During the Monday session on performance measurement and CDS, Paul Tang, M.D., vice president and chief medical officer of Palo Alto Medical Foundation and is vice chair of the federal Health IT Policy Committee, gave his perspective on the approach taken with Stage 1 meaningful use, and the direction for future stages.
Healthcare costs in the U.S. are two to three times what other developed countries spend, he said. “We can spend the money in a better way, especially when we compare it to our outcomes. We have an excess of mortality that we could have prevented with our current state of knowledge.”
Behind the scenes, in 2009 the Meaningful Use Workgroup and HIT Policy Committee only had six weeks to put together the framework of how to go forward with the meaningful use program, he said.
The first stage of meaningful use was to provide data in a structured way; the second was to pass it around people who needed it in a secure way; and the third was to have enough good information to report to provide feedback and continuously improve. One point that is often missed is that people talk about three stages, Tang said. There is no limit to the number of stages. There is no limit in how many stages can come thereafter.
The five categories that came with the first stage that is the subject of this framework are: quality, safety and efficiency of healthcare and to reduce the healthcare disparities; the ability to share health information with patients electronically, which will get more stringent over time; the exchange of information in care coordination; exchange of information in public health; and privacy and security.
Among the goals for meaningful use are to get information in coded form; CPOE; a better handle on populations; the ability to share patient information electronically and securely; and better care coordination.
“In care coordination, we understood then, and it’s true today, that we don’t have the mechanisms, standards, or the policies in governments in place to exchange information among partners,” he said.
The early returns were very encouraging. The slope of monies that is being dispersed will continue to rise, Tang said.
Tang mentioned highlights of HIT Policy Committee recommendations to HHS for Stage 2:
- There is a need to do more for the care coordination phase of the program.
- CPOE should be expanded beyond medication orders to other important domains, including lab test orders and radiology.
- Progress notes are being advocated to be part of the certification criteria. In Stage 1, the committee tried twice to get the progress notes as part of the objective.
- Discharge electronic prescribing-prescriptions will be pushed for in Stage 2.
- An enriched function for patient access to health data. “We instituted HIPAA electronically in Stage 1; and here we are giving them richer capabilities, not only to view it, but to download it, in a timely way, whether following discharge from the hospital or in an ambulatory setting,” he said.
- Secure online messaging. “If we are asking patients to take more responsibility for their health financially, you have got to give them the tools and the data to do that,” he said.
- Care coordination, which is still a problem area. Part of the problem is that there is no industry standard. “How do we ask for a care plan if people don’t understand what a care plan is?” he said. “With the increased attention to care coordination, we are trying to build towards having a common care plan. Our first recommendation for Stage 2, you must at least have a goal for a care plan, and you must have instructions.”
- Regarding care teams, the industry needs a little more time to uniquely identify all who would participate in care.
- Electronic care summaries.
- Population health. If the f your health department can accept it submit your information electronically.
- With the security, “We are trying to up the ante by making encryption part of meaningful use,” he said.