Reaching for the sky
Work group: Meaningful users should aim high, but don’t have to be perfect
The federal incentive payment program for the meaningful use of electronic health-record systems is set up to require providers to meet increasingly high targets through each of the program’s three stages. As providers await the CMS’ release this summer of the final rule for Stage 2 criteria, what can they anticipate down the line? How high will the bar rise to define success?
According to a panel charged with advising the federal Health IT Policy Committee on meaningful-use criteria, that meaningful-use bar won’t hit the ceiling.
“One of our principles is not topping out,” said Dr. Paul Tang, vice chairman of the federal Health IT Policy Committee and co-chair of the meaningful-use work group that met last week.
There should be an upper limit short of perfection, or less than 100%, of whatever metric is being measured—for example, recording a patient’s vital signs electronically, according to the panel.
“We sort of stopped around 80%,” Tang said. “There’s always going to be legitimate reasons why we can’t get to 100%.”
Through June, 3,388 hospitals and 108,308 office-based physicians and other so-called eligible professionals have shared nearly $6.2 billion in Medicare and Medicaid EHR incentive payments through programs created by the American Recovery and Reinvestment Act of 2009, according to CMS data.
The Medicare program recipients were paid after attesting they had met Stage 1 criteria for meaningful use of an EHR system. At deadline, the Stage 2 final rule was under review by the Office of Management and Budget.
Tang and other work group members were reviewing feedback from the full policy committee on its initial draft of recommendations on meaningful-use criteria for Stage 3, which isn’t expected to take effect until at least 2016.
Work group members let stand their recommendation that “100% is always the goal from a policy perspective,” but “80% is the bar we want to set.”
For a provider to fall short of 100% by a percentage point or two and lose a payment or to be encumbered by the need to seek waivers would be detrimental to the program, which aims to improve the quality of care and lower healthcare costs through health IT adoption and use, Tang and his work group colleagues concluded.
Their discussion of the upper limits of effective measurement came as members reviewed recommendations on several specific criteria that require percentage calculations, including a requirement that providers use their EHRS to record changes in a patient’s vital signs, including blood pressure, height, weight and body mass index.
The Stage 1 meaningful-use requirement is that vital signs be recorded in an EHR for 50% of patients ages 2 and older.
The Stage 2 proposed rule, published by the CMS in March, pushed the vital signs target up to 80%. But that’s where it should stay for Stage 3, the work group recommended.
If a provider is capable of achieving 80% of a compliance target, they are capable of doing more—and probably will, Tang said. “People don’t stop and say let’s don’t go beyond 80,” he said. The work group reviewed 51 proposed criteria types. One of those criteria, under the broad category of leveraging health IT to better engage patients and their families in the care and wellness process, addresses the advent of accountable care organizations and patient-centered medical homes. It seeks to leverage home and mobile-health technologies to generate patient data that is communicated to and stored in providers’ EHRS.
For example, it would require that hospitals, physicians and other EPS give at least 10% of their patients the ability to send to a provider’s EHR one or more type of patient-generated information. That would include a patient’s family health history, functional status, blood glucose level, blood pressure or weight.
Much of patient input in the medical record of the future is expected to come from personal health monitoring applications on smartphones and tablets, according to mobile health experts. (See story on p. 30.)