In the meantime, QIOs in the midst of the 9th Statement of Work are already at work helping physicians use technology meaningfully, following that criteria of improved outcomes, reduced costs and reportable results, said CMS Chief Medical Officer Barry Straube.
What started under the 8th Statement of Work requiring QIOs to help providers implement IT has becomeunder the latest contract, begun last Augusta focus on ensuring that IT is used with great effect for prevention and safety measures. Those types of issues are exactly what the stimulus act has put down as meaningful use, said Straube, who is also the director of the Office of Clinical Standards and Quality in the agency.
The 9th Statement of Work represents a transition, Straube said. QIOs have to meet more stringent performance measurements to ensure that the types of work they do comply with contract requirements. The program has made major, major changes in response to criticisms outlined in a 2006 Institute of Medicine report that said the work QIOs were doing was ineffective, Straube said. Were hoping the 9th Statement of Work will prove the value of the QIO program.
QIOs already have made great strides with health IT, said David Schulke, executive vice president of the American Health Quality Association, the umbrella QIO organization. Under the last contract, QIOs recruited 3,932 physician practice sites to implement IT, exceeding the contract requirement of 3,695. Now in the 9th Statement of Work, organizations are beginning to address the workflow issues that represent challenges to physician engagement, said Schulke, who advocates that QIOs are the right group to lead the launch of regional extension centers.
One of the issues that QIOs have found is that doctors dont know how to use the systems that have been implemented, Schulke said. Instead of using the automatic fields provided for clinical data through the applications, doctors are using other text fields in the electronic records to enter their notes. By doing that, the systems cant process the data the way they were designed to, he said.
At issue is workflow and changes to the way people practice, Schulke said. The machine is the least of it. QIOs now have to address training and education needs. Doctors dont know what the machine needs to make it useful, he said.
Providers and IT vendors both have to move away from thinking that technology itself will solve healthcare problems, said Evan Falchuk, president of Best Doctors, a Boston-based company that provides clinical consulting to physicians and patients to ensure proper diagnosis and treatment options. Theres always magical thinking around IT.
It comes down to making sure that IT improves outcomes and quality for individual patients, and the industry isnt able to measure yet how well that happens, Falchuk said. While regional extension centers might help providers with technology, doctors must also be sure they are still working in the best interest of their patients, listening to them and paying attention to their needs. You cant replace that with a computer program, he said.
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