Alie Cohen

What is the Meaning of... Meaningful Use?

April 29, 2021

Last time you were here, we talked about the HITECH Act. The time before that, we took a quick dive into an overview on federal policy. Today, we’re going to pick it up from where we last left off on Meaningful Use. Here’s a pretty great summary of the evolution of Health Tech interoperability.

What is the Meaning of... Meaningful Use?

Welcome back, Health Tech Policy friends!

Last time you were here, we talked about the HITECH Act. The time before that, we took a quick dive into an overview on federal policy. Today, we’re going to pick it up from where we last left off on Meaningful Use.

Let’s revisit this for a minute: the HITECH Act established the Meaningful Use program. Meaningful Use was defined by the use of certified (by an ONC-approved certification body) EHR technology in a “meaningful” manner (for example electronic prescribing) thus ensuring that technology used improves the quality of care. It seemed pretty great, but there were a few problems, like a lack of standardization, inconsistent data quality, onerous enforcement and incompatible system design. It was eventually rebranded to Promoting Interoperability Programs and set the stage for the beginning of a discussion and set of requirements around the use of APIs.

In 2014, HIMSS decided to take some interoperability definitions used in other industries and detailed three levels of interoperability required to improve the efficacy of health data exchange architectures, application interfaces and standards. These were later updated in March 2019 to include a fourth level. We think this is a pretty great summary of the evolution of Health Tech interoperability:

The Four Levels of Interoperability

  1. Foundational (Level 1): Establishes the inter-connectivity requirements needed for one system or application to securely communicate data to and receive data from another
  2. Structural (Level 2): Defines the format, syntax and organization of data exchange including at the data field level for interpretation
  3. Semantic (Level 3): Provides for common underlying models and codification of the data including the use of data elements with standardized definitions from publicly available value sets and coding vocabularies, providing shared understanding and meaning to the user
  4. Organizational (Level 4): Includes governance, policy, social, legal and organizational considerations to facilitate the secure, seamless and timely communication and use of data both within and between organizations, entities and individuals. These components enable shared consent, trust and integrated end-user processes and workflows

We made you a pretty diagram too:

So what came next, Alie?

The 21st Century Cures Act (Cures Act) was signed into law on December 13, 2016 by President Obama. It was an almost completely bipartisan law, passing the house 392-26 and the senate 94-5. It very nicely, with the HITECH Act signed in 2009, bookended President Obama’s presidency with laws that involved access to healthcare data. The law, and the associated policies that have been recently implemented were designed to:

  • Promote and fund the acceleration of research into preventing and curing serious illnesses (hence the name, Cures Act)
  • Accelerate drug and medical device development
  • Address the opioid abuse crisis
  • Define improvements to mental health service delivery


For our purposes, it also very importantly includes provisions that push for greater interoperability, adoption of electronic health records (EHRs) and support for human services programs. Here are some of those key relevant provisions:

  • Enhancement of Patient Access Modalities
  • Development of a trusted exchange framework
  • Decreased Administrative Burden for use of EHRs
  • Implementation of Information Blocking Prevention
  • Provider Digital Contact Information
  • Establishment of HIT Advisory Committee


There’s another piece of the puzzle I want to cover: the Trusted Exchange Framework Common Agreement (TEFCA). It’s a common set of principles, terms and conditions for the nationwide exchange of electronic health information. We can further break it down into two parts:

  1. Trusted Exchange Framework: high-level principles that networks should adhere to for trusted exchange.
  2. Common Agreement: legal agreement that will enable network-to-network data sharing.

And let’s drill down even further.

The Principles of the Trust Exchange Framework are:

And the Common Agreement includes:


Ultimately, the TEFCA is designed to scale EHI exchange nationwide and ensure that stakeholders have secure access to electronic health information when and where it’s needed.

I’ll have to stop myself here or else I’ll keep going all night. Next time you tune in, we’ll be talking about the players in the interoperability ecosystem.