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Should Quality Measure Results Determine Meaningful Use?

September 8, 2009
by David Raths
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I have been intrigued by a few recent and perhaps related developments in the ongoing "meaningful use" saga. The first was the ONCHIT HIT Policy Committee Certification and Adoption Workgroup's recommendations submitted on Aug. 14. The committee suggested that HHS take over establishing certification criteria from CCHIT and focus them on meaningful use objectives involving interoperability, privacy and security, etc., at a higher level with less specificity about product features.

This may be an important and necessary shift in the direction of the certification regime. It's clear that just making sure that physicians and hospitals are purchasing feature-rich products is not going to guarantee that they are used to improve the quality of care. It may indeed make more sense to have a less specific certification program for software products and much more sophisticated procedures for measuring how providers are using the systems for quality and patient safety gains.

That leads, however, to a second development: an Aug. 26 letter from the Federation of American Hospitals to ONCHIT. FAH, an organization of investor-owned hospitals, argues that HHS will be overstepping ARRA's mandate if it takes the HIT Policy Committee's suggestion to use the results of quality measures, rather than just the capability to submit results, to determine who gets EHR incentive funding.

"It has been suggested that 'meaningful use' funding should be tied to provider performance on outcomes-related quality measures," the letter states. "However, our outside legal experts view the ARRA funding as tied only to accelerating the adoption and use of EHRs by providers and clinicians, and not to patient care achievements or outcomes that may be attained while using EHRs."

To make its point, FAH uses the example of readmission rates. The HIT Policy Committee recommended that HHS should adopt a measure for 2013 requiring a 10 percent reduction in preventable readmissions from 2012 to qualify as a meaningful EHR user. FAH notes that a provider's readmission rates are affected by several factors, many of which are not related to EHR use.

"If HHS expanded this policy beyond the submission (or reporting) of data, it will have the adverse impact of limiting provider adoption of EHRs because it will prohibit ARRA funding for those who do not satisfy the performance measures. This result would run directly counter to the reason Congress provided the funding."

This seems to be a key point of contention. Could a hospital be a widespread user of EHR and related systems but not be a "meaningful" user because it is not making enough progress on quality measures to meet HHS guidelines?

Does FAH have a good point here? I'd be interested to hear what members of the Healthcare Informatics online community think.

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