Among the chief complaints lodged against the meaningful use incentive program is the fact that there is little time built into the regulatory schedule for feedback from one stage to inform the development of the next. For instance, as the Health IT Policy Committee members met to discuss Stage 3 options, it was too early for them to get any input from providers on Stage 2 progress. And although they approved moving forward with Stage 3 proposals, several Policy Committee members expressed their desire to wait for attestation experience from Stage 2 before proceeding with recommendations on Stage 3.
Recognizing this problem, the federal Agency for Healthcare Research and Quality (AHRQ) has a dozen grant projects under way to inform Stage 3 meaningful use requirements. These projects are designed to produce results by June 2014 that will be taken into consideration during the regulatory process to shape final meaningful use objectives. The projects will propose strategies for improving the proposed objectives at the policy level as well as EHR innovations that would support meeting the proposed objectives, and suggestions for primary care practices to increase the value of meaningful use objectives.
For instance, one project targets the proposed requirements in Stage 3 that focus on care coordination and patient and family engagement. The project team will work with medical practices and hospital settings affiliated with University of North Carolina Health Care and Vanderbilt University Medical Center to obtain feedback from hospital and ambulatory clinic sites about the EHR innovations needed to support the objectives, and the anticipated value provided to organizations from these objectives.
According to the grant, 10 sites that implemented EHR capabilities prior to September 2013 related to the proposed objectives will be recruited for this project, five each focused on either patient and family engagement or care coordination. In addition, focus groups will be conducted at two regional extension centers, one in North Carolina and one in the Washington, D.C., area. Following data collection and analysis, findings will be synthesized in a final report and presentation. This input is intended to ensure that the Stage 3 objectives are valuable to both patients and providers as they seek improved quality, safety, efficiency, and effectiveness of care.
Another project is looking at the exchange of immunization information. Columbia University’s “Data Exchange of Vaccine Information Between an Immunization Information System and Electronic Health Record” (DEVISE) will assess the impact of immunization exchange from a regional immunization information system to a local EHR on under- and over-immunization of low-income urban children and adolescents. It will also assess the impact of immunization exchange from a regional immunization information system to a local EHR system on completeness of documentation of immunization status in the EHR.
Still another project being conducted at Northwestern University is studying best practices for integrating clinical decision support into clinical workflow.
In addition to these studies, the Meaningful Use Work Group is scheduling listening sessions to gather more impressions from EHR users that will help it respond to the Notice of Proposed Rulemaking from CMS this fall. The Stage 3 requirements will go into effect in 2017.