Core Competencies of Meaningful Use
William Hersh, MD
Professor and Chair
Department of Medical Informatics & Clinical Epidemiology
Oregon Health & Science University
Although many people think of meaningful use (MU) as something that IT systems must do, I, as an educator, often contemplate the competencies, i.e., the knowledge, skills, and attitudes, require to achieve Meaningful Use. There are competencies not only that people must have, but also organizations and even the information systems they are deploying. Analysis of the final meaningful use rules make it clear that there are many competencies that people, organizations, and systems must have to succeed with the HITECH agenda.
The list of Meaningful Use criteria and what must be done to implement them are a veritable textbook of clinical informatics. They also include some additional competencies from other sub-areas of biomedical and health informatics as well.
Clearly the major competency area for meaningful use is clinical informatics. Individuals, their organizations, and their information systems must have a thorough understanding of most of the tenets of clinical informatics. A list of what competencies are needed and why includes the following:
- Clinical data, e.g., demographics, vital signs, problem lists, medications, structured data, advance directives
- Clinical decision support – rules, drug-drug and related checks, medication reconciliation
- Computerized provider order entry
- Health information exchange
- Privacy and security
- Healthcare quality
- Organizational and project management
- Standards and interoperability – e.g., HL7, ICD-9, SNOMED, LOINC, CCR/CCD, etc.
Of course, MU is not limited to clinical informatics. People, organizations, and systems must understand elements of public health informatics, since of the “menu” criteria must include the exchange of information with state or local public health agencies. Likewise, these entities must have competence in consumer health informatics, understanding the ramifications of the requirements to provide patients with summaries of their care and, in the long run, exchange information with personally controlled health records.
There are many ways to achieve these competencies, e.g., the educational programs described in my other recent posting. Regardless of how it is obtained, competency in MU is something that all people, organizations, and systems that deal with health must have. Many must master it, not only to achieve the short-term objectives and funding of HITECH, but also to provide a patient-centered, evidence-based, and cost-effective healthcare system for the 21st century.