Tag Archives: HITECH Act

Quality Measures – Stage 2 and Stage 3 Meaningful Use

Having announced the Stage 1 Meaningful Use rules this past summer, the U.S. Office of the National Coordinator for Health Information (known to most people as the ONC) did not wait long to start work on stage 2 and stage 3 Meaningful Use rules.    Earlier today, David Lansky, Chair of the Quality Measures Workgroup, posted a request for comments on proposed new clinical quality measures.  These measures were developed by five tiger teams, each focused on different measure domain:

  • Patient and Family Engagement,
  • Clinical Appropriateness/Efficiency,
  • Care Coordination,
  • Patient Safety, and
  • Population and Public Health.

The resulting measures were reviewed and consolidated by the Quality Measures Workgroup which is now calling for public comment. In addition to general comments, the Quality Measures Workgroup also seeks specific examples of measure for each measure concept.

Comments will be accepted until December 23, 2010 [which, by the way, also happens to be my oldest son’s birthday 🙂 ]



US PHR Roundtable

Interested in personal health records (PHRs)?  So is the US Congress.  Section 13424 of the HITECH Act directs the Office of the National Coordinator (ONC) for Health IT to conduct a study and make recommendations related to the application of privacy and security requirements to “non-HIPAA Covered Entities”, with a focus on PHR vendors and related service providers.

To collect information related to the mandated study, the ONC is hosting a PHR Roundtable on December 3rd, 2010. According to the ONC website for this event, the Roundtable will “address the current state and evolving nature of PHRs and related technologies (including mobile technologies and social networking), consumer and industry expectations and attitudes toward privacy and security practices, and the pros and cons of different approaches to the requirements that should apply to non-CE PHRs and related technologies.”

The roundtable will include “four panels of prominent researchers, legal scholars, and representatives of consumer, patient, and industry organizations.”  These panels will include:

  • PHRs: Origins, Developments, Privacy and Security Practices
  • PHRs and Related Technologies: New Forms, New Audiences, and New Challenges
  • Privacy and Security of Identifiable Health Information in PHRs and Related Technologies: Expectations and Concerns
  • Perspectives on Privacy and Security Requirements for PHRs and Related Technologies

The ONC will begin accepting public comment at the beginning of November.



US EHR Strategy

I have been watching with great interest the development of the US EHR strategy, spurred, in large part, by stimulus funding through the HITECH.  I recently came across a succinct and insightful summary of this strategy written by John Glaser,  VP and CIO at Partners Healthcare in Boston and soon to be CEO at Siemens Health.  What I thought was particularly insightful and perhaps even profound was Mr. Glaser’s views on the uncertainity associated with the US strategy:

“It is not possible to launch this much activity of this scope with this many actors and have great certainty about the outcome. This uncertainty will be magnified by the evolving actions of the private sector—hospitals, health plans, suppliers and others that are engaging in a diverse array of often very imaginative implementation activities.

The implementation plans are good plans. Change of this magnitude will bring very real progress, but it will also bring a period of time that is likely to be bumpy.

The federal electronic health record strategy has been formed, and the country is at the start of its implementation. The strategy is ambitious, multifaceted and sophisticated. This journey faces many uncertainties and will not be easy. However, the strategy has a high likelihood of causing many health care organizations to make meaningful use of EHRs and improving the health care delivered in this country.”

Sometimes it is simply not possible to predict with any accuracy how change will play itself and being too prescriptive is a recipe for disaster.  I think that the US approach will generate sufficient activity that there will more successes than failures and a natural momentum will be created that will carry the eHealth agenda forward in that country.


US eHealth policy and social media

As I have mentioned in previous blog posts I am closely following the evolution of eHealth policy in the US.  Based on policy direction from president Obama, the Office of the National Coordinator (ONC) for Healthcare IT is trying hard to be as open and transparent as possible about all discussions and decisions related to eHealth policy and standards.  One way that the ONC is implementing this directive is to webcast all HIT Policy and HIT Standards committee and working group meetings.

At the end of each session the public is invited to offer their comments. I have been listening to many of the webcasts and was struck by the relative lack of public comments.  For most of the sessions that I have attended there have been only one or two people stepping forward to offer comments or asking questions.  For the past week I have pondered why there have been so few comments and whether this apparent lack of interest means that the webcasts are a wasted effort.  It struck me this morning that the webcasts are simply one element in a complex social media ecosystem.  While many people might not take the time to sit through literally hours of sometimes dry committee and working group sessions, bloggers and journalists are doing so and are reporting on the highlights of these sessions.  These individuals then post and tweet about what they have heard and quickly spread the word.  I have been amazed at how quickly summaries of committee and working group sessions are available.

The ONC is using a variety of techniques to keep people informed about their activities and to solicit their feedback. These techniques rely heavily on social media technology and, based on the information appearing in trade magazines and the mainstream press, seem to be effective at engaging many constituencies.


Openess and Transparency

I have been following the US “meaningful use” debates quite closely and regularly listen in on committee and working group sessions related to this topic that are broadcast over the Internet.   Another venue for public participation in the debate is through a web-based discussion forum:


An example of the type of comments posted on this site is a letter from signed by Massachusetts  senators Paul G. Kirk Jr. and John F. Kerry.  They ask that “meaningful use” criteria require “the inclusion of a physician narrative beyond the template text”.  They argue that such narrative “enables medical providers to explain their thought processes, including issues such as why they recommended one treatment over another”.

I continue to be amazed at the degree to which the debate on “meaningful use” is made public.  My sense is that this level of openness and transparency is not only leading to a more robust definition of “meaningful use” but is also contributing to a more constructive and respectful debate.


Teaching old dogs new tricks

COACH, Canada’s health informatics association, has raised the alarm about a potential shortage of qualified healthcare IT professionals.  Given this concern, I was intrigued to read about one US approach to dealing with a similar shortage:


This approach takes advantage of the skills people already while giving people not yet ready to exit the workforce new opportunities.  Clearly a win / win situation, one that we might want to consider in Canada.


“Meaningful Use” Defined

Mark and I have written in the past year about the concept of “meaningful use” associated with EHR funding in the US and the open and transparent process by which “meaningful use” is being defined.  At the very end of last year (still hard to remember that it is now 2010), two documents were posted that, among other things, offer an initial definition of “meaningful use” and describe the process by which the definition was conceived:



Three stages of meaningful use are specified:

  • Stage 1 (beginning in 2011): The proposed Stage 1 meaningful use criteria “focuses on electronically capturing health information in a coded format; using that information to track key clinical conditions and communicating that information for care coordination purposes (whether that information is structured or unstructured, but in structured format whenever feasible); consistent with other provisions of Medicare and Medicaid law, implementing clinical decision support tools to facilitate disease and medication management; and reporting clinical quality measures and public health information.”
  • Stage 2 (beginning in 2013): CMS has proposed that its goals for the Stage 2 meaningful use criteria, “consistent with other provisions of Medicare and Medicaid law, expand upon the Stage 1 criteria to encourage the use of health IT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible, such as the electronic transmission of orders entered using computerized provider order entry (CPOE) and the electronic transmission of diagnostic test results (such as blood tests, microbiology, urinalysis, pathology tests, radiology, cardiac imaging, nuclear medicine tests, pulmonary function tests and other such data needed to diagnose and treat disease). Additionally we may consider applying the criteria more broadly to both the inpatient and outpatient hospital settings.”
  • Stage 3 (beginning in 2015): CMS has proposed that its goals for the Stage 3 meaningful use criteria are, “consistent with other provisions of Medicare and Medicaid law, to focus on promoting improvements in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to self management tools, access to comprehensive patient data and improving population health.”

The rules in which the meaningful use criteria are incorporated will be published in the Federal Register by mid January and will be subject to a 60-day comment period effective.  The interim final rule will become effective 30 days after publication.