At the Jan. 8 Health IT Policy Committee meeting, Farzad Mostashari, M.D., national coordinator for health IT, and Paul Tang, M.D., vice chair of the committee, outlined some priorities for the year ahead, including a glimpse of what Stage 4 of meaningful use might address.

Stage 1 of meaningful use was defined as getting data structured; Stage 2 about getting it where it is needed in the health system; Stage 3 is about measuring and improving outcomes. “You might think of Stage 4 as moving toward the learning health system,” Tang said, “for both professionals and patients, so that we make better and better use of data.” That includes how to incorporate patient-generated data, shared care plans and observations of daily living and encouraging the active participation of patients in their care as well as support of continuous learning for healthcare professionals. “It’s a big lift and we have to start thinking about it,” Tang added.

Mostashari put ONC’s work for 2013 and 2014 into three buckets.

The first is continuing to work on the meaningful improvement of the implementations and optimization of tools already in place. “How do we optimize the design of our technology and implementation of meaningful use to become a health system of learners?” he asked. “It will involve the triad of population health, decision support, and quality measurement, including dashboards and registries.”

The second area involves meaningful interoperability and exchange of data. ONC will continue to focus on getting the building blocks in place for HIEs and overcoming technology and policy challenges.  It will also take into account the emerging business needs of the healthcare partners and look at policy levers in conjunction with payers and providers to “help improve and increase the business case to exchange data rather than hold it in silos.”

The third area of focus is consumerism in healthcare. ONC will look at enabling consumers’ access to their own medical records as well as the ability to take action on that data, he said. This will also require paying attention to the accompanying shift in providers’ attitudes as consumers become partners. As ONC focuses on all three of these areas, Mostashari added, it must be vigilant about fostering innovation and maintaining a vibrant marketplace in technology.

The meaningful use workgroup will make its Stage 3 draft recommendations in the first quarter of this year and its final recommendations in the second quarter. From the Policy Committee meeting’s Powerpoint slides, here are the detailed areas of focus ONC’s work groups intend to address in 2013:

Meaningful use

• Meaningful Use of HIT to support health and healthcare

• Recommendations to HHS about MU3 objectives, criteria, and clinical quality measures

• Preparing for MU4 – towards a learning health system

• Creating a shared health record

• Patient-generated data

• Shared decision making

• Clinical documentation

• Safety-enhanced design of EHRs

Measuring clinical quality

• Facilitating supply of de novo quality “measures that matter” to leverage clinical data from EHRs and PHRs

• Facilitating incorporation of flexible platforms for measuring and reporting QMs in HIT systems

• Role of data intermediaries and their sustainability

• “Near real time” clinical quality dashboards for practitioners

• Connections to clinical decision support – drivers and feedback

Health information exchange

• State of the field and best practices

• Role of HIE in new payment models

• Facilitating greater exchange across organizational and geographic boundaries through policy and certification levers and standards development

• Governance models and principles to facilitate HIE

EHR safety

• Safety Plan Review

• ONC HIT Safety Action and Surveillance Plan

• Leveraging MU and certification to improve safe use of EHRs

• Other ONC activities to improve safety

Privacy areas

• Patient identities in cyberspace

• Consent and control of information in automated query/response exchanges

• Challenges of implementing minors’ rights in cyberspace

• Personal representatives

• Cloud computing

• Right of access in electronic world

• Patient-generated data

Consumer empowerment

• Managing and using patient data

• Blue button – ongoing access

• Combining and sharing data from multiple sources

• Data overload – for patients and providers

• Reconciliation of data

• Protecting downloaded patient data

• Shared decision-making.

New models of care

• Accountable care.

• Supporting population management

• Longitudinal data and shared care plans across the continuum, including wellness

• Supporting new payment models

• Medicare Shared Saving Program requirements

Emerging areas

• API for innovation

• Quality Improvement Plan Review

• Supporting Patient-Centered Outcomes Research and PCORI

• Meaningful use support of continuous learning for healthcare professionals (e.g., Maintenance of Certification).

• Leveraging “big data”