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MU Stage 2 Work Begins

September 14, 2010
by David Raths
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Policy Committee Discusses ‘Health IT-Sensitive’ Clinical Quality Measures

Healthcare CIOs may be excused for trying to catch their breath after a year of following the federal government’s path to Stage 1 of meaningful use rules. But, of course, that effort was just the first lap in a longer race, and the public hearings on Stage 2 begin next week.

On Sept. 22, the federal Meaningful Use Work Group will hold a meeting to begin developing draft recommendations for Stage 2. Topics under consideration include patient engagement, health disparities, public health reporting and care coordination.

The work group will present initial recommendations to the Health IT Policy Committee on Oct. 20, seek public input in November and December, and make final recommendations to the Office of the National Coordinator in the second quarter of 2011.

At a Sept. 14 Health IT Policy Committee meeting, David Blumenthal, M.D., the national coordinator for health IT, said Stage 2 would follow a path similar to one taken during Stage 1. In the interim between the policy recommendations and the Centers for Medicare & Medicaid Services (CMS) draft final rule, there would be plenty of time for public comment. “There will be time to learn more about experience with meaningful use Stage 1 before we finish the second iteration,” he said. “We will again use the Policy Committee’s recommendations as a signaling mechanism and set some directions, but then take advantage of experience and public input in modifying those recommendations.”

The Meaningful Use Work Group’s efforts will be linked closely to the work of another work group focusing on clinical quality measures that can be derived from electronic health records. To date, measure development has largely been based on claims data and chart abstraction and hasn’t taken advantage of a robust clinical IT environment. The Quality Measures Work Group is seeking to identify measures that are health IT-sensitive, enable longitudinal measurement across various settings of care, improve population health and reduce the burden of care, explained David Lansky, Ph.D., president and CEO of the Pacific Business Group on Health and co-chair of the work group.

Lanksy’s presentation of the group’s charter was followed by a lively discussion of its goals. Neil Calman, M.D., president of the Institute for Family Health, noted that there is a big distinction between quality measures used for public reporting versus those used for internal quality improvement. “If you get into comparing providers, one to another, you get into an abyss around risk adjustment,” he said. “Physicians will say, ‘These really aren’t my patients,’ or ‘They don’t come back when I tell them to.’”

Paul Tang, M.D., vice president and chief medical information officer with the Palo Alto Medical Foundation in California and co-chair of the Meaningful Use Work Group, agreed with Calman that the measures developed should be the type that seeks to focus on internal quality improvements, although they would be reported to CMS to verify meaningful use of health IT. He said that measures developed for public reporting purposes have different goals and implications and involve a political context and cultural pushback from providers. “Measures that help improve quality locally should be our immediate target,” he said.

“We have to do creative work around metrics that are useful for quality improvement,” Blumenthal responded. “Reporting does have an effect on providers. No one wants to be in the bottom 10 percent. When good data are reported, providers respond.”