Wednesday, April 29, 2009

NCVHS Executive Subcommittee Hearing Defining "Meaningful Use"

The National Committee on Vital and Health Statistics (NCVHS) is an advisory body to the Department of Health and Human Services. The committee is considering options for defining "meaningful use" of Electronic Health Records (EHR) as it pertains to the Medicare and Medicaid financial incentives under the American Recovery and Reinvestment Act (ARRA).

I have been keeping up with the NCVHS Executive Subcommittee hearing for defining "Meaningful Use" by audio stream on the NCVHS agenda web site and via Twitter on the
NCVHS Meeting Twitter Stream (special thanks to Sherry Reynolds and Anthony Guerra who kept tweeting information. :-)

Also there is a great conversation going on at the John D. Halamka, MD, Life as a Healthcare CIO Blog. John proposed a potential basci meaningful use definition to “Processes and workflow that facilitate improved quality and increased efficiency.” You can also view Dr. Halamka's PowerPoint Presentation which gives an overview of his testimony.

Blackford Middleton M.D., corporate director of clinical informatics research and development at Partners Healthcare in Boston, said that "we should not set our sights too low" and risk hampering long-term advancements in quality.

John Tooker M.D., CEO of the American College of Physicians, said we need to make sure that the definition of meaningful use includes software certification from the Certification Commission for Healthcare Information Technology (CCHIT). I agree, and think that HHS will do well to build on the exisiting work of CCHIT and others.

Fred Trotter of Free/Libre and Open Source (FOSS) Health Software testified. He has extensive experience with FOSS in Health Information Exchange. He is currently the Chief Information Architect at HealthQuilt, which is a prototype HIE in Houston, Texas. Trotter asked why this meeting was even taking place and why it is necessary to provide incentive funding before an industry like healthcare would computerize. “We’re here because we’ve had a massive, catastrophic market failure,” Trotter said. Sellers of proprietary healthcare IT systems “have failed to provide a compelling option that doctors can buy.”

Judy Murphy, RN, FACMI, FHIMSS Vice President, Information Services Aurora Health Care, Milwaukee, WI testified as a panelist before the Executive Subcommittee on "Panel 6: The 'Glide Path' to Meaningful Use for 2011 and Beyond for Providers" in support of answering the big question: what path do we follow and how do we know when we’ve arrived?

During her testimony, this nursing leader discussed six key themes regarding the definition for “meaningful use” and the roadmap to achieve it:
  • Interoperability
  • Accessibility
  • Personal Health Records
  • Adoption
  • Measuring Success
  • Education

“Each theme incorporates one of my biases - a very strong patient point of view. Nurses, in general have this partiality. There are 2.9 million practicing Registered Nurses, who comprise 55% of the U.S. health care workforce. As the providers who spend the most time with patients, particularly in hospitals where we are the caregiver and patient advocate 24/7, we have always had a solid focus on seeing things from the patient’s vantage point.”

Micky Tripathi, president and chief executive officer of the Massachusetts eHealth Collaborative (MAeHC), spoke of the need for interoperability and expressed that Health Information Exchange (HIE) would be critical to the use of EHR's. He is also a member of the Board of Directors of MA-SHARE, a community utility service for state-wide clinical data exchange also in Massachusetts that has had great success.

Mark Leavitt MD, PhD, chair of CCHIT, testified at the National Committee for Vital and Health Statistics (NCVHS) Executive Subcommittee hearings on the topic of “EHR Product Certification” and “meaningful use” as they apply to the American Recovery and Reinvestment Act (ARRA).
You can download Dr. Leavitt’s CCHIT presentation for the NCVHS

Overall, I think that the meeting was good start and look forward to seeing future developments.

Tuesday, April 28, 2009

HIMSS Publishes 'Meaningful Use' Definitions

On Monday, April 27, HIMSS published its definitions of ‘meaningful use of certified EHR technologies,’ as outlined in the American Recovery and Reinvestment Act of 2009 (ARRA). HIMSS sent a cover letter, plus two definitions: 1) meaningful users of certified EHR technologies and 2) meaningful use for hospitals, to the National Coordinator of Health IT and the Acting CMS Commissioner, within the Department of Health and Human Services (HHS)

ARRA calls for multiple years of Medicare incentive payments to hospitals and physicians who meet the requirements of “meaningful use of certified EHR technology” (an electronic health record). To be eligible for the incentive payments, hospitals and physicians must use the technology in a meaningful manner; to exchange electronic health information to improve the quality of care; and, submit clinical quality measures – and other measures – as selected by the Secretary of HHS. Further, hospitals and physicians must meet the definition within a specified time frame, which as described in ARRA, must be made increasingly stringent over time by the Secretary.

Approved by the HIMSS Board of Directors, the definitions resulted from consensus-building effort with input from HIMSS members (73 percent of which work in end-user settings), and the public at-large. HIMSS represents more than 20,000 individual members and 350 corporate members.

In summary, HIMSS recommends the following:
  1. To ensure continuity, recognize CCHIT as the certifying body of EHRs.
  2. To achieve incremental maturation of “meaningful use,” adopt metrics that can be reasonably captured and reported beginning in FY11/2011,* and then made increasingly stringent using intervals of not less than two years. HIMSS’ definitions include specific metrics to enact, in phases, over a multi-year period.
  3. To bridge existing gaps in interoperability of health information, coordinate with HITSP and IHE to create new harmonized standards and implementation guides.
  4. Reconcile the gap between “certified EHR technologies,” “best of breed,” and “open source” technologies.

As noted in the letter, HIMSS believes that the Act has tremendous potential to improve the quality, safety, and cost-effectiveness of patient care.

*ARRA requires the hospital-focused definition to be effective FY11 (October 1, 2010). For meaningful users (physicians), the definition must be effective January1, 2011.

Thursday, April 23, 2009

EHR Adoption and HIT

David Blumenthal, M.D., M.P.P. was director of the Institute for Health Policy, Massachusetts General Hospital–Partners Healthcare System and Harvard Medical School — both in Boston. He has been named National Coordinator for Health Information Technology.

His NEJM article "Stimulating the Adoption of Health Information Technology" is well worth reading...

Monday, April 20, 2009

Patient Centered Medical Home Model

one of the better articles on Patient Centered Medical Home Model

Home Sweet Medical Home

New York is making $60 million in health information technology grants available to providers who follow the medical home model, which seeks to have primary care physicians manage all treatment, wellness plans and referrals for their patients.

HEAL NY Phase 10 - Improving Care Coordination and Management Through a Patient Centered Medical Home Model Supported by an Interoperable Health Information Infrastructure

HEAL Phase 10