HITPC approves MU Stage 3 quality measure recommendations

The Health IT Policy Committee (HITPC) has endorsed a package of Meaningful Use (MU) Stage 3 recommendations governing quality measures that includes an “innovative pathway” giving eligible professionals and hospitals more flexibility in achieving compliance.

The Quality Measures Workgroup had previously obtained approval for MU Stage 3 policy recommendations in January 2014, but the HITPC had asked the workgroup to also draft recommendations about specific MU Stage 3 measures.

The recommendations signal a broader move from process toward outcomes measures, said workgroup co-chair Terry Cullen, MD, director of informatics at the Veterans Health Administration. “The assumption is that providers have implemented the baseline infrastructure for Meaningful Use 1 and Meaningful Use 2 measurements, and we want to promote more forward thinking options in Stage 3.”

HITPC approved recommendations for two options to meet quality measures:

• Track 1 which continues the traditional MU electronic clinical quality measure (eCQM) reporting pathway but looks to align measures, move to e-specified measures and adhere to standards; and
• Track 2 which promotes a pathway to test, share and implement new and innovative measures, and build a health IT infrastructure for advanced care models and multisourced materials.

In Track 1, prioritized domains include functional status and well-being, shared decision-making, coordination of care, efficiency, safety and prevention and population health. The workgroup recommended the following key measurement concepts for MU Stage 3:

• Patient and family engagement: Functional status assessment and patient goal setting for patients with specific health conditions; improvement in symptoms among specific conditions; and condition-specific overall outcome measures.
• Population and public health: An annual wellness assessment that includes an assessment, management and reduction of health risks that focus on a specific domain (e.g., cancer) and/ or specific population group.
• Care coordination: Closure of the referral loop, so critical information is communicated with request for referral and integrated into the decision-making process.
• Patient safety: Set specific settings and conditions (e.g., rate of readmission to the ICU within 48 hours)

The workgroup also recommended development of functional status measures; measures that allow evaluation of data over time for providers; and a focus on more generic functionality that can be applied to multiple conditions, as opposed to developing additional condition-specific measures.

In Track 2, the workgroup’s innovative measure pathway included two possible approaches for implementation: the establishment of certified development organizations to develop, release and report proprietary eCQMs for MU; and an alternative approach to open the process to any eligible professional or hospital but constrain allowable eCQMs expressed in national data and e-processing standards.

Quality Measure Workgroup chair Helen Burstin, MD, MPH, senior vice president for performance measures at the National Quality Forum, noted that with the innovative pathway, a workbench may need to be created so new measures can be standardized.

Under this route, healthcare organizations and providers must furnish evidence that the measure can help improve care.

The workgroup also continued recommending the use of the measure criteria to evaluate measures. It also called out a need for health IT infrastructure to support interoperable systems; cohort identification and usage; and display and integration of transactional and analytical data at the point of care.

“I like the two tracks a lot, it’s reflective of the reality while keeping the foot on the pedal,” said Christine Bechtel, vice president of the National Partnership for Women and Families, during a discussion preceding the vote. She said that patient experience data remain missing from the picture, but she is unsure if such data should reside within or outside the EHR.

“Thank you for the flexibility,” said Gayle Harrell, a Florida state legislator, in her comments. She added that the move away from core measures to greater flexibility in particular will aid specialists.

In response to concerns about a lack of regulatory overlap between multiple agencies, Burstin said much work remains to better align measures. “Cacophony without value needs to stop.”