EHR clarification shows room for improvement in ARRA

Mary Stevens, Editor

Congress passed the Continuing Extension Act of 2010 earlier this week. As widely reported, the bill extends unemployment insurance and postpones the 21 percent cut in physician reimbursement under Medicare until June 1. Another section of the bill has received less coverage, but is just as significant for a multitude of practitioners—the “EHR Clarification” language for qualification for clinic-based physicians.

Section 5 of the Continuing Extension Act amends the ARRA definition of hospital-based Eligible Professional, striking “in-patient or out-patient” setting, and replacing it with “in-patient or emergency room setting.” As a result, physicians practicing in an outpatient setting can now be eligible for the ARRA incentive program for HER implementation.

Health IT organizations including HIMSS, CHIME, AMDIS and others have pushed for this change, and this more inclusive definition of physician eligibility will likely encourage EHR adoption. Stay tuned as the questions over the ramifications of this “Clarification” start to emerge.

On another EHR front, a recent report calls for meaningful use measures for EHRs to include assessment of patient experiences as well as the currently proposed measures for clinical quality. EHRs that directly engage patients and families represent a platform for improving access to care, empowering patients and supporting care between office visits, according to Dr. James D. Ralston, from Group Health Research Institute, Group Health Cooperative in Seattle, along with his colleagues.

You can’t improve what you don’t measure, the old adage says, but measuring is only the beginning. In a recent HIMSS-sponsored webinar, Louis Diamond, MBChC, vice president and medical director for Thomson Reuters Healthcare and Science summarized: “We cannot only focus on quality measurement … Measuring is essential but not sufficient to improve quality.”  

The 2009 AHRQ’s 2009 National Healthcare Quality Report bears this out. According to the report, the quality of U.S. healthcare is improving, but slowly, especially in the areas of preventive care and chronic disease management. Subjects including patient safety and hospital-acquired infections merit urgent attention if the U.S. is to achieve higher quality healthcare in the near future.

In terms of patient safety, the findings are “disturbing,” according to the report. Rates of healthcare-associated infections are not declining. The silver lining? “Care delivered in hospitals improved at an annual rate of change of almost 6 percent, which continues to be the highest rate of quality improvement among the major healthcare delivery settings,” the report found.

Where there’s room for improvement, there’s also an opportunity.

--Mary Stevens, Editor
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