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Status Report: HITPC and Workgroup Activities on HITECH Stages 2 & 3

 

OK, let me be the first to admit that today’s “just-the-facts-ma’am” post might be a little dry…but trust me, its really important stuff to know in understanding the process of how the Health IT Policy Committee (HITPC) and its workgroups are approaching formulating recommendations for HITECH Stages 2 and 3.

At this point at least two different workgroups are involved in developing recommendations for HITECH Stages 2 and 3.

  • A newly formed Quality Measures Workgroup. This group will “produce initial recommendations on quality measure prioritization and the quality measure convergence process pertaining to measure gaps and opportunities for Stage 2 Meaningful Use”. The group is chaired by Dr. David Blumenthal and held its first meeting on September 10.
  • The Meaningful Use (MU) Workgroup. Most recently, the MU Workgroup solicited expert testimony on Care Coordination (August 5) and Population Health (July 29).

Important recent HITPC and Workgroup activities are summarized below.

Quality Measure Workgroup — Report to HITPC (September 14)

Current status [of MU quality measures]

  • Stage 1 Meaningful Use contains 44 PRQI measures and 15 RHQDAPU Clinical Measures that have been retooled with electronic specifications.
  • Currently, measure development does not take advantage of robust clinical health information from EHRs.
  • A need to develop measures that are parsimonious, HIT sensitive, enable longitudinal measurement, across various settings of care, improve population health and reduce burden of care.

Meaningful Use Workgroup — Report to HITPC (September 14)

Timetable for MU Stage 2

  • Sep 22: Meaningful Use Work Group meeting to develop draft recommendations for Stage 2, including input/feedback from:
    • CMS final rule
    • Meaningful Use work group public hearings
    • Gretzky group report
    • Public input
  • Oct 20: Presentation to HIT Policy Committee
  • Nov/Dec: RFI for additional public input
  • 1-2Q11: Monitor Stage 1 submissions
  • 2Q11: Draft recommendations to HIT Policy Committee
  • Late 2Q11: Final recommendations to ONC?
 
Meaningful Use Workgroup Report on Care Coordination (August 5)
On August 5 the MU Workgroup held a hearing and solicited expert testimony on Care Coordination. Three panels discussed differing aspects of care coordination:
  • Current HIT Support of Care Coordination
  • Transitions and Care Coordination
  • Care Coordination in the Ambulatory Environment.

For more details, here are links to the agenda, expert bios and written testimony of the August 5 meeting, PowerPoint Summary presented to HITPC on August 19, and minutes of August 19 HITPC meeting (see pp. 2–4). ?

Here are a some key excerpts from the PowerPoint summary of the meeting.

Overall Assessment of Current Status

  • EHRs of today do not support many of the key needs of practices especially those focusing on enabling team care
  • Tremendous evolution underway today in how these processes are being managed
  • Leaders did report some best practices
  • Many minor issues with EHRs of today which can be addressed soon
  • But is an area in which additional change will occur

Key Functions of EHRs for Care Coordination

  • Reconciling medications
  • Tracking laboratory tests
  • Communicating across settings
  • Mediating care plans between disciplines

Key Domains of EHRs for Enabling Care Coordination

  • Medication-based care
  • Problem lists
  • Progress of patient over time
  • Population-oriented tools

Other Key Activities in Care Coordination

  • Referrals
  • Consultations
  • Care transitions

Overarching Recommendations

  • Include the ability to support an interactive and longitudinal care plan
  • Track who is on a care team-and share the information with the patient
  • Display and record for all patients who is the PCP and share with the patient
  • Aggregate data or messages and send it to all who need it
  • Support medication reconciliation including at least 4 functions
    • Importing medication data from other sources
    • Displaying and comparing medication lists
    • Ordering medications
    • Documenting that information
  • Transfer Summary Document–ensure that 9-11 elements from the Care Transitions Performance Set are included in transition recommendations (at least for discharges)
  • Not only provide summary but include ability to confirm receipt
  • Include advanced care directives

Specific Recommendations

  • Support longitudinal views, for issues like admissions including discharge diagnosis
  • Support the ability of multiple providers on a team to write notes and document simultaneously
  • Support the ability to designate who ordered the medication and who is allowed to refill it
  • Ensure that referrals include the question to the consultant
  • Make problems list sortable and searchable
  • Make the medication list sortable by organ system

Conclusions

  • EHRs today do not support needed care coordination activities well
  • But enormous variation in processes among practices
  • Doing well in this area broadly will be central to improving efficiency, safety, quality
  • Are a number of specific items that can be targeted for 2013 but evolution will be needed
  • Important area for further research

Meaningful Use Workgroup Report on Population Health Hearing (July 29)

The MU Workgroup held a hearing and solicited expert testimony on Population Health.  The overall theme of this public hearing was:

“What effects public health agencies should expect on population health as we move toward meaningful use of certified EHRs” Note: During the hearing,  the term “population health” is used almost synonymously with “public health”;  “population health” often has a broader meaning referencing the health status of a given population (e.g., a health plan population, the Medicare population, the population living in a specific geography).” ?

Three panels discussed differing aspects of population health:

  • Achieving population health through meaningful use: How do governmental public health (PH) agencies view the process to date?
  • Experiences and current status of MU-like projects: How do governmental public health agencies use MU-like criteria or measures to achieve population health?
  • Potential areas where the HIT Policy Committee consideration: Where should the committee focus its attention to support MU measure and criteria that complement the public health mission?

For more details, here are links to the agenda, expert bios and written testimony of the July 29 meeting, PowerPoint Summary presented to HITPC on August 19, and minutes of August 19 HITPC meeting (see pp. 1–2). 

Here are a some key findings from the PowerPoint summary of the meeting.

  • Concept of “one health”: it is all linked, including clinical care, personal wellness, and public health
  • Meaningful use criteria:
    • send-it-to-public-health button (case reporting)
    • dashboards for providers including quality indicators, preventive care status, environmental factors
    • clinical decision support that includes information from public health
    • report ability to download immunization data
  • Population health record (popHR) that informs health workers and clinicians about local disease rates
  • Bidirectional flow of information (e.g., for immunization)
  • Need for national data standards, especially use of CCD as common medium and use of LOINC for laboratory
  • How to create a truly longitudinal record, including clinical care, vital records, care delivered from within public health depts
  • Occupation as a key variable to assess risk
  • Importance of addressing privacy (maintain public trust) and patient identification (e.g., newborn screening ID)
  • Next generation health system that pulls together personal health records and public health

Still awake?  …good…this foundation will help us understand and dissect future progress on HITECH Stages 2 and 3.

This work is licensed under a Creative Commons Attribution-Share Alike 3.0 Unported License. Feel free to republish this post with attribution.

3 Comments

  1. Vince Kuraitis on September 15, 2010 at 6:39 pm

    kinda dry but important–Status Report: HITPC & Workgroup Activities on #HITECH Stages 2 & 3 http://bit.ly/dgB2lj #HealthIT #EHR



  2. CGCollaborative on September 15, 2010 at 8:21 pm

    Status Report: HITPC and Workgroup Activities on HITECH Stages 2 & 3 | e-CareManagement http://ow.ly/2EYK3



  3. CGCollaborative on September 15, 2010 at 8:21 pm

    Status Report: HITPC and Workgroup Activities on HITECH Stages 2 & 3 | e-CareManagement http://ow.ly/2EYK3