Certification and Meaningful Use: Reframing Adoption of Electronic Health Records as a Quality Imperative

Abstract

This article examines the promise of the Health Information Technology for Economic and Clinical Health Act ("HITECH") to reduce or eliminate the market failures that have impeded the adoption of Electronic Health Records ("EHR"). Specifically, the article considers a key provision of the statute, a condition for receiving EHR subsidy funds, namely meaningful use. This deceptively simple requirement, that a health care provider must make "meaningful use of certified EHR technology," has become both the regulatory core and the talisman for the next decade's implementation of health information technology. This article describes the background of the subsidy program and examines the specifics of the "certification" and "meaningful use" regulations that have followed. The article concludes by taking a broader view of "meaningful use" and relating it to the concept of more fundamental health care reform. The provisions of the HITECH Act are best understood not as investments in technology per se, but as efforts to improve the health of Americans and the performance of their health care system . . . . Combined, [the HITECH] programs build the foundation for every American to benefit from an EHR, as part of a modernized, interconnected, and vastly improved system of care delivery.