For better or worse, the phrase “meaningful use” is quickly becoming used to describe a metric by which many eHealth projects will be measured, either directly or indirectly. Enshrined in the legislation governing the funding of electronic health record implementations in the United States, this term has caught the attention of eHealth leaders and decision makers across the world. Close to home, for example, the theme for the eHealth track at this fall’s OHA HealthAchieve conference is “Meaningful Use: The Canadian Context”.
In an insightful paper entitled “Certification of Electronic Medical Records: Lessons Learned from Canada”, Dr. Matthew Morgan and Dr. Mark Dermer assert:
“Meaningful use is not only the primary goal for EMR adoption, it is also essential to health system sustainability and can serve as a powerful inductive force for the other key components of comprehensive nationwide health informatics infrastructure“.
They also note:
“The current US national dialogue on defining meaningful use criteria
and reconsidering initial targets is appropriate and productive.
Physicians and health informatics professionals are engaged in this
dialogue with payers, policy makers, product vendors, certification
agencies, politicians and patients.”
While they use the term explicitly, Dr. Morgan and Dr. Dermer describe a process for reaching consensus on “meaningful use” that includes “meaningful engagement” of all stakeholders. Having watched the US “meaningful use” debate for the better part of the past year, I believe that it is this “meaningful engagement” that is driving the constructive and productive debate regarding “meaningful use” and that has allowed the US to move so quickly in developing its eHealth strategy.
While “meaningful use” may be capturing many people’s attention, perhaps we should think more about the “meaningful engagement” that seems to be a core philosophy in the US “meaningful use” debate. I wonder if it is the process by which “meaningful use” was defined and the policies and standards needed to achieve it are determined that it is the more significant achievement.
Another way to think about “meaning engagement” is to consider a “middle-out” approach to eHealth strategies and architectures rather than either “top down” or “bottom up” approaches. Commenting on a blog post weighing the merits of top-down vs bottom-up approaches to developing the Australian eHealth strategy, Enrico Coiera suggests that a “middle-out approach” is a “co-production of industry, health service providers, and government“. He further states that “Middle out is about setting the agenda co-operatively from the start – consultation is not necessary because everyone is already in the room. These aren’t just words or cliches, they are a mind set.”
What do you think? Is “meaningful engagement” a metric that we should perhaps apply to the process by which eHealth related discussions and debates are measured? Is a “middle-out” approach more effective at achieving “meaningful engagement”?