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LESLIE: At the end of April, the National Committee on Vital and Health Statistics (NCVHS) held a 2-day hearing as part of a process to define "meaningful use" for the adoption of certified EHR technology.
PATTY: I was impressed to read in the NCVHS summary report that more than 100 individuals provided oral and written testimony in an effort to define and clarify the term "meaningful use" as included in the American Recovery and Reinvestment Act (ARRA) of 2009. That is a lot of stakeholder perspectives to process!
LESLIE: It is a lot of testimony to read and listen to. I give kudos to the committee for ensuring a cross industry perspective on this topic.
PATTY: I understand that the Office of the National Coordinator (ONC) for Health Information Technology and Centers for Medicare and Medicaid Services (CMS) provided the questions that were used during the hearings. Their goal was to obtain varying perspectives, which ultimately fell into five main themes:
1. Vision for health and heath care transformed
2. Meaningful use capacity
3. Paths to meaningful use
4. Evaluation and ideal circumstances for product certification
5. Mechanisms for measuring meaningful use.
A summary of the 2-day hearing can be found at www.ncvhs.hhs.gov/090518rpt.pdf. The summary does not include recommendations at this time; however highlights and themes are included.
LESLIE: I noticed the summary included statements on the importance of training the work force on HIM skill sets -- in particular, skills related to "system redesign, workflow and process change, quality improvement and comparative effectiveness."
PATTY: That got my attention too. It's pretty clear to me the focus on skills needed for EHR adoption are becoming more commonplace discussions. The goal now is for HIM professionals to grab this opportunity and lead training efforts in their organizations.
LESLIE: I also think this is a golden opportunity for HIM academic programs to seek ARRA grants and establish or expand undergraduate and master's degree informatics and information management related curriculum, as well as develop certificate programs in HIM for the health care work force.
PATTY: I just finished reading AHIMA's comments on meaningful use made at the April hearings. AHIMA was represented by Sandra Fuller, MA, RHIA, FAHIMA, who provided testimony on AHIMA's position. AHIMA's testimony can be found at www.ahima.org/dc/CommentsTestimony.asp. The comments focused on the coordination of care, health information exchange (HIE) and the capture and use of data for quality and public reporting. I thought AHIMA represented these issues strongly and in an unbiased manner.
LESLIE: What were your takeaways from the AHIMA testimony?
PATTY: I liked how AHIMA urged NCVHS to apply the definition of "meaningful use" across the health care industry, thus avoiding the potential of providers being asked to document one way to meet ARRA incentive requirements and another way to meet payer requirements.
LESLIE: What a mess it would be if they create one definition under ARRA and other industry players use variations of this definition. It can happen. We see this with quality reporting. Each payer or agency has their own agenda, which makes it so complex and frankly costly for organizations to comply with quality reporting requirements.
PATTY: I think it was also good that AHIMA requested that NCVHS strongly consider leveraging the work already completed and/or in progress, particularly in the areas of standards development, EHR certification and HIE.
LESLIE: This work has been ongoing for several years and includes progress toward advancing coordination of care, information exchange and streamlining the collection and reporting of quality measures. I think our government would be remiss if they didn't tap into this work.
PATTY: Let's hope they heed that good advice.
LESLIE: I am glad AHIMA took a position on this. We can't take for granted that referencing completed work will automatically happen. Individual states and public and private groups have been actively engaged in defining effective EHR use through standards and certification work long before the term "meaningful use" was coined. Perhaps now, however, with added urgency, we can work that much more collaboratively to achieve consensus and move the work along more quickly.
PATTY: AHIMA also recommended that an incremental approach be used to measure meaningful use. This would enable providers and EHR vendors the capability to anticipate requirements.
LESLIE: As a practical matter, that makes sense. We live as such a quick-fix society that I hope the committee realizes that human beings need time to process, plan and mobilize their resources. As much as we need to solve personal HIM problems, I don't think we should take short cuts either.
PATTY: One example of an incremental approach was included in the Minnesota Department of Health testimony (www.health.state.mn.us/e-health/hitech/ht042909ncvhstestimony.pdf). I was impressed by Minnesota's statewide implementation plan and EHR adoption continuum. I think their plan is evidence of what an incremental approach might look like from assessing, planning and selecting systems to utilizing them effectively and ultimately exchanging data across the state.
LESLIE: I also liked the fact that their testimony described the work of the Minnesota e-health initiative in some detail. The e-health initiative is a private public collaboration developed in 2004 but likely got a boost from the 2007 Minnesota legislature when they set a mandate to achieve interoperability across the state by 2015. As part of their work, they developed a definition for "effective use." They define "effective use" as "adequately planned for, selected and implemented EHR systems are efficiently and properly populated and at a minimum, include:
• Addressing post-live organizational issues
• Using clinical decision support systems
• Providing quality reporting and improvement
• Support for population and public health status improvement"
PATTY: It's interesting that they don't mention information exchange in their definition given that it is their ultimate goal.
LESLIE: What are AHIMA's recommendations for the definition of "meaningful use?"
PATTY: AHIMA recommends that EHR's include five key components to meet the definition of meaningful use (Refer to AHIMA testimony for recommendation details):
1. Functional, transactional and data standards necessary for EHRs and HIEs
2. HIE that "preserves data integrity in a secure and accurate manner from one entity to another and from one system to another within the same entity"
3. Coordination of care information that include the following functionality/data:
a. Medication administration and e-prescribing
b. Laboratory orders and results
c. Discharge data
4. Secondary data use for:
a. Quality reporting - awareness that physician practices need more time before using EHRs to meet quality reporting measures; awareness that there is more work to be done to address the complexity of reporting systems, definition of quality reporting data sets, and the lack of EHR functionality for collection and reporting.
b. Public health reporting - need for coordination between providers and public health entities.
c. Administrative simplification - work toward achieving simplification using EHRs
5. Return on investment:
a. Prevention and detection of fraud - "Three to ten percent of health care spending, or $50 billion to $200 billion, is lost to fraud"
b. Use of existing processes for reporting meaningful use requirements - use of audit trails and transaction reports to automatically track meaningful use.
LESLIE: I like that the AHIMA testimony included additional recommendations related to fraud prevention and detection. So where do we go from here with the development of a definition?
PATTY: We can expect to see Health and Human Services issue a proposed definition, but the timing of that is not confirmed; it is speculated it should be by this fall. The goal is to have a finalized definition in 2009 as this drives decisions around EHR use incentive programs.
LESLIE: In the meantime, we can begin to engage providers in the dialogue and prepare ourselves for the biggest transition the HIM profession has ever experienced.
References:
A Statement by the AHIMA on Determining the Definition of "Meaningful Use" to the NCVHS, April 2009
Defining "Meaningful Use" in ARRA Posted By Kevin Heubusch on April 29, 2009 http://journal.ahima.org
"Meaningful Use" testimony on April 29th to NCVHS by Marty LaVenture, PhD, MPH Director, Center for Health Informatics & e-Health Minnesota Department of Health
National Committee on Vital and Health Statistics: Report of Hearing on "Meaningful Use" of Health Information Technology, April 28-29, 2009.
Leslie Ann Fox is chief executive officer and Patty T. Sheridan is president, Care Communications Inc., Chicago. They invite readers to send their thoughts and opinions on this column to lfox@care-communications.com or ptsheridan@care-communications.com.
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