Feature: With Stage 2 on horizon, what's in store for Stage 3?
 |
| Paul C. Tang, MD, vice president and CMIO at the Palo Alto Medical Foundation. Source: Palo Alto Medical Foundation |
The Office of the National Coordinator for Health IT (ONC), in cooperation with the HIT Policy Committee, the National Quality Forum and quality measure and standards development organizations, is planning to finally iron out the rough edges in contemporary measures that have made them the No. 1 concern among hospital CIOs trying to achieve meaningful use, according to the College of Healthcare Information Management Executives.
Besides fixing what ails current quality measures, most of which were developed for a paper-based world using claims and administrative data, the Stage 3 deep-thinkers' plan to commission and incorporate new breeds of quality measures that determine how well cross-cutting activities such as medication reconciliation and care coordination are being done on behalf of patients, Paul Tang, MD, chair of the policy committee’s meaningful use workgroup, said in an interview.
The second stage of the meaningful use timeline originally was envisioned as a springboard to the demands of Stage 3 for outcomes improvements, but ended up “more incremental from Stage 1,” said Tang. Meanwhile the passage of the healthcare reform law has made constructs like quality measures important for more than meaningful use. Consequently Stage 3 “may have a very different look and feel than Stage 1 and Stage 2,” said Tang, describing it as “a support program, an enabling infrastructure to accomplish the changes we need in healthcare reform.”
Pivotal to that aim is a set of quality measures based on clinical data from EHRs. The labor-intensive and time-consuming process of “human beings going though charts, looking for things” is unsustainable even for the current reporting requirements much less future demands, Ferdinand T. Velasco, MD, vice president and CMIO of Texas Health Resources and chair of the quality and safety committee formed by the Healthcare Information and Management Systems Society, said in an interview.
But converting quality measures predicated on this legacy process into an electronic form hasn’t provided the solution, Velasco said. “The challenge of these measures is they are not yet there in terms of faithful reproduction of what those quality measures would look like (when) derived using the traditional human method. We’re still in a transition phase where what you get out of an EHR is very different from what you get from the traditional paper-based process.”
The ONC is well aware. “There are certainly hurdles and challenges to getting electronic quality measure reporting to the level of accuracy that we would all agree we all want,” Joshua J. Seidman, PhD, the office’s director of meaningful use, said in an interview. The office is at work on a “quality data model” for measure authors to use that will enable new measures “to be developed electronically rather than going back and re-jiggering existing paper-based measures.”
The model will get a workout as the Stage 3 project roster extends to “essentially defining new quality measure concepts, the measures of which need to be developed,” said Tang. For example, information on medication needs to follow a patient for reconciliation purposes, “and we would like measures that can assess how well that happens.
“We would like to have both EHR support of true med reconciliation and [a way to] measure this reconciliation process itself, not just a check-off that says, 'I did it.’"