A "Meaningful User" is a Patient Centered Medical Home

As the first stage criteria of meaningful use have been announced it is important for primary care physicians to understand them. It is also important to realize that the criteria for meaningful use were not developed in a vacuum. The Office of the National Coordinator (OCN) has said all along that for the implementation of Health Information Technology to be successful there needs to be concurrent transformation at the practice level particularly with opportunities specifically related to Health Information Technology (HIT).

The chart below clearly outlines the way that the requirements for Stage 1 under the American Resource Recovery Act (ARRA) are clearly aligned with PCMH. This did not occur by accident as David Blumenthal and his staffed reached out to those involved with PCMH to understand the issues and opportunities.

ARRA Stage 1 Meaningful Use		TransforMED Patient-Centered Model
Safety outcomes		Safety outcomes
Quality outcomes		Quality outcomes
Care coordination		Care management & coordination
Engage patients & family		Engage patients & family
Improve population health		Improve population health
Increase provider, staff & patient satisfaction		Increase provider, staff & patient satisfaction
Decrease healthcare costs		Decrease healthcare costs
Reduce health disparities		Reduce health disparities
Ensure privacy & security		Ensure privacy & security

Both PCMH and ARRA have a focus on safety and Quality at the practice level. Both PCMH and ARRA seek to provide efficiencies at the practice level. That is why TransforMED has a separate module on practice management. Technology and PCMH need to be leveraged to make primary care practices and the healthcare system more efficient. Care Coordination is specifically listed as a requirement for a "meaningful user" under ARRA and is obviously a hallmark of PCMH along with care management. ARRA has a specific mention of engaging patients and families and the TransforMED model has been so focused on the Patient as the critical success factor in PCMH that the patient is at the center of the model. Finally, both ARRA and PCMH speak to the importance of managing populations of patients. We have spoken many times before about how the paradigm for primary care is shifting and we will be accountable to manage and coordinate the care for a population of patients and not just those that show up in our offices. The challenge to date has been inadequate technology and incentives to accomplish it.

It is good to point out that the TransforMED model for PCMH has nine components: the Patient, HIT, Practice Management, Quality and Safety, Practice-Based Team Care, Care Coordination, Care Management, Practice-Based Services, and Access. Six of these nine modules are essentially the requirements for stage 1 meaningful use. TransforMED also adds practice-based services, access and team care which can certainly be complementary to ARRA while being critically important to primary care practices and patients in improving satisfaction at multiple levels and the financial viability of practices. ARRA has an additional focus for meaningful use of reducing health disparities and privacy and security which are in perfect lock-step with PCMH.

One often hears the term "meaningful user" as opposed to "meaningful use". Just purchasing capability to do things discussed is not going to qualify. Actually using the things discussed to actually make a difference at the practice level will. The bottom line is becoming a TransforMED Patient Centered Medical Home will. The time to start the journey is now. The roadmap and incentives become more clear every day.