Head of Product Management, Geneia
Since its creation as a part of the American Recovery and Reinvestment Act of 2009, Meaningful Use has grabbed healthcare IT headlines every few months. Physician sentiment toward electronic health records (EHRs), attestation statistics, and politicians seeking to amend or freeze the program have all resulted in media-worthy controversy. Just last October, rulemaking changes were announced that simplified the reporting burden for Stage 2 and extended the deadline for providers and states to comply with the new requirements and prepare for the next set of system improvements.
To refresh your memory, the American Recovery and Reinvestment Act of 2009 specified the three main components of Meaningful Use:
- The use of a certified EHR in a meaningful way;
- The electronic exchange of health information to improve the quality of care; and
- The use of certified EHR technology to submit information about clinical, quality, and other measures.
There are three successive phases, each more rigorous than the one that came before. Simply put, “meaningful use” means providers and hospitals need to show they are using certified EHR technology in ways that can be measured to improve healthcare quality, and when they do, they receive incentive payments.
My extensive work with EHRs and those using them has led me to conclude the use of an EHR alone is insufficient to meet the goals articulated by the creators of the Meaningful Use program. Very often, providers using EHRs do not know what happens once a patient leaves their facility. Hospitals and physician practices need a complementary platform that catches all of a patient’s interactions with the healthcare system – a platform that integrates and aggregates the information from all sources to create a full, 360-degree view of the patient and his or her risks and ideally automatically populates pertinent, prioritized actionable patient-specific information into the existing clinician workflow.
The creators of the Meaningful Use program had five core goals, and today’s innovative analytics and insights platforms offer providers and hospitals robust tools that go beyond the EHR to meet these goals cost effectively.
Goal #1: Improve the quality, safety, and efficiency of care while reducing disparities
There are a number of features within cutting-edge analytics and data solutions that help providers achieve this goal. A common data fabric brings disparate sources of data together, including clinical, claims, EHRs, medications, lab results, family medical history, and patient-generated information from clinical and fitness wearables, and integrates all of this information into a single, holistic patient record. This 360-degree view of the patient improves the visibility of information to all members of the care team and, subsequently, reduces silos of care and improves care coordination. Leading analytics platforms seamlessly provide prioritized actions to the clinician, integrate the information into a patient summary, and identify open care opportunities, such as mammograms and colonoscopies, and open quality opportunities to improve a patient’s health based on clinical guidelines.
Similarly, there are a number of provider-specific features, including:
- Provider performance information and dashboards that illustrate efficiency and trends, and demonstrate how providers are managing quality and efficiency as compared to peer groups and/or benchmarks;
- Quality performance dashboards with high-level statistical information for attributed patients currently enrolled in disease or case management programs that illustrate how providers are performing with respect to standard measures, such as healthcare effectiveness data and a physician quality reporting system;
- Opportunities and gaps related to coding, quality, and care, and the ability to submit metrics to the Centers for Medicare & Medicaid Services (CMS) and health plans; and
- Cost and utilization reporting that enables administrators to understand how consumers – whether they are called employees, members, or patients – can be guided to use healthcare services more efficiently.
Goal #2: Engage patients and families in their care
The single holistic patient record referenced above also supports patient and family engagement by including all members of the patient care team: primary care physicians, specialists, facilities, nursing, and support staff, as well as involved family members. Referrals can be made easily to other care team members and care management nurses. Information is seamlessly shared among the complete care team.
Mobile engagement apps can be integrated into the patient record to improve engagement and health. Similarly, some mobile apps and patient portals engage patients and members in important ways to understand cost and price transparency, interact with clinicians, and educate them on diseases and health conditions.
Goal #3: Promote public and population health
The common data fabric that integrates multiple and varied sources of data into a holistic record for each patient enables all venues of care to achieve the Triple Aim and Meaningful Use goals, thereby supporting public and population health. Measurement of providers by cost, utilization, and specialty enables benchmarking and lends support for the best practices to achieve population health.
The most robust analytics platforms not only identify coding, quality, and care gaps, but also push these opportunities into the provider and payer workflows to facilitate closing these gaps. Rules and algorithms that continuously sniff the data and dynamically create new insights that improve individual and population health are equally important features in these platforms. Understanding and stratifying patient risk and using that information in day-to-day healthcare operations is key to achieving the “meaningful use” of EHRs. This requires organizations and systems to interoperate and, rather than just automate, use the technology to redefine their processes.
Goal #4: Improve care coordination
The holistic patient record built from the common data fabric improves care coordination where members of the patient care team, including primary care physicians, specialists, facilities, nursing, and support staff, as well as involved family members, can easily share information with each other and communicate. The EHR in a hospital or a physician’s office typically does not have the ability to show everything that a patient experiences as they move through the healthcare system to get care.
In addition, a population health platform with the 360-degree view of the patient includes care gaps with the ability to close them at the point of care. It should also include tasks and workflows that allow the care team to view and manage every encounter a patient has – regardless of whether those encounters are inside or outside their facility. The result is better management of patient care, improved patient experience, and fewer touch points. A true longitudinal view of the patient record uses advanced predictive algorithms at an individualized patient level, such as the ability to predict their propensity to engage in health programs like oncology or disease management.
Goal #5: Promote the privacy and security of patient information
Above all, today’s data and analytics platforms must protect the privacy and security of patient information. Our ability to create a holistic, 360-degree view of each patient and use this information to improve their health is predicated upon the consumer’s belief that we have deployed the best minds and cutting-edge technology to protect their data – and will continue to do so.
It seems likely that physicians and hospitals will continue to be challenged by the expanding Meaningful Use requirements that must be met to receive incentive payments, and that increasingly they will look beyond the EHR to innovative analytics and insights platforms to help them meet these requirements while simultaneously improving the health of their patients.
CHIME calls for ‘laser-like focus’ on interoperability and a new timeline to implement Stage 3
The College of Healthcare Information Management Executives (CHIME) urged the federal government on Dec. 14, 2015, to give healthcare providers more time to adjust to recent changes to the Meaningful Use program before mandating new Stage 3 requirements. CHIME said extending the timeframe for Stage 3 no sooner than 2019 would allow all stakeholders – policymakers, providers, and vendors – to fully implement modifications made in October to Stage 2, and to focus energies on the critical issue of interoperability.
“CHIME members are committed to the goals of the Meaningful Use program,” said CHIME Board of Trustees Chair Charles E. Christian, CHCIO, LCHIME, FCHIME. “We have made significant progress in implementing information technology systems to improve patient care and reduce costs. However, we do not believe that the course laid out by the Centers for Medicare & Medicaid Services for Stage 3 will help us achieve some important goals, including better alignment of quality improvement efforts and widespread health information exchange. We need to let providers and vendors continue down the adoption curve and perfect systems that many are still putting in place.”
What’s needed now, Christian added, is a laser-like focus on interoperability. Central to that is finding a safe, secure, and accurate methodology for patient identification. Also, Christian said, there needs to be a concerted effort to protect patients’ health information from cyber threats and data breaches. Christian also noted concerns among CIOs and IT vendors that the Stage 3 timeline is unrealistic for ensuring that certified products are available in the marketplace.
In written comments to CMS on Stage 3 regulations that were published in October, CHIME called for:
- Starting Stage 3 no earlier than 2019 and only after 75 percent of all eligible providers have met Stage 2;
- Removing the 2017 transitional year for meeting Meaningful Use Stage 3 and requiring 2015 Edition CEHRT no earlier than 2018;
- Creating a 90-day reporting period for every year of the program, including the first year at Stage 3, to allow providers adequate time for upgrades, planned downtime, fixes related to technology, or optimizing the use of new technology within workflows;
- Creating parity for both eligible providers (EPs) and eligible hospitals (EHs) by removing the existing pass/fail approach for Meaningful Use; and
- Reducing the burden for providers by streamlining reporting redundancies and refraining from requiring data collection and submission on measures that do not advance patient care.
“CHIME appreciates the increased flexibility CMS created in Stage 2 and the agency’s willingness to receive comments on Stage 3 regulations,” Christian said. “We are all striving to create a more efficient delivery system; one that improves patient care and lowers costs.”