The "meaningful use" issue has been attracting a lot of attention in healthcare reform efforts lately. In very broad strokes, the debate stems from a provision in the American Recovery and Reinvestment Act (ARRA) that allocates funding for physicians who are deemed to be meaningful users of electronic health records by 2011.

Since ARRA doesn’t spell out exactly what qualifies as meaningful use, defining the concept has become a source of great discussion. Things got a bit clearer in June, however, when the Health IT Policy Committee of the Department of Health and Human Services (HHS) released its preliminary definition of meaningful use. In essence it says that meaningful use involves implementing EHRs to enhance health carequality, safety and affordability and to foster better patient engagement, increase security, advance care coordination and generally improve the health of the entire population.

 In July, the Health IT Policy Committee published its final recommendations for the definition of meaningful use, as it were. Some of the committee’s more interesting proposals include: a recommendation that incentives be paid according to an adoption year rather than a calendar year framework; reduction of initial adoption year objectives to permit hospitals and eligible providers to implement one clinical decision rule and still qualify; a mandate that providers and hospitals check insurance eligibility electronically from public and private payers; and a mandate that providers and hospitals submit claims electronically. The last two can be accomplished easily using technologies long ago implemented by most major payers.

 The proposed meaningful use definition recognizes that it is simply too much to expect physicians to go from using little or no EHR technology at all to a full-blown, highly complex and technical system virtually overnight. The workflow disruptions alone would be extraordinary, as would the necessary upfront investment. A more streamlined approach would be to slowly and steadily raise the meaningful use bar over a period of time so users can familiarize themselves with technology and build it into their practices a piece at a time.

The behavioral and organizational change necessary for successful EHR implementation needs to be facilitated, not forced. Taking this route will spare the process lengthy delays and outright resistance among adoptees, and still make President Obama’s goal of creating EHRs for all Americans by 2014 a very realistic one.