Tuesday, May 5, 2009

More Meaningful Use

My colleague Micky Tripathi testified to NCVHS about meaningful use on April 29. His major points included:

1) We need substantial implementation support and significant resources for health information exchange if we are going to achieve meaningful use. The Regional Health Information Technology Extension Centers (RHITECs) are ideal organizations to assist with these issues.

2) ARRA currently delivers incentive payments directly to clinicians. These payments should be shared with RHITECs, which will assist clinicians with implementation of EHRs. Otherwise, RHITECs will bear the burden/expense of implementation but the physicians alone will be paid for meaningful use.

3) We should use Health Information Exchange activity measurement as a “sufficient statistic” for meaningful use. We should require basic clinical summary exchange through authorized health information exchanges, and require quality measures/public health reporting to be sent to authorized data aggregation entities. If a physician is accomplishing these, then we do not need to measure at the EHR-level because they could not accomplish these things without meaningfully using the EHR.

Also, for completeness, here is the meaningful use statement from the College of Healthcare Information Management Executives (CHIME), also submitted to NCVHS. Sharon Canner from CHIME added a clarification to this testimony:

There is an error in our statement, discovered late in the process. The statement should have read “HL7 Continuity of Care Document (CCD).” CHIME Prefers the CCD; however, it may be a stretch for some hospitals initially.


GreenLeaves said...

I like Micky's third point about making HIE part of meaningful use. The only thing I would add to that is having a metric on what types of data are being exchanged.

Summary data may not be sufficient. We should make sure that we don't miss the opportunity to structure meaningful HIE nationally.

Deborah Kohn said...

And I like Micky's first and second points - about the need for substantial implementation support for not just health information exchange but also for clinician / hospital "certified" EHR adoption.

I strongly believe the RHITECs are ideal for both. However, as important as they are for adoption and attaining "meaningful use", they are woefully underfunded in the HITECH Act.

Dr. H, in a recent webinar you suggested that, perhaps, ONC (through their HITECH reserves) fund the RHITECs (as well as deploy cloud computing....). And, today you wrote that Tripathi suggested tying the RHITECs to the incentive payments. I hope one or both of these suggestions (or others) gets adopted or we might end up with only a handful of these important RHITECs in the entire country!!!

Unknown said...

Within MIcky's statement is a value for outcome and an ethic to create a "practice" of meaningful in network.

I listened carefully to the meetings on line and had difficulty with some of the questions and presentations, because the value I just described was not present by representatives of commercial health care interest who have the attitude that meaningful use is something being imposed, rather than approaching meaningful use to learn and apply that learning to a system of thought based in total quality.

I see the idea of non profit regional health information networks as an opportunity to facilitate programs that take into account the diversity of its stakeholders and aligns the stakeholders to learn that their needs can be met and a regional agenda for total quality can be authored and put into practice.

I believe HCR has taught us that there are natural clashes that will continue to occur when you convene people who work for government, commercial interests, academic institutions and advocacy organizations and work to set an agenda with people representing all these sectors.

I see real opportunity to translate meaningful use through stories and scenarios that describe improvements to practice and establishing a team based practice management system in small physician practices focused on serving the patient while the expert culture that supports total quality review and more convenes to map out an agenda and priorities they can carry out if practice management promises quality data input and adoption of all methods of technology use in a way that serves the patient and supports translational medical practice.

I don't believe the second stage of community and system development within a regional network can occur until clinicians find relevant benefits to how adopting this practice can be advantageous in the process of delivery of care and something that is not a disruptor they have to think about.

Much of what inspired Mayo Clinic and UCLA Medical Center to pilot adoption of tele-medicine practices in rural settings or by creating global outreach for their most complex specialties was based on thinking like this.

These projects drew concretely demonstrated the possibility of what was learned in the early stage of LCS COSTAR adoption on an ambulatory care basis at Harvard Community Health Plan.

In the early days of COSTAR the greatest benefit was achieved in decreasing the obstacles between clinician practices for obtaining test results and assuring the proper preparation of a patients record, information and lab reports for referrals.

To me what I just described supports and paints a picture of what I believe to be real meaningful use.

I know this kind of practice can be expanded adopting a more sophisticated use of health informatics schemes and search engines that can deliver information to a patient chart on the most current clinical trials and completed research by diagnosis. Creating a health culture that is receptive to these practices in the long term, I believe will be the role of the regional network groups.

I hope as a lay person skilled in IT, health informatics and social media, I can help contribute. My mission and personal passion is an outgrowth of interest to contribute to a patient centric -medical home culture where EMR is designed to serve the patient in any stage of life responding to any care need from cradle to death.

I believe this view embraces the new reality that care can no longer be hospital based and must build a culture that understand how to serve a chronically ill population of people who need care that supports them to go to work and be live independently and not become disabled without community driven access that insures them what they need based at home to institutional response and their inability to live independently.

I think this view too easily gets hidden in the HCR debate, obstruction by the naysayers and the bravado of pushing EMR into adoption.