Webinar: Stage 1 of meaningful use is for quality reporting acclimation

Stage 1 requirements for meaningful use incentives aim to strike a balance between the overall goal of EHR use and widespread adoption, while avoiding added work, said Jonathan Teich, MD, PhD, chief medical informatics officer at Elsevier Health Services, during a HIMSS webinar titled “Meaningful Use: Safety and Quality of Care.”

The compliance thresholds for some tasks were rolled back to make it more feasible for more practices to “get into the game and get people’s feet wet,” said Teich, who also founded and chaired the HIMSS Patient Safety and Quality Care Steering Committee.

Although the five meaningful use categories haven’t changed, the reduced number of quality measures show the federal emphasis that “this is the first of three stages," he said. “So you have the functional capability to fulfill future requirements. What has gone down is the number of things you have to do right now."

In Stage 2 and 3, most of the emphasis lies on quality improvement and more stringent standards, and many criteria that were in the proposed requirements, but were removed for the final rule, will likely reappear in Stage 2 and 3 (2013 and beyond).

Some of the calculations have been simplified, and the reporting formula has changed to the number of patients for which something applies, as opposed to the number of encounters. Requirements for manual chart review and claims and eligibility transactions are also gone, he said. “Most transactions will be through clinical use of the EHR itself, so the necessity for following claims and eligibility transactions has been removed,” he said.

Eligible professionals must implement one clinical decision support (CDS) rule relevant to their specialty or to a high clinical priority, and attest that they can track compliance with that rule. “That implies that I need to design a rule [and] be able to figure out a way to detect that the rule is running, that it’s actually capturing patients, and the ability to track that I’m actually following that rule,” said Teich.

The original meaningful use requirements included 90 core measures and specialty-related quality measures, but “we’ve backed that down” to 44 measures for eligible professionals, he said. The requirement now calls for three core quality measures that everyone must do, three alternative measures if those don’t apply to your practice, and three others chosen from the additional menu of 38. This represents a significant reduction, “but it does allow you to get into the practice of reporting on quality measures.” For hospitals, there are the 15 required core measures, down from 35, he added.

The selection of quality measures was designed to favor well-established measures and those for which electronic tallying and reporting was actually possible, without duplicating measures in other federal payment programs, according to Teich. The selection of measures was toned down from specialty measures to core target areas mentioned in many places—“broadly applicable, widely found conditions,” he said.

Stage 2 and beyond
Many specialty measures and tasks that were taken out of the final rule to encourage better adoption in Stage 1 will likely come back in Stage 2, he said. In addition, some measures that need only be reported in Stage 1 will likely become performance criteria on particular processes, Teich said.

Items currently in the menu set are likely to become core tasks and additional tasks might be added. Compliance thresholds will likely increase, and the single CDS rule requirement could expand to five, according to Teich.

Stage 2 may call for implementation of disease management tools, robust CDS, medication management, patient access to their health information and communication to and from public health and research areas, “making broader use of certain kinds of de-identified data,” he said.

Beyond that, “Stage 3 is about improvements in care,” Teich said. “Is care actually improved by what we’ve done?” He predicted that Stage 3 goals will focus on ensuring CDS is highly focused on high-priority conditions, and on enabling patients to make better use of their data.

First, however, “you need to make the computer your friend before you make it a taskmaster,” he said. The Stage 1 expectation is that providers will get some of the “easy no-pain, joyful things,” like being able to get notes and medication lists, in an EHR. More complicated and task-based capabilities will be required once users get more familiar with the technology, Teich said.