CHIME/HIMSS: Interop, patient engagement are next big MU push

NEW ORLEANS—These “exciting times” of healthcare reform and IT overhaul have given birth to great technological changes in the provider setting, but improvements in interoperability and patient engagement still present challenges, said Judy Murphy, RN, deputy national coordinator for programs and policy at the Office of the National Coordinator for Health IT (ONC) during her March 3 lecture at the 2013 CIO Forum.

What initially drove IT into healthcare was the desire to introduce technology into the clinical environment to improve workflow, explained Murphy.

To demonstrate, where IT is today under current government initiatives, she showed that 36 percent of the Meaningful Use funds have been distributed to the 521,000 eligible professionals in the U.S. Also, ambulatory EHR use has doubled in the last five years, to its current 72 percent.

The progress is even “more remarkable” for eligible hospitals (EHs) and the Meaningful Use (MU) program, as 70 percent of EHs in the U.S. already have been paid and 14 percent have registered. “We’re doing a lot better. We know this 85 percent probably results from the resources available in the hospitals, compared with individual providers or practices,” Murphy said.

In fact, there has been a tripling of hospital EHR use since 2010. There is significantly higher use of EHRs of eligible hospitals clustered around Midwest states, and not as much in the West or South.

Looking at the percentage of hospitals with capabilities to meet select MU Core objectives from 2008 to 2012, Murphy focused on the drastic improvement in the use of computerized physician order entry: from 27 percent to 72 percent.

As of the end of 2012, the Centers for Medicare & Medicaid Services (CMS) had distributed $10.6 billion, which means “we are more than halfway through the amount of funding designated for Meaningful Use,” she said.

The key priorities going forward involve keeping the patient at the center of healthcare, Murphy explained. To lay the groundwork for interoperability, patient-centric healthcare and health records must have standards, testing and certification. The goal is to facilitate broad implementation of health information exchange and to engage patients by enabling patients through access, action and attitude.

Interoperability through HIE is growing, said Murphy. For instance, three EHR vendors (Cerner, eClinicalWorks and EPIC) are each exchanging millions of patient records per month. The New England Healthcare Exchange Network has 200,000 directed exchanges per month. HealthBridge in Ohio has 3.2 million directed exchanges per month. In general, many integrated delivery networks and hospitals are spearheading exchange, and there is rapid growth in exchange supported by the State HIE program.

One area that needs improvement is giving patients access to their information, according to Murphy. “If there is already a portal for providers, it should be just as easy for patients, but that is not so.”

“The next stages of MU criteria will step up the interoperability expectations,” said Murphy, who listed some specifics, including:

• E-prescribing;
• Transition of care summary exchange: Create & transmit from the EHR/receive & incorporate into the EHR;
• Lab tests & results from the inpatient to the ambulatory setting;
• Public health reporting: transmission to immunization registries, public health agencies for syndromic surveillance; public health agencies for reportable lab results; and cancer registries;
• Patient ability to view, download and transmit their health data to a third party;
• Create an export summary of patient data to enable data portability; and
• Registry participation.

Again, the connection to patients needs work, as 48 states have immunization registries, and only three of those allow patients to access their record, Murphy pointed out. “Interoperability is quite complicated,” she acknowledged, recognizing that the challenges do not dissipate after implementation.

However, the key to the next phase is patient engagement, which she defined as “the blockbuster drug of the century.”

Moving forward, there also will be an expectation of improved patient outcomes and metrics to make sure that providers achieve these outcomes. “With the data accumulated in these new IT systems, we have an opportunity to study the outcomes to build a new body of understanding for patient care,” Murphy summed.

The CIO Forum is hosted by the College of Healthcare Information Management Executives (CHIME) and the Healthcare Information and Management Systems Society (HIMSS) and presented simultaneously at the 2013 HIMSS annual conference.