HITPC: MU workgroup discusses Stage 3 proposals, pace concerns

After the Meaningful Use (MU) Workgroup revealed an extensive list of proposed MU Stage 3 objectives at the Aug. 7 Health IT Policy Committee meeting, the committee discussed the mounting concerns about the pace of the MU program.

MU Workgroup chairman, Paul Tang, MD, said the group tried to reconcile public feedback and plans to present draft recommendations next month. “Meaningful Use is a floor, not a ceiling. It takes a bit of time but the floor is there because the majority of vendors don’t supply some of these necessary tools,” he said, referring to MU’s original principles which include broad applicability, population management, national health priorities, new models of care and team-based outcomes.

“The floor allows a network effect to take place,” Tang said, including a substantial increase in adoption.

One challenge the workgroup hopes to address in Stage 3 is the fact that providing certain functions in EHRs is easier than proving that those functions are available and part of the product.

Tang also said the group plans for Stage 3 to simplify and reduce reporting requirements, rely more heavily on market pull, promote innovative approaches and reward good behavior. They also plan to address newer goals, including patient engagement and reducing disparities.

George Hripcsak, MD, MS, workgroup co-chair, discussed the latest changes to the proposed recommendations for Stage 3. The workgroup, he said, has reviewed duplicative concepts and reduced objectives from 43 to 27. They also plan for providers to get credit for objectives that should be standard of practice after Stages 1 and 2.

Providers will be required to have a written electronic note within four calendar days for at least 30 percent of their patients. Feedback indicated that the language should include the use of LOINC for hospital labs. For order tracking, the workgroup plans to close the loop not just on tests but also referrals.  

Unique patient identifier numbers are a new objective, Hripcsak said. Eligible providers and hospitals should record unique device identification (UDI) when patients have devices implanted for each newly implanted device with a threshold of 80 percent. This is “important and doable,” he said.

Under demographics, the language now explicitly says that the patient-preferred method of communication must be recorded.

In the Engaging Patients and Family subgroup, the view, download and transmit objective now includes optional family history. And, he said the workgroup aims to “correct myths that have occurred” around the topic of clinical summary. “The notion that you had to put a printout in every patient’s hand is not true. It needs to be in the format the patient requests.” Another concern they heard was that “people turned this useful document into eight pages nobody could make sense of. They were printing out the entire summary of the record rather than an actionable visit summary indicating what needs to be done for the patient next.”

Patient education now provides a data element for language of preference and secure messaging now acknowledges the option of no response needed. The workgroup also plans to start giving providers and patients the ability to access clinical trials available to them for which they qualify. “This isn’t ready yet, but we want to move functions along for EHRs to talk to clinical trial management systems.”

In the Care Coordination subgroup, Hripcsak said the workgroup wanted to find ways to help providers ensure they haven’t omitted something when it comes to medication reconciliation. “We didn’t want to force a checkbox activity onto reconciliation and create unintended consequences.” Instead, they hope to incorporate decision-making rules so that information systems are helping providers be thorough.

The workgroup aims to make the care summary more useful and, eventually, make it part of the core objectives, Hripcsak said. New recommendations include four requirements for the care summary: why is this patient here, contact information, relevant family caregiver and overarching patient goal.

Regarding medication adherence, Hripcsak said Prescription Drug Monitoring Programs “can be very useful, particularly in managing controlled substances,” but it’s not widely adopted enough to make it a requirement in Stage 3.

In the Population and Public Health subgroup, the workgroup has revised the threshold for immunization registry to at least 10 query results. “This is about getting information back from the registry to put into action to help people.”

The workgroup continued earlier discussions about creating a deeming program for high performers and significant improvers as an optional pathway to qualifying for MU. They proposed a baseline reporting period of 12 months prior to the performance reporting period. Those considering taking advantage of the program would have to carefully choose the quality measures they want to use because they would be compared against those in the future, Tang said.

After much debate in recent months about the pace of the MU program, Tang acknowledged the need for discussion about the timing for Stage 3.

After the workgroup presentation, Farzad Mostashari, MD, ScM, national coordinator of health IT, said he wondered if information could be turned around to focus on outcomes in population health, care coordination and safety. He acknowledged concerns about timing. “I think more time is always appreciated for us to take a little step back and see what we can do in terms of refactoring what we have so far.”  

Other committee members echoed Mostashari’s concerns about timing. “We don’t need to be in such a hurry to do this,” said one member.

The Meaningful Use Workgroup has been a place to discuss potential objectives and changes far in advance of rulemaking, said Mostashari, but “even discussions of Stage 3 are overwhelming. Perhaps our desire for the greatest transparency possible is having an undesired effect.” He acknowledged the efforts of the workgroup but said, “it is important that we nail Stage 2 and we get interoperability in place. We do have for more time for Stage 3—we don’t need to flood the attention of folks with the thoughts about what might be in Stage 3.”