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Moving Forward on Meaningful Use

March 4, 2013
by John DeGaspari
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The View from the ONC and the experience of a provider organization

At the pre-conference session on Meaningful Use on Sunday, several speakers from the U.S. Department of Health and Human Services (HHS) and the private sector gave their views on Meaningful Use as an organizational initiative.

Standing in for Kevin Larsen, M.S., medical director, Meaningful Use, for the Office of the National Coordinator for Health Information (ONC), was Jacob Reider, M.D., the ONC’s chief medical officer. He spoke of the triple aim of Meaningful Use: better healthcare for the population, better healthcare for individuals, and lower costs through improvement. The only way to achieve this triple aim is to focus on all three, not just one, he said.

The role of the ONC is one of a coordinator, to set the stage for new care models of accountable care for Medicare, Medicaid, and commercial ACOs, a national quality strategy, and standards. He said the priorities of the national quality strategies is to increase safety, ensure person and family engagement, communication and care coordination, promote prevention and treatment best practices, promote  best practices for healthy living and make quality care more affordable.

At a high level, Stage 1 is about data capturing and sharing, stage 2 about advanced clinical processes, and Stage 3 about improved outcomes, he said. “We know we can’t do all at once,” he said.

While he acknowledged that many hospitals had serious problems during Hurricane Sandy on the East coast recently, those with HIT infrastructure off site or made use of the cloud were up and running more quickly.

He noted that interoperability and Stage 2 is about sharing data, and standardization is essential for making that possible. He compared healthcare under meaningful use as a beehive, a complex adaptive system that uses standard procedures to share information.

Blue Button is a set of standards whose concept is to allow patients to retrieve tbeir own health information. Roughly 300,000 CMS beneficiaries have downloaded their data to date. 

He said measures drive improvements, drive value-based purchasing, andwill inform consumers. Measures between organizations will allow them to compare results.

He said that when choosing an electronic health record system, provider organizations should make sure it’s useable. “Usability is not in the eye of beholder. Task completion should be high, and error rate should be low,” he said. People use smartphones because they are excellent tools and easy to use. That’s not a bad standard for EHRs as well. 

Liz Johnson is vice president, applied clinical informatics, at Tenet Healthcare Corp., a system with 49 hospitals and 117 outpatient centers in 39 states. She said Tenet has both purchased its EHRs and built its own enterprise data warehouse, and has had to certify both under meaningful use. Today it is taking our 30th site live.

In describing Tenet’s experience with meaningful use Stage 1 attestation, she said governance is critical. Every hospital has a steering committee, she said. She advised not losing sight of workflow. “If you put technology in place ands doesn’t work, it’s a wasted effort.”

Clinicians, represented by clinical advisory teams, are critical to the attestation process, she said. “We are doing CPOE, and it’s critical that clinicians be involved around the order sets.”

She said it was important for the hospital to assemble the right teams, hospital sponsors, physician champions, internal vendor and consultant teams, and clinical informaticists.

She said that infomaticists will be critical for the future, and at the end of the day they can improve performance. More hospitals are using clinical informaticists, and important to use them as go forward as hospitals rely on data analytics.

Overall, Johnson said the experience of preparing for attestation taught several lessons: the need to think about smart data, the need for a useable EHR, and need to think about workflow. “We work on this every day,” she said. “Make sure you have other people involved, and bring in everyone in the communication loop.” Tenet sends out newsletters to keep people informed about the attestation effort. Adoption has to be everywhere, including physicians, nurses, labs, and pharmacies, she said.