Meaningful Use

Maine MSO has been asked to contribute to the proposed definition of "meaningful use" by the HIT Policy Committee of the Office of the National Coordinator (see http://healthit.hhs.gov/portal/server.pt for more information).

Here is the ONC's questionnaire and Maine MSO's responses:

  1. How will the proposed 2011 and 2013 meaningful-use objectives and measures help your specific area (pediatrics, psychiatrist, nurse practitioner dentists, etc.] demonstrate that they are improving care?
  • The current draft proposes an appropriate set of quality measures that are in broad use and broad agreement (ie hgba1c, ldl control, htn control, mammography, colorectal cancer screening, flu shots, pneumovax…)  It’s a good start to recognize improvements in care.
  1. What are the special considerations when applying meaningful use measures to your specific area or to underserved populations?
  • We are concerned about meaningful comparison to national benchmarks.  We need to understand differences in implementation and in utilization adjusted to such factors as:
    • access to broadband internet
    • local patient access to computers and internet
    • local cultural attitudes toward HIE
    • average local income and education levels
    • proximity to specialists, hospitals, secondary, and tertiary care centers
  1. What are other EHR adoption barriers unrelated to the definition of meaningful use, that affect providers like you?  What solutions would you recommend to address those issues? What would your role as a provider be in this solution?
  • No one can afford to do it alone. 
    • We need to pool together in larger, multi-organizational projects that can afford to build a shared meaningful use infrastructure. 
    • The more participants in individual projects, the more resources they will have to succeed. 
    • The stimulus package already has some dynamics in place that reward these collaborations, but it could be more overt.
    • One possible area for great improvement is grant funding.  A gratifying amount of dollars are available to individual federally qualified health centers.  But none of it is directed specifically at funding larger projects.  It seems too likely to be used to fund projects that health centers would not pay to do otherwise and may not be sustainable.  There should be more preferential and overt funding of collaboratives that include, but are not exclusively FQHCs.

Maine MSO also answered the questions they are asking of specialists and the use of registries. We think the Committee will benefit from knowing how far along primary care practices are in the use of registries and how they do indeed improve the health of the population we serve.   

Specialists

  1. In the context of the policy priorities, care goals and objectives that are part of the definition of Meaningful Use, what is the best way for specialists to be integrated into that framework?
  • Specialty quality is not driven so much by rules based medicine.  Yes, endocrinologists should care for diabetics with the same quality standards as primary care offices.  But rules based care should be centered in the primary care office. 
  • Specialty care quality should be driven more by performance than by outcomes.  Measures like:
    • Time from referral request to appointment
    • Time from appointment to return of the consult note.
    • patient satisfaction with the encounter and communication
    • primary care provider satisfaction with the encounter and communication
    • medication reconciliation
    • duplication of diagnostic studies
  1. Are there relevant national registries in your specialty? Would participation in those registries be a good measure of meaningful use for the HIT incentive?
  • Yes, but limited by the discussion, above.
  1. How can specialists and the societies that represent them help accelerate the development of HIT-enabled quality measures that are appropriate for the definition of meaningful use?
  • We are not convinced that specialty societies are the best source of quality measures. 
  • There are built in biases that require a cross-specialty discipline to overcome, as is seen in the United States Preventive Services Task Force. 
  • Specialty Societies need to engage in those cross-specialty projects that define desirable interventions and levels of risk factor control on strict evidence based standards.
  1. Which measures could be incorporated in the definition of meaningful use that would help drive more communication and coordination between specialists and primary care?
  • In addition to the measures suggested above, there should be evidence that specialists
    • analyze where their referrals come from
    • engage with their top referral sources to contribute to the evidence based decision support used by the referring provider.  The specialists should have input into what happens before and after the referral:
      • diagnostic tests performed
      • diagnostic criteria
      • hierarchy of treatments offered
      • indications for referral
      • Data needed for an effective referral
      • target performance expectations
      • goal time from referral request to visit
      • goal time from visit to consult note
      • scope of services provided by each contributor