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Deconstructing the "Hidden" MU Requirements for Physicians

February 8, 2011
by Mark Hagland
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Interview: Jane Metzger, Principal Researcher, Emerging  Practices, CSC

A new report from the Falls Church, Va.-based CSC, “Physician Quality Reporting: The Hidden Requirements of Meaningful Use,” examines the many issues facing physicians and physician groups as “eligible professionals,” as defined by the Healthcare Information Technology for Economic and Clinical Health (HITECH) Act, move forward to pursue meaningful use under that program. The report’s authors, Jane Metzger, principal researcher, and Jared Rhoads, senior research analyst, are both members of the Waltham, Mass.-based Emerging Practices team at CSC. They conclude, just as they had when they analyzed meaningful use requirements in the inpatient sphere last year, that the MU requirements in the outpatient sphere are also far more complex and challenging than might appear at first glance.

HCI Editor-in-Chief Mark Hagland spoke recently with Jane Metzger regarding the results that she and Jared Rhoads articulated in their report, and explored the implications for providers. Below are excerpts from that interview.

Healthcare Informatics: What are the fundamental complexities underlying the ostensible meaningful use requirements for physicians under HITECH?

Jane Metzger: The basic answer is that you need a lot of data for quality measures that you won’t have in your EHR [electronic health record], even if you’ve met the Stage 1 requirements under meaningful use. And that message is the same with physicians, as it was when we studied hospitals. Now, the situation is the same, because the hospitals have to do 15 measures, but on the EP [eligible provider] side, it’s much more complex, because each EP has to do three core measures and three from the menu.

What’s more, the perspective we took was of that of the large medical group, and we figured, if it’s a multispecialty practice, by the time you’d pick the measures that are relevant to the different specialties, you’d end up having to satisfy most of the measures. So assuming that it’s a big medical group, the question we were trying to answer was, basically, what are the data capture challenges involved in meeting the measures?

And that’s an important distinction, because for an individual EP, there would be six measures. And one thing that the analysis we did shows is that you need to be thinking about the data capture that you’ll be doing for meaningful use, as you pick measures. So if you’re not going to do lab results in Stage 1, there’s a whole bunch of data you won’t be capturing.

And you’ll either have to do different measures, or figure out a way to get that data in. And the manual alternative would be pretty amazing, and I would argue, to the point of impracticable. So if we were a medical group setting out to figure out this puzzle, we’d want to be thinking about the quality reporting requirements, and how we’re going to meet the other functional requirements, in a meaningful, strategic way.

Jane Metzger

HCI: That speaks to a number of sub-issues, obviously.

Metzger: It does indeed, For example, it turns out that medication reconciliation is also going to be pretty important, because that’s how you find out about the meds that aren’t in the EHR, but that the patient is on. The reality is that, even though a lot of people thought, oh, we’ll get to quality reporting eventually, our major conclusion is that you’d better be thinking about quality measures as you develop your Stage 1 plan. Just to take one example, there are a lot of quality measures that use lab results; and for the measures you do pick, you’d better be sure you have all the data.

The other conclusion is that there’s a lot of data that is needed for the quality measures that won’t be captured through the inpatient EHR, because there isn’t really a structured designed into the EHR to make capturing that data easily. Fortunately, there is one element in the ambulatory EHR that is useful in this context, and it’s called the health maintenance profile.

Vendors and medical groups have relied on the health maintenance profile for years, and physician practices have been making use of it for years. And the health maintenance profile provides, for any given patient, a view of what health maintenance and disease management guidelines apply, and it translates those guidelines into measures.