The combination of electronic health-record systems and clinical quality measures is supposed to improve patient care, but whether the federal program to incentivize the meaningful use of EHRs can be harnessed to boost clinical quality measures' development was a question raised Monday at a health IT policy work group meeting.
The quality measures work group of the federally chartered Health IT Policy Committee met in Washington to review its final list of recommendations to the full policy committee on the proposed rule for the Stage 2 meaningful-use
criteria issued by the CMS in February
At issue was how clinical quality measures for physicians and other eligible professionals could best be incorporated into the Stage 2 meaningful-use requirements, expected to take effect in 2014 as part of the EHR incentive payment program.
The proposed rule solicited comments on several options. The one most favored by the work group would require eligible professionals to select and submit 12 clinical quality measures from a table of 125 possible measures. In addition, at least one measure would have to address each of six care-improvement "domains": patient and family engagement, patient safety, care coordination, population and public health, efficient use of health resources, and clinical process/effectiveness.
But there are several problems with this approach, according to work group member Eva Powell, director of the health IT program at the National Partnership for Women & Families. Powell tossed out for discussion whether there wasn't a better approach.
One problem is trying to find measures to fit all of the various medical specialties. (There are 145 specialties and subspecialties, according to the American Board of Medical Specialties.) The work group's list of recommendations conceded that specialists will face "a significant challenge" finding a dozen measures, even out of 125, that are applicable to their practices and cover all six domains. Even with "a very generous assignment scheme," just eight measures could be relevant to gastroenterologists, the group found.
In a telephone interview, Powell said quality measurement needs a much faster, iterative development process than the "pretty laborious and time-consuming process" to create a measure today. She questioned whether the meaningful-use reporting process might be used to hone and develop new quality measures as well.
"It only makes sense in my mind to use meaningful use as a testing ground because a lot of what we need to do this is the technology itself," she said. "I don't think we're using the opportunities to get there that allows the process to be ongoing and iterative and constantly evolving and getting better."
The new process may not be able to be put in place for Stage 2, she said, given that a final Stage 2 rule is expected this summer, but Stage 3 isn't planned to take effect until 2014.
The work group has another meeting scheduled for Friday. Its final list of recommendations on the proposed rule is to be presented to the full policy committee May 4.