First meaningful use definition proposed
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Members of the work group--including John Glaser, PhD, group chair and senior special adviser to the Office of the National Coordinator for Health IT (ONC) and co-chairs Paul Tang, MD, and Farzad Mostashari, MD--presented a draft description of meaningful use to the Health IT Policy Committee, chaired by David Blumenthal, MD, national coordinator for health IT, for full discussion and consideration.
A public comment period on the recommendations and discussion the meeting starts today, after which the Centers for Medicare & Medicaid Services (CMS) will spearhead the final rulemaking process. The public comment period will be open through the close of business on Friday, June 26. Instructions on how to submit public comment can be found at http://healthit.hhs.gov.
"This is the beginning of a conversation that is going to last for sometime," Blumenthal said. "There is a long way to go before we get to a formal governmental posture on the definition of meaningful use."
Blumenthal also noted that the definition of meaningful use must be ambitious and implementable in the 2011/2014 timeframe.
"We want a definition that is simple enough to be understandable, but specific enough to be meaningful," he said. The work group's hope with this first definition is to focus on where "we want to get to and how the definitions that we take into account today could get us there in the allotted timeframe."
2011 objectives
The group focused on five categories of criteria and objectives when thinking about meaningful use in 2011:
1. improving quality, safety and efficiency and reducing healthcare disparities;
2. engaging patients and families;
3. coordinating care;
4. raising the health status of the population and
5. maintaining privacy and security of systems and data.
Improve Quality, Safety, Efficiency
- Capture data, such as problem list, active medication list, vital signs, patient characteristics, in coded format
- Document progress note for each encounter (outpatient only)
- Use computerized provider order entry (CPOE) for all order types; and
- Use of e-prescribing for permissible Rx
- Implement drug-drug, drug-allergy and drug-formulary checks
- Manage populations
- Generate a list of patients by specific conditions (outpatient only)
- Send patient reminders per patient preference
Engage Patients and Families
- Provide patients with an electronic copy of or electronic access to clinical information per patient preference
- Provide access to patient specific educational resources
- Provide clinical summaries for patients for each encounter
Improve Care Coordination
- Exchange clinical information among providers of care
- Perform medication reconciliation at relevant encounters
Improve Population and Public Health
- Submit electronic data to immunization registries
- Submit electronic reportable lab results to public health agencies
- Submit agencies according to applicable law and practice
Ensure Privacy and Security Protections
- Comply with HIPAA rules and state laws
- Comply with fair data sharing practices set for in the National Privacy and Security Framework
Meaningful use framework
The group's ultimate vision of an EHR is for all patients to be fully engaged with their care, and for providers to have real-time access to medical information and tools that ensure the quality and safety of the care provided, while affording improved access and the elimination of healthcare disparities.
"This ‘north star' must guide our policy objectives, advance care processes needed to achieve them and lastly, enable the specific use of IT to produce the desired outcomes and our ability to monitor them," the group noted.
They presented a meaningful use framework that is divided into three parts:
1. improved outcomes;
2. advanced clinical processes and
3. data capture and sharing.
For example, demonstrating improved performance and reduced disparities in blood pressure control among diabetics that will require a host of new care processes for many outpatient providers, e.g., monitoring medication adherence, use of evidence-based order sets, clinical decision support tools at the point of care, as well as patient outreach and reminders. To use the tools that undergird these processes and monitor progress toward improved outcomes, information such as vital signs, problem lists, medications, procedures and lab tests must be digitized, queriable and trendable.
The goal is achieve continuously measurable results, in order to continuously improve the state of U.S. healthcare, said Tang, who is also chief medical information officer at Palo Alto Medical Group Objectives.
The group hopes to achieve that goal through a series of steps, including, "shifting from capturing data in a coded format and sharing it among those who need it, including patients, and toward using that platform to change our advanced care processes so that we are really focused on the patient and the patients' needs. Finally, with that infrastructure in place, we will have the ability to measure and constantly improve our system."
Transforming assessment metrics
"The journey to a transformed health system requires meaningful use of transformation-capable health IT," Tang said.
While there are number of quality measures currently available, the vast majority are based on billing or claims data--which are limited in terms of accuracy and reliability, Tang noted. Instead of using these claims-based measures, the group has proposed to move some of them as being defined by clinical data out of an EHR.
"There are certain measures that we can take the definitions and change them into quality measures derived from an EHR," he said, citing examples of the percentage of diabetics with A1c under control or the percentage of aspirin prophylaxis for patients at risk for a cardiac event.
"This is not only a system change, but a cultural change on the part of the provider," he said. By changing the measures from claims-based to health IT-based, reporting on them "implicitly means you are using an EHR."