DIVURGENT

The federal HIT Policy Committee approved revised recommendations for “meaningful use” of electronic health records. The meaningful use workgroup of the HIT Policy Committee met for a second time on July 16, 2009 and has released its newest recommendations. Overall, the committee states that “the focus of meaningful use must be on objectively measurable improvement of health outcomes and actual effective use, not simply to promote the adoption of technology for its own sake.” Meaningful use of HIT is critical to the President’s and Congress’s agenda for health reform, which drives the urgency and the seemingly aggressive nature of the timelines. Thus, the alignment of the planned healthcare reform and meaningful use must be met in order to assure the success of health reform. Although extremely ambitious, the 2015 vision is achievable.

Vision for 2015
• Prevention and management of chronic diseases
o A million heart attacks and strokes prevented
o Heart disease no longer leading cause of death in the US
• Medical Errors
o 50% fewer preventable medication errors
o Health disparities
o The racial/ethnic gad in diabetes control halved
• Care Coordination
o Preventable hospitalizations and re-admissions cut by 50%
• Patients and families
o All patients have access to their own health information
o Patient preferences for end of life care followed more often
• Public Health
o All health departments have real-time situational awareness of outbreaks

Recommendations

Improve Quality, Safety, Efficiency; Reduce Disparities (Timing)
• If an organization cannot meet 2012, the 2013 criteria sets an even higher bar (“rising tide”)
• Recommendation – use of “adoption year” timeframe.
If a provider is not ready by 2011 to meet meaningful use, they can become meaningful users at a later time and still use 2011 criteria as their meaningful use standards for their first adoption year. In other words, a provider’s criteria for meaningful use would be according to adoption year 1 criterion, two years later they would use the 2013 criteria, no matter the start year.

• Computerized physician order entry (CPOE) too fast (primarily hospitals)
– Unintended consequence of trying to implement faster than feasible, considering workflow redesign pre-work
• Recommendation – Establish 10% threshold of CPOE orders for hospitals
• Accommodates pilots, implementations in-progress

• Start clinical decision support earlier
– It’s the payoff (faster)
– Need to implement EHR before turning on rules; also need to populate the database (slower)
• Recommendation – Start with one rule; make it important: “Implement one clinical decision rule relevant to high clinical priority”

Patient and Family Engagement
• Provide access to electronic health information (in addition to electronic copy)
• Included in 2011
• Moved up real-time access to patient information in PHR from 2015 to 2013

Efficiency Measures
• Initial starter set
• % of all medications entered into EHR as generic, when generic options exist in the relevant drug class
• % of orders for high-cost imaging services with specific structured indications recorded
• Claims submitted electronically to both public and private payers
• Eligibility checks performed electronically

Specialists
• General approaches discussed
– “500 criteria” model of something for everyone (yet, very few NQF-endorsed measures)
– “Critical few” model of build and prove out the necessary capabilities using exemplar measures
• Use of exemplar measures that would “exercise” the EHR capabilities and meaningful use of the capabilities to measure and improve care
• Require specialists’ participation in electronic registries (approved by CMS) as relevant and available

Improve Care Coordination
• Need better outcomes measures for care coordination
• NQF has a call for measures in care coordination (NPP priority)
• Propose 2013 measure of 10% reduction in 30-day readmission compared to 2012
• Improvement in NQF-endorsed measures of care coordination

• How to meet health information exchange in 2011 when HIE organizations do not currently exist or do not connect all clinical trading partners
• 2015 should include required participation in nationwide HIE
• Require capability and exchange where possible in 2011
• Defer to HIE workgroup for specific requirements and roadmap

Privacy and Security
• Clarify “under investigation”; could any complaint trigger “investigation”?
– Length of investigation could also potentially cause a missed payment (even if found “not guilty”)
• Intent was to disallow participation in HIT incentives if confirmed HIPAA violation goes unresolved
• Revised wording: “…recommend that CMS withhold meaningful use payment for any entity until any confirmed HIPAA privacy or security violation has been resolved”

• How can federal program “enforce” compliance with state privacy laws?
• Shift to Medicaid section: “…recommend that state Medicaid administrators withhold meaningful use payment for any entity until any confirmed state privacy or security violation has been resolved”

Future Work
• Refine 2015 achievable vision
• Refine 2013 and 2015 meaningful use objectives and measures
• Develop process for ongoing development and refinement of meaningful use objectives and measures
• Review barriers to broad adoption of meaningful use and provide recommendations, to the HIT Policy Committee, for removing barriers

Upcoming HIT Policy Committee Meetings:
• August 12, 2009
• September 18, 2009
• October 27, 2009
• December 15, 2009

Like you, I will be anxiously awaiting the final definition.

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