Panel Discussion: What Does it Mean to be a Meaningful User of Electronic Health Records?
*Randall D. Cebul, Case Western Reserve University 
*Lara Jehi, Cleveland Clinic 
*Irene Katzan, Cleveland Clinic and The MetroHealth System 
*Deborah Miller, Cleveland Clinic 

Keywords:

While the Office of the National Coordinator for Health Information Technology and CMS have established rules for meaningful use of EHR, what does this mean to clinicians, researchers, and patients? In a move to value-based reimbursement, how does an organization demonstrate treatment efficacy and outcomes to the patients, public, government, and other payers while doing so in a way that is meaningful and relevant to real-world patients? This panel will discuss various challenges, successes, failures, and unintended consequences of the collection and use of clinical data for performance measurement and public reporting as well as for looking at patient reported outcomes (PRO) in the context of both clinical practice and clinical research. The panel will include Dr. Cebul, director of the Better Health Greater Cleveland project, supported in part by the Robert Wood Johnson Foundation, which has been doing performance measurement and public reporting of clinical data on chronic illness (diabetes, heart failure and hypertension) across seven health care systems in Northeast Ohio since 2007, and recently reported substantial improvements in diabetes care and intermediate outcomes in the region, noting wide disparities between patients of EHR and paper-based record systems. Three panelists from Cleveland Clinic's Neurological Institute (Drs. Jehi, Katzan and Miller) will discuss their experiences with Cleveland Clinic's Knowledge Program, which permits patients to record self-assessments directly into their EMR. Leveraging both PRO and clinical data systematically, information collected during patient encounters provides updates on patient clinical status, progression and illness severity. The systematic collection and large number of records also provide insight into clinically relevant issues that may have been overlooked, and assessments of the efficacy of treatment protocols in a real world patient population. The Knowledge Program has been designed both to aid individual clinical encounters and to make information readily available for future clinical research. Topics discussed by the panelists will include choosing and developing clinically relevant and useful measurements as well as the technological and political struggles to implement and use such a system in research and practice.