Groups seek changes in meaningful use definition

Major healthcare organizations met a deadline last week to comment on a draft of a policy on “meaningful use” of health IT unveiled by the Office of the National Coordinator for Health IT. The policy is the cornerstone of the administration’s plan for using some $30 billion in economic stimulus funding to create a means for nationwide electronic health information sharing.

In general, the organizations said they wanted more flexibility in the criteria under which they would qualify for payments and more time to put new required systems in place.

In its initial draft, released June 16th, ONC proposed a three-stage timetable for healthcare providers to install IT systems that met the goals of meaningful use. Under the plan, providers would have to show by 2011, 2013 and 2014 that they had used health IT to accomplish specific performance goals for sharing electronic health information and reporting quality data.

National health IT coordinator Dr. David Blumenthal said he expected to discuss revising the criteria for those goals at the next meeting of ONC’s Health IT Policy Committee, which is scheduled on July 16th.

Below is a summary of comments on the draft policy from several healthcare interest groups:

American Health Information Management Association

The meaningful use definition needs to align with other data measures providers are putting in place. The healthcare industry is already working on technical standards for future electronic capture and reporting of quality measures that may overlap with meaningful use reporting requirements for 2011. Providers also must comply with mandates affecting health information processes for HIPAA transactions in 2012 and diagnosis and procedure coding in 2013. The national health IT coordinator’s office needs to provide precise data element level definitions and reporting guidelines, including detailed cross-walks to National Quality Forum endorsed measures.

Certification Commission for Healthcare IT

CCHIT’s current certification criteria for electronic health records already supports more than half of the 22 meaningful use draft objectives for 2011 and seven proposed for 2013. With some adjustments, the 2011 meaningful use objectives are achievable based on current electronic health record technology. However, the meaningful use measures should be simplified for 2011 or delayed until 2013. This is because only a small percentage of providers would be able to qualify for incentives because of the time to deploy a system, and the proposed measures focus on the highest cost diseases, which only a subset of providers treat. Measures that are tailored to many specialties and settings could be developed during the intervening time.

College of Healthcare Information Management Executives

The meaningful use definition should identify a total number of required functions as its final goal and let providers be flexible in sequencing these functions for each of the milestone years. Providers may have different reasons for their sequencing, and the defined number of elements they would pick to accomplish each year should be based on improving success for that particular organization. The 2011 objective for CPOE use should also be clarified. The technical readiness for CPOE is easier than getting physicians engaged. CPOE requires cultural transformation, resolution of operational issues to support dual processes and sustaining changes in workflow that will continue after the incentive program ends.  

Healthcare Information and Management Systems Society

The criteria needs to more clearly distinguish between hospitals and physician practices, with separate objectives and a progression of measures for each setting. Some will begin implementation later in the incentive period than others. If a provider has not already made a health IT selection, it will be “almost impossible” to meet the 2011 criteria. Smaller practices and facilities will not be able to financially comply with the recommended quality reporting metrics. Qualifications for incentive payments should be dependent upon meeting the measures, not verification to meeting the specific objectives.

Markle Foundation Connecting for Health

The measures incorporated into meaningful use must be focused tightly on the goal and make the most of the timelines for financial incentives with technology and process adoption. Some requirements should be accelerated to align with the front-loading of the financial incentives. In the draft, the timeline for the “achievable vision” goals culminates as the incentives will be phasing out. Broader reforms need to pick up where the economic stimulus leaves off, such as rewarding better health outcomes or slowing costs.