HIMSS: Mostashari fields questions on meaningful use, EHR certification
 |
Meaningful use isn’t perfect—that wasn’t the intention of the Health IT Policy Committee—but it ended up being pretty good, said Mostashari. “Really, what’s happening is healthcare itself cannot and will not continue to be not focused on quality and safety and efficiency. Financial incentives for healthcare organizations will be increasingly tied to the quality of care they deliver.”
Mostashari lauded the audience for taking meaningful use's imperfect systems and polishing them until they added value. He urged symposium attendees to be prepared to work with the Office of the National Coordinator for Health IT (ONC) on meaningful use measures and whether certification criteria are being followed by vendors.
“We can improve the program, but I hope that when you walk out the door you have a sense of meaningful use being a kickstart on behalf of what you need to do to improve care. Early adopters can be powerful in instituting change--or not,” he said.
Likewise, the health IT certification program is helping ensure that systems can do what is necessary to meet meaningful use, so providers and organizations won’t have to negotiate for necessary system capabilities, he said.
In the year since the rules for certification were announced, there are now multiple test and accrediting bodies, 330 approved products, the price of certification has come down and speed and service of certification have improved, he said. “Certification has been something we can do better, but certification is a way we have helped establish a floor.”
During the question and answer session that followed, Mostashari predicted some initial metrics for EHR usability, as well as the Direct Project-based information exchange in the coming year. Some questions and answers are included below.
Q: How can we create enough momentum to ensure a mass healthcare change?
A: We’re in for a couple years of fun. Reaching out beyond the early majority and late majority of adopters, to encourage physician EHR adoption gets tougher, until you get to a tipping point or critical mass where the ecosystem changes. The hopeful news is that even before the incentive program started, the adoption of EHRs jumped from 21 percent to 29 percent in the last year. The key is to continue to make it easier for people to get there, and also begin to show value.
In information exchange for example, the Direct Project is a simple, secure way to use the internet to exchange health information that is so easy to implement that we think most everybody will want it. We’re going to show value in exchange, if not semantic interoperability this year. Exchange of referrals and information to public health will need to be securely exchanged this year. There will be a sea change. We will show value there, but we need to share the stories.
Q: How does the program provide for the community of providers that aren’t early adopters, so if things are ramped down, we’re still moving forward?
A: For those providers, we have to shrink the expectations of change, making it easier for them to see this is doable. I want to tell them, ‘Call your regional extension center.’ Also, as policy makers, we have to demonstrate value and show momentum. We have to address this cluster of privacy and security, standards and interoperability, and information exchange, as a cluster of interrelated issues.
Q: How can ONC and the Centers for Medicare & Medicaid Services (CMS) enforce usability of EHRs? It shouldn't be so complicated that it takes extensive training and refreshers every six months to make EHRs work.
A: I don’t think we should set standards for what a user interface looks like. You don’t want government telling you what it should be. We need more transparency, with agreed-upon metrics for measuring usability first. That’s what we’re doing this year. By next year's HIMSS, there will be--as a result of an open process with industry participation and comments--some initial guidelines and metrics around aspects of usability and measurability. We need to get the current systems to have incentive for usability and transparency. We’ve gone too far not to have some guidelines.
Q: Has there been any thought of making vendors responsible for including data reporting modules so we don’t need to pay extra to get necessary capabilities? Also, with modular certification, if vendor A has been certified with X modules, one has to have all X modules to qualify for meaningful use. This could force professionals to buy modules they never use just to qualify.
A: We’re aware of this issue, but we have to filter it through the lens of what is an appropriate government role. Permitting modular certification is the right policy, but right now it’s buyer beware in terms of assessing if the modules work together, but this should change.
Q: Can you explain some of the ambiguity in the proposed stage 2-3 measures?
A: We have to do rulemaking; we can’t predetermine what rules will look like. A more satisfying answer is things change. To have five-year plans for nationwide health IT is important, but has to come with big dose of humility in terms of predicting, for example, the rate of e-prescribing five years from now. We’d rather build in a sense of clear targets for health outcomes that we want to see and flexibility in how we get there. We need to more clearly articulate what it's all for.