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Washington Debrief: Federal Policy Committee Mulls Stage 3 Comments

February 11, 2013
by Jeff Smith, Assistant Director of Advocacy at CHIME
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Jeff Smith, Assistant Director of Advocacy at CHIME

Federal Policy Committee Ponders Stage 3 Strategic Direction The federal Health IT Policy Committee met for their monthly meeting this past week in Washington and Meaningful Use Stage 3 was back on the agenda. In under a month, ONC staff culled through more than 500 comments submitted to the Policy Committee that underscored concerns regarding the timing of Stage 3, the growing list of competing priorities for providers and a feeling that more interoperability limitations needed to be addressed.  After walking though comment overviews on all the measures and objectives, quality measurement questions and privacy / security questions, the Policy Committee took a step back to think more broadly about how Stage 3 could be approached.  A host of strategic suggestions were made, including comments that Stage 3 (1) needs to be more flexible in determining how health outcomes are improved; (2) should look to enable innovation; and (3) that maybe standards and certification timelines could be separated from provider timelines.  National Coordinator, Farzad Mostashari, M.D., wondered if incentives aren’t the best way to drive change, perhaps a star-rating for Meaningful Use could be developed that used a regulatory floor, but then created competition among peer providers to achieve greater levels of Health IT-enabled care delivery.

In providing the Health IT Standard Committee’s view, chair John Halamka said the main concern was that much more work had to be done to develop mature standards and implementation guides.  He said standards and interoperability for many functionalities and clinical procedures are still catching up to aspirations.

In related news, Policy Committee chair Paul Tang said that a report based on hearings held last week on barriers to health information exchange would be produced in March and that another hearing was planned for next week to look at issues surrounding clinical documentation.

CMS Looks to Align PQRS, Meaningful Use and Several Non-Federal CQM Programs The Centers for Medicare & Medicaid Services (CMS) is looking for information on how physicians and other eligible professionals might use clinical quality measures reported to non-federal programs to satisfy reporting requirements in the Physician Quality Reporting System and Electronic Health Record Incentive Program.  CMS is hoping that stakeholders can provide information on how data reported to the American Board of Medical Specialties, clinical data registries, regional health care quality organizations and other non-federal reporting programs may be similar, different or duplicate reporting requirements for clinical quality measures in the federal programs. The request for information will be open for public comment until April 8.

CHIME’s Policy Steering Committee is currently looking at the RFI and will be issuing a response to CMS in the coming weeks.  Stay tuned!

AHRQ Releases Updated Guidance on Children’s EHR Format The Agency for Healthcare Research and Quality (AHRQ) has officially outlined a redesign for pediatric EHRs, calling on vendors to improve functionality and customization features.  To address these needs, the Format includes a minimum set of data elements and applicable data standards that can be used as a starting point or checklist for EHR developers seeking to create a product that can capture the types of health care components most relevant for children. The child-specific data elements and functionality recommendations are sorted into various topic areas, including:

1.    Prenatal and newborn screening tests

2.    Immunizations

3.    Growth data

4.    Information for children with special health care needs

5.    Well child/preventive care

The project was developed by a host of organizations, including the University of Maryland’s Center for Health Information & Decision Support and will be piloted in two states – Pennsylvania and North Carolina – to use in their CHIPRA programs.

Doc Fix Price Tag Decrease Means Permanent Fix Prospects Increase For “doc-fix” observers, this past week was busy in Washington.  First, the Congressional Budget Office  revised estimates of how much the sustainable growth rate will cost to fix.  According to CBO, a projected $138 billion will be required – not the $300+ billion previously projected – to offset the scheduled pay cuts to provider reimbursements.  Then, a bipartisan bill, sponsored by Reps. Allyson Schwartz (D-Penn.) and Joe Heck (R-N.V.), was introduced that would use so called, “war-savings offsets.”  Finally, on Thursday of this week, leaders of the House Energy & Commerce and Ways & Means Committees announced their intentions to introduced a framework they will use to formulate a competing plan.  “It is time to bring Medicare into the 21st century," Ways and Means Chairman Dave Camp (R-Mich.) said in a statement. "Achieving that goal will be an all hands on deck effort, and we want all the stakeholders — doctors, patients, and others — to be a part of that process.”

So who knows, 2013 may be the year that the docs get a permanent fix.  Stay tuned.

CHIME Weighs In on Federal Health IT Safety PlanResponding to ONC’s Patient Safety Action & Surveillance Plan, CHIME agreed with the proposed approach to leverage existing policy levers and programs within HHS, rather than create another federal entity to enhance health IT safety.  While CHIME urged the involvement of ONC in designing a framework to use health IT to make care safer and continuously improve the safety of health IT, the group suggested that implementation of the patient safety plan should rely on a stakeholder-driven organization that included federal partners, but was not under the direct control of federal agencies.

CHIME also urged a more focused effort to address patient data-matching, saying that, “despite years of development, no clear strategy has emerged to accurately and consistently match patient data.  The results of a 2012 CHIME survey suggest that now, more than ever, action is needed to ensure the right data is matched with the right patient.  Unintended injury or illness attributable to patient data-matching error is a considerable, and growing, problem in this era of health information exchange.  And with a substantial portion of CIOs involved with HIEs that use differing approaches to data matching, we can expect the inconsistency and variability inherent to healthcare IT systems to persist – and become more endemic – without national leadership and consistent standards.”  Finally, CHIME strongly urged that attention be paid to how much time and resources are expected of providers to report on safety events.  While the group supported the need for more information on patient safety events and believed the general approach ONC is suggesting (through AHRQ Common Framework and PSOs) is reasonable, CHIME said there is a significant danger in developing a reporting regime that unduly burdens providers.

Edited by Gabriel Perna


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