comprehensive
patient
data,
and
improving
population
health
outcomes
(US
Department
of
Health
and
Human
Services,
2010).
Page 4

5. Jodi
Sperber
Quality
and
Performance
Measurement
in
Health
Care
March
31,
2010
Each
module
within
the
meaningful
use
definition
contains
a
specific
objective
and
measurable
goal
that
must
be
met
for
disbursement
of
the
associated
financial
incentive.
Sample
hospital
objectives/measures
include:
1. Objective:
Use
of
computerized
physician
order
entry
(CPOE)
for
orders
(any
type)
directly
entered
by
authorizing
provider
(for
example,
MD,
DO,
RN,
PA,
NP)
Measure:
CPOE
is
used
for
at
least
10
percent
of
all
orders
2. Objective:
Implement
drug-­‐drug,
drug-­‐allergy,
drug-­‐
formulary
checks
Measure:
The
eligible
hospital
has
enabled
this
functionality
3. Objective:
Maintain
active
medication
list.
Measure:
At
least
80
percent
of
all
unique
patients
admitted
by
the
eligible
hospital
have
at
least
one
entry
(or
an
indication
of
“none”
if
the
patient
is
not
currently
prescribed
any
medication)
recorded
as
structured
data.
4. Objective:
Record
demographics.
Measure:
At
least
80
percent
of
all
unique
patients
admitted
to
the
eligible
hospital
have
demographics
recorded
as
structured
data
5. Objective:
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
eligible
hospital
with
a
specific
condition.
Similar
measures
and
objectives
have
been
created
for
providers
who
do
not
work
within
a
hospital
system
(Beaudoin,
2009a,
2009b).
On
its
face,
each
module
appears
relatively
straightforward.
However,
as
evidenced
by
the
lack
of
EHR
adoption
within
the
US
and
the
lively
discussion
that
is
taking
place
with
the
initial
definition
released,
it
is
clear
that
there
is
room
for
debate
on
the
viability
of
the
current
federal
strategy.
Page 5

6. Jodi
Sperber
Quality
and
Performance
Measurement
in
Health
Care
March
31,
2010
One
would
be
hard
pressed
to
find
a
provider
who
is
not
interested
in
providing
quality
(however
they
define
the
word)
care.
At
the
same
time,
a
wide
range
of
studies
have
suggested
that
EHRs
are
an
important
factor
of
quality
improvement
strategies
(Chen,
Garrido,
Chock,
Okawa,
&
Liang,
2009;
MW
Friedberg,
et
al.,
2009;
M
Friedberg,
et
al.,
2009;
Orszag,
2008).
With
this
in
mind,
it
is
reasonable
to
inquire
why
all
health
care
providers
have
not
already
embraced
meaningful
use
of
EHRs
as
an
automatic
member
of
the
overall
care
approach.
Research
to
date,
as
well
as
comments
from
experts
in
the
field,
consistently
underscore
that
it
is
not
the
mere
presence
of
an
EHR
that
makes
a
difference,
but
rather
the
use
of
the
information
contained
as
a
decision
support
device
that
improves
quality
(Dexheimer,
Talbot,
Sanders,
Rosenbloom,
&
Aronsky,
2008;
Ford,
Menachemi,
Peterson,
&
Huerta,
2009;
M
Friedberg,
et
al.,
2009;
Poon,
et
al.,
2010;
Sequist,
et
al.,
2005).
This
distinction
is
at
the
heart
of
the
challenge
of
universal
EHR
adoption;
crossing
the
divide
between
the
presence
of
an
EHR
and
the
proactive
use
of
an
EHR
is
where
strategy,
creativity,
and
technological
savvy
meet.
This
paper
does
attempt
to
tackle
the
myriad
facets
of
EHR
creation
and
adoption;
to
do
so
would
require
volumes
as
an
entire
industry
is
devoted
to
this
pursuit.
Instead,
focus
is
placed
specific
elements
underlying
the
possibility
of
adoption
and
widespread
use
of
such
tools,
with
an
eye
towards
the
overarching
question
of
Page 6

7. Jodi
Sperber
Quality
and
Performance
Measurement
in
Health
Care
March
31,
2010
whether
or
not
EHRs
will
in
fact
impact
the
quality
of
health
care
in
the
United
States.
These
elements
include
design,
interoperability,
and
patient
access
to
data.
The
three
elements
named
are
at
the
heart
of
moving
from
EHRs
being
viewed
as
impediments
to
EHRs
being
seen
as
tools
to
positively
impact
quality
of
care
for
all
patients,
regardless
of
geographic
location
or
health
status.
Justification
for
slow
adoption
rates
are
complex,
involving
cost,
variability
in
EHR
platforms,
culture
within
each
practice,
a
lack
of
incentives,
and
a
lack
of
resources
to
install,
train,
and
maintain
such
systems.
While
the
current
meaningful
use
standards
and
incentives
are
limited
to
Medicare
and
Medicaid
patients,
it
is
important
to
remember
that
providers
for
these
patients
are
situated
within
the
larger
context
of
the
American
health
care
system,
which
at
its
core
is
based
in
a
competitive
business
model.
The
business
of
EHRs
is
a
part
of
this,
with
a
number
of
individual
vendors
vying
to
gain
market
share.
This
has
only
increased
with
the
possibility
of
financial
incentives
from
the
federal
government.
For
evidence
of
this,
one
needs
to
look
no
further
than
the
most
recent
Healthcare
Information
and
Management
Systems
Society
(HIMSS)
conference
that
took
place
in
early
March
of
this
year.
Per
feedback
from
attendees,
there
was
a
surge
in
attendance
from
EMR
and
EHR
vendors,
and
everyone
was
talking
about
meaningful
use
(Dillon,
2010;
Halamka,
2010a).
Page 7

8. Jodi
Sperber
Quality
and
Performance
Measurement
in
Health
Care
March
31,
2010
At
present,
there
is
no
industry
standard
on
core
elements
that
should
be
included
within
an
EMR,
and
many
EHR
providers
are
striving
to
set
the
standard
(or
have
enough
market
share
that
they
are
by
default
the
standard).
This
means
there
is
a
long
list
of
EHR
providers
to
choose
from
–
a
quick
web
search
resulted
in
over
200
distinct
vendors,
each
offering
variations
on
the
general
idea
of
an
EHR
("EMR
and
EHR
Matrix,"
2010;
John,
2006).
For
smaller
offices,
most
of
who
do
not
have
IT
staff
knowledgeable
about
EHRs,
the
task
can
seem
overwhelming
to
the
point
of
being
impossible.
It
is
here
that
design
and
interoperability
must
be
carefully
considered,
as
they
play
a
critical
role
in
the
ability
to
effectively
use
an
EHR.
With
each
company
striving
to
stand
out
from
the
pack,
there
is
a
lack
of
uniformity
within
current
systems.
Each
has
a
unique
user
interface,
meaning
there
is
a
learning
curve
for
providers
switching
from
one
vendor
to
another.
Even
within
vendors,
there
is
variability
of
design,
as
each
individual
implementation
is
generally
customized
based
on
the
purchaser’s
needs.
Thus,
if
a
provider
has
worked
with
a
particular
vendor’s
system
at
Hospital
A,
there
is
no
guarantee
that
the
same
vendor’s
EHR
will
look
similar
if
the
provider
takes
on
a
new
job
at
Hospital
B.
This
can
be
frustrating,
and
a
deterrent
for
adoption
of
the
technology.
A
frequent
concern
voiced
by
physicians
is
that
EHRs
are
designed
to
suit
the
needs
of
administrators,
rather
than
reflecting
the
flow
of
clinical
interactions
(Loomis,
Page 8

9. Jodi
Sperber
Quality
and
Performance
Measurement
in
Health
Care
March
31,
2010
Ries,
Saywell,
&
Thakker,
2002;
McDonald,
1997;
Smith
&
Zastrow,
1994).
As
a
result,
the
user
interface
is
not
well
suited
for
efficient
entry
from
a
clinical
perspective.
Similar
to
the
learning
curve
encountered
when
learning
a
new
system,
the
inability
to
enter
data
in
an
intuitive
fashion
is
seen
largely
as
a
deterrent
and
inefficient
use
of
time,
as
opposed
to
being
helpful
for
patient
care.
Customization,
while
reasonable
from
an
individual
practice
perspective,
also
leads
to
interoperability
challenges,
as
there
is
generally
more
focus
on
tailoring
the
interface
than
forethought
on
core
elements
that
should
be
carried
through
to
other
practices.
What
is
often
neglected
along
the
way
is
attention
put
towards
having
a
patient’s
medical
record
live
anywhere
but
the
place
in
which
it
originates.
Thus,
using
the
same
Hospital
A/Hospital
B/same
vendor
scenario
above,
it
is
possible
that
a
patient
can
change
providers
and
not
have
their
record
travel
electronically
with
them,
even
if
both
systems
utilize
an
EHR
from
the
same
company.
Interoperability
is
not
only
of
concern
for
providers,
but
patients
as
well.
Patients
are
increasingly
interested
in
the
ability
to
access
their
own
medical
information
on
an
on
demand
basis.
Personal
health
records
(PHRs)
are
patient-­‐facing
interfaces
designed
to
handle
this
task,
and,
like
EHRs,
come
in
many
different
forms.
Ideally
PHRs
are
a
subset
of
EHR
data,
with
the
capability
of
being
augmented
by
the
patient
and/or
multiple
data
sources
to
create
a
more
complete
health
picture.
Large
organizations
such
as
Kaiser
Permanente
have
invested
heavily
in
this
type
of
Page 9

10. Jodi
Sperber
Quality
and
Performance
Measurement
in
Health
Care
March
31,
2010
tool,
most
recently
partnering
with
Microsoft
to
transfer
data
between
internal
systems
and
Microsoft’s
HealthVault,
and
online
data
platform
(Press
Release,
2008a,
2008b).
Kaiser
is
unique,
however,
in
having
the
resources
and
willingness
to
adopt
this
type
of
approach.
The
ability
of
patients
to
access
their
information
from
EHRs
as
an
element
of
improving
quality
of
care
was
a
topic
covered
within
the
public
comments
on
the
meaningful
use
proposed
definition.
Notably,
Google,
Microsoft,
and
Dossia
(a
consortium
of
Fortune
500
companies
striving
to
aggregate
health
information
into
a
web-­‐based
platform)
submitted
joint
testimony
highlighting
the
significance
of
including
PHRs
in
meaningful
use
criteria.
In
their
joint
comments,
they
requested
that
HHS
“clarify
that
patients
have
the
right
to
direct
EPs
and
eligible
hospitals
to
electronically
transmit
such
information
to
a
destination
of
their
choice
and…
require
that
at
least
80%
of
all
unique
patients
seen
by
the
EP
are
provided
timely
electronic
access
to
their
health
information”
(Dossia,
Google,
&
Microsoft,
2010).
Even
with
the
aforementioned
concerns
in
mind,
there
is
a
strong
case
to
be
made
for
the
federal
government’s
efforts
to
define
meaningful
use
and
promote
adoption
of
EHRs
via
the
use
of
financial
incentives.
The
staged
approach
was
established
intentionally
to
allow
time
for
debate
and
development,
and
incentives
are
not
tied
to
quality
improvement
until
the
final
stage.
Still,
without
establishing
core
Page 10

11. Jodi
Sperber
Quality
and
Performance
Measurement
in
Health
Care
March
31,
2010
principles
early
on,
it
is
possible
that
the
efforts
will
fail
to
meet
the
ultimate
goal
of
quality
improvement.
One
of
the
central
principles
that
should
be
established
is
the
creation
of
a
core
set
of
data
points
should
be
determined
for
all
EHRs,
and
structured
such
that
these
data
elements
can
be
transferred
between
all
EHRs
eligible
for
meaningful
use
certification.
These
data
elements
could
include
aspects
such
as
demographics,
allergies,
immunizations,
and
medication
lists.
A
second,
and
more
controversial,
consideration
is
to
allow
EHRs
utilizing
the
use
of
an
open
application
programming
interface
(Open
API)
to
qualify
for
certification
(only
EHRs
certified
by
the
Certification
Commission
for
Health
Information
Technology
(CCHIT)
are
eligible
for
financial
incentives
as
proposed
in
the
stimulus
package).
An
Open
API
entails
a
set
of
technologies
that
enable
websites
to
interact
with
one
another
in
a
more
seamless
fashion.
This
generally
presumes
web-­‐based
applications
(in
contrast
to
software
installed
on
a
local
hard
drive),
although
that
is
not
required.
The
benefit
of
such
systems
is
that
it
allows
for
a
vast
and
vibrant
ecosystem
of
smaller
programs
to
develop
and
work
together
to
deliver
a
more
robust
overall
product.
For
example,
a
design
specialist
could
work
on
a
malleable
user
interface,
while
an
engineer
can
implement
the
back
end
data
elements
into
software.
It
would
not
be
necessary
that
these
two
workers
be
with
the
same
company.
Alternatively,
a
small
company
could
create
a
solution
to
store
and
track
Page 11

12. Jodi
Sperber
Quality
and
Performance
Measurement
in
Health
Care
March
31,
2010
data
related
to
a
unique
set
of
conditions,
which
could
then
be
read
within
the
patient’s
EHR.
At
present
this
approach
is
highly
uncommon,
and
there
is
some
debate
over
whether
this
is
due
simply
to
a
lack
of
lobbying
power
(Blankenhorn,
2009;
Douglas,
2009).
However,
with
cloud
computing
becoming
more
prevalent,
and
with
an
increasing
shift
towards
democratizing
application
development
(see
the
success
of
Firefox’s
add-­‐ons
as
a
challenger
to
Microsoft
Internet
Explorer
for
an
example
of
this
approach)
it
is
likely
that
certification
will
have
to
address
the
possibility
of
Open
API
in
the
future.
Overall,
the
development
of
meaningful
use
standards
is
a
step
in
the
right
direction.
EHRs,
when
utilized
in
a
systematic
and
purposeful
fashion,
can
have
a
tremendous
impact
on
quality
measures.
At
present
the
possibilities
are
tempered
by
consensus
on
how
to
best
define
meaningful
use,
a
lack
of
core
standards
across
all
EHRs,
and
a
general
hesitancy
within
the
provider
community.
By
coupling
a
transparent
and
open
process
with
financial
incentives,
however,
large-­‐scale
change
should
be
seen
over
the
next
five
years.
Tremendous
opportunity
for
quality
improvement
exists
if
people
can
remain
patient
and
persistent
throughout
the
process.
Page 12

13. Jodi
Sperber
Quality
and
Performance
Measurement
in
Health
Care
March
31,
2010
References
cited
Beaudoin,
J.
(2009a).
Eligible
Hospital
"Meaningful
Use"
Criteria.
Retrieved
March
15,
2010,
from
HIMSS:
http://is.gd/b8oQ0
Beaudoin,
J.
(2009b).
Eligible
Provider
"Meaningful
Use"
Criteria.
Retrieved
March
15,
2010,
from
HIMSS:
http://is.gd/b8p0Q
Blankenhorn,
D.
(2009,
March
15).
Open
source
to
meet
with
CCHIT
at
HIMSS.
http://is.gd/b99JZ.
Blumenthal,
D.
(2010).
Launching
HITECH.
The
New
England
journal
of
medicine,
362(5),
382.
Centers
for
Medicare
and
Medicaid
(2006).
Strategic
Action
Plan
for
2006
-­
2009:
Achieving
A
Transformed
And
Modernized
Health-­care
System
For
The
21st
Century.
Baltimore,
MD:
US
Department
of
Health
and
Human
Services.
Chen,
C.,
Garrido,
T.,
Chock,
D.,
Okawa,
G.,
&
Liang,
L.
(2009).
The
Kaiser
Permanente
Electronic
Health
Record:
transforming
and
streamlining
modalities
of
care.
Health
Affairs,
28(2),
323.
Department
of
Health
&
Human
Services
(2009).
Health
Information
Technology.
CMS
Information
Related
to
the
Economic
Recovery
Act
of
2009.
Retrieved
March
13,
2010,
from
http://is.gd/aDZbL
DesRoches,
C.,
Campbell,
E.,
Rao,
S.,
Donelan,
K.,
Ferris,
T.,
Jha,
A.,
et
al.
(2008).
Electronic
health
records
in
ambulatory
care-­‐-­‐a
national
survey
of
physicians.
The
New
England
journal
of
medicine,
359(1),
50.
Dexheimer,
J.,
Talbot,
T.,
Sanders,
D.,
Rosenbloom,
S.,
&
Aronsky,
D.
(2008).
Prompting
clinicians
about
preventive
care
measures:
a
systematic
review
of
randomized
controlled
trials.
Journal
of
the
American
Medical
Informatics
Association,
15(3),
311-­‐320.
Dillon,
B.
(2010,
March
16).
HIMSS
2010
Wrap
Up.
http://is.gd/b920z.
Dossia,
Google,
&
Microsoft
(2010).
Re:
CMS-­‐0033-­‐P;
Medicare
&
Medicaid
Programs;
Electronic
Health
Record
Incentive
Program
Proposed
Rule.
Unpublished
Public
Comment.
Douglas,
M.
(2009,
March
15).
US
Market:
Open
Source
EHR
and
CCHIT
certification.
http://is.gd/b99Fh.
EMR
and
EHR
Matrix
(2010).
Retrieved
March
20,
2010,
from
http://is.gd/b8DYS
Ford,
E.,
Menachemi,
N.,
Peterson,
L.,
&
Huerta,
T.
(2009).
Resistance
is
futile:
but
it
is
slowing
the
pace
of
EHR
adoption
nonetheless.
Journal
of
the
American
Medical
Informatics
Association,
16(3),
274-­‐281.
Friedberg,
M.,
Coltin,
K.,
Safran,
D.,
Dresser,
M.,
Zaslavsky,
A.,
&
Schneider,
E.
(2009).
Associations
Between
Structural
Capabilities
of
Primary
Care
Practices
and
Performance
on
Selected
Quality
Measures.
Annals
of
Internal
Medicine,
151(7),
456.
Page 13

14. Jodi
Sperber
Quality
and
Performance
Measurement
in
Health
Care
March
31,
2010
Friedberg,
M.,
Coltin,
K.,
Safran,
D.,
Dresser,
M.,
Zaslavsky,
A.,
&
Schneider,
E.
(2009).
Electronic
Health
Records
are
Associated
with
Higher
Quality
in
Primary
Care
Practices.
Glaser,
J.
(2010).
2009:
Reflections
on
a
Transformative
Year:
The
Federal
Perspective.
Halamka,
J.
(2010a,
March
2).
Dispatch
from
HIMSS.
http://is.gd/b91L6.
Halamka,
J.
(2010b).
The
ONC
Strategy:
Acceleration,
Standards,
and
Meaningful
Use.
Paper
presented
at
the
Massachusetts
Health
Data
Consortium.
HHS
Press
Office
(2009).
CMS
and
ONC
Issue
Regulations
Proposing
a
Definition
of
‘Meaningful
Use’
and
Setting
Standards
for
Electronic
Health
Record
Incentive
Program.
Retrieved
March
13,
2010:
http://is.gd/aDYw9
Jha,
A.,
DesRoches,
C.,
Campbell,
E.,
Donelan,
K.,
Rao,
S.,
Ferris,
T.,
et
al.
(2009).
Use
of
electronic
health
records
in
US
hospitals.
The
New
England
journal
of
medicine,
360(16),
1628.
Jha,
A.,
Ferris,
T.,
Donelan,
K.,
DesRoches,
C.,
Shields,
A.,
Rosenbaum,
S.,
et
al.
(2006).
How
common
are
electronic
health
records
in
the
United
States?
A
summary
of
the
evidence.
Health
Affairs,
25(6),
w496.
John.
(2006,
March
15).
Overwhelming
List
of
EMR
Companies.
http://is.gd/b8FaW.
Loomis,
G.,
Ries,
J.,
Saywell,
R.,
&
Thakker,
N.
(2002).
If
electronic
medical
records
are
so
great,
why
aren't
family
physicians
using
them?
Journal
of
Family
Practice,
51(7),
636-­‐641.
McDonald,
C.
(1997).
The
barriers
to
electronic
medical
record
systems
and
how
to
overcome
them.
Journal
of
the
American
Medical
Informatics
Association,
4(3),
213.
Neal,
H.
(2008,
March
13).
EHR
vs
EMR
What’s
the
Difference?
Blog
posted
to
http://is.gd/aqt8q.
Orszag,
P.
(2008).
Evidence
on
the
Costs
and
Benefits
of
Health
Information
Technology:
Congressional
Budget
Office.
Poon,
E.,
Wright,
A.,
Simon,
S.,
Jenter,
C.,
Kaushal,
R.,
Volk,
L.,
et
al.
(2010).
Relationship
Between
Use
of
Electronic
Health
Record
Features
and
Health
Care
Quality.
Medical
Care,
48(3),
000-­‐000.
Press
Release
(2008a).
Kaiser
Permanente
and
Microsoft
Empower
Consumers
to
Take
Charge
of
Their
Health.
Retrieved
March
20,
2010:
http://is.gd/b90mu
Press
Release
(2008b).
News
Conference
Call
–
Microsoft
HealthVault
&
Kaiser
Permanente
Pilot
Program.
Retrieved
March
20,
2010:
http://is.gd/b907k
Sequist,
T.,
Gandhi,
T.,
Karson,
A.,
Fiskio,
J.,
Bugbee,
D.,
Sperling,
M.,
et
al.
(2005).
A
randomized
trial
of
electronic
clinical
reminders
to
improve
quality
of
care
for
diabetes
and
coronary
artery
disease.
Journal
of
the
American
Medical
Informatics
Association,
12(4),
431-­‐437.
Smith,
W.,
&
Zastrow,
R.
(1994).
User
requirements
for
the
computerized
patient
record:
physician
opinions.
US
Department
of
Health
and
Human
Services
(2010).
Meaningful
Use
Retrieved
March
15,
2010,
from
http://is.gd/b8pqw
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