At its Oct. 20 public meeting, the Health IT Policy Committee stepped back from looking at specific measures to include in Stages 2 and 3 of meaningful use requirements and instead discussed broader conceptual approaches.
Paul Tang, M.D., vice president and chief medical information officer with the Palo Alto Medical Foundation in California and co-chair of the committee’s Meaningful Use Work Group, led the discussion of whether Stage 2 should simply add incrementally to the process measures introduced in Stage 1 or whether it should begin a migration to health outcome measures that would be fully defined in Stage 3. In seeking comments on the idea from the full committee, Tang noted that focusing on outcome measures might allow for greater freedom to innovate if providers are less focused on measuring structures and processes. Examples of outcome measures enabled by health IT might include reducing prescribed major drug interactions (for prescribed drug categories) by a certain percentage or reducing 30-day hospital readmission rate by 10 percent. “This could represent the best of both worlds in that it requires the health IT capability but leaves it to the provider on how to get there,” Tang said.
Tang asked the committee to consider if next year the Office of the National Coordinator for Health Information (ONC) were to specify Stage 3 outcome measures for 2015, what should Stage 2 look like to introduce an outcomes orientation?
Some committee members seemed wary of a shift to outcome measures. David Bates, M.D., chief of the Division of General Internal Medicine and Primary Care at Brigham and Women’s Hospital in Boston, said he was nervous about the committee trying to establish outcome measures by 2015. “Outcome measures take a long time to develop,” he noted. He said health executives in the United Kingdom have been trying for several years to develop measures but have been having trouble defining them. “I think it would be risky to put all our eggs in the outcomes basket,” Bates said.
David Blumenthal, M.D., the national coordinator for health IT, acknowledged several comments about outcome measures having to take into account variations in baseline status of health providers and whether you are measuring percentage improvements or the ability to meet specific thresholds. He also said it wouldn’t be enough to focus solely on outcomes because other issues such as privacy and security still must be taken into account. But he noted that if ONC takes the route of just adding on to Stage 1 functionality requirements, it may lead to too great a proliferation of specific metrics that “collapse under their own weight,” and ONC would be accused of micro-managing the efforts of community health centers and hospitals.
At the end of the discussion, there was little clarity about how the Meaningful Use Work Group would proceed to resolve the tension between continuing to develop process metrics vs. actually measuring health outcomes.
Noting the diversity of opinion on the topic, Tang quoted Yogi Berra, and said the message from the committee might be “When you come to a fork in the road, take it.”