Recognizing the importance of evolving quality concepts within the Electronic Health Record (EHR) Incentive Programs, two ONC federal advisory committee workgroups jointly held a full day hearing on June 7, 2012 to identify ways in which Meaningful Use Stage 3 may advance the consistent delivery of high quality care in diverse care settings. Experts from health care delivery organizations, quality improvement organizations, industry, and academia shared insights regarding how clinical decision support, quality measurement, and the use of clinical data can improve care. Participants encouraged an increased focus on the dynamic ability to ask questions and get answers about patient populations, the use of clinical decision support as an “in-the-moment quality improvement” mechanism, and a transition from retrospective reporting to prospective identification of care improvement opportunities.
The discussion among committee members generated many areas and concepts of great interest upon which we would appreciate comment. We’d greatly appreciate input on the following questions:
- How can we best leverage EHRs to support quality improvement (QI) and accelerate the QI work of providers and organizations under the meaningful use program?
- How can we improve the availability of “small data”— the data that providers and patients can use in real time to improve their decision making and improve quality?
- How do we build and deploy “plug and play” clinical quality and decision support functionality in EHRs and data systems?
- What types of measures foster accountability for care outcomes and concurrently support tactical quality improvement at the provider and organizational level?
- How can we use the meaningful use program to promote data liquidity and transparency across care settings and payors?
- How can we best leverage patient reported data to improve care?
Make Your Voice Heard
The FACA workgroups that hosted the joint hearing, Health IT Policy Committee’s Quality Measurement Workgroup and the Health IT Standards Committee’s Clinical Quality Workgroup, invite you to read the written testimony and voice your perspectives in the comments section below to help inform future deliberations on recommendations for Meaningful Use Stage 3.
Thank you in advance for your thoughts!
Tags: Clinical Quality, HIT Policy Committee, HIT Standards Committee, meaningful use
I agree with the initiative. so many patients are not able to answer the healthcare questions in the event of an emergency. Having their records online will help the doctors to initiate better care.
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Just my opinion, but patient-reported data is highly accurate and cheaper to obtain that other forms of data. Although this may not fully apply to the health care field, in my 30 years in business, I have found it to be true. There’s no substitute for hands-on and eyes-on data.
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Technology is always a vital step in enhancing people standard of living. I can’t imagine a hospital without the usage advanced technology equipment! Remember, the aim is to save life and provide speedy services to people who needed extra care in the hospital.
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Always excited with the prospects technology brings to our industry. We do hope for a system with instantaneous access to information throughout the hospital with an extra stringent easily applicable security system.
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Might I suggest we begin to leverage networks like Facebook, PatientsLikeMe and Avado? Patients constantly share their experiences openly on these systems. How much could we learn from these updates!??
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Very great post. I just stumbled upon your blog and wanted to say that I have really enjoyed surfing
around your blog posts. In any case I’ll be subscribing for your rss feed and I am hoping you write again very soon!
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I just finished reading an excellent perspective (The 8th Pillar of Patient-Centered Medical Home) that relates to these questions, particularly: How can we improve the availability of “small data”— the data that providers and patients can use in real time to improve their decision making and improve quality? I agree that what is needed is a network of Medical Record Aggregators (MRAs), with each individual having a specific MRA from which the patient and the provider can ask questions. Quantal Semantics, Inc. defined a similar network to MRAs calling them “Personal Identity Information Banks” because they would also provide individuals with a means of controlling and monitoring access to their personal identity information. A network of such MRAs would also provide a means for substantial improvements in the availability of information for public health monitoring, clinical effectiveness research, and clinical decision support systems.
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MU Phase 3 requirements must address provider usability. Current EHRs are cumbersome, time-consuming to use, and often poorly designed to support providers’ typical workflow. This leads to either not entering data or entering it in a way that is not “understandable” to the EHR or likely to transport well to other systems. For example, having accurate medication regimen data is critically important for providing safe, effective care, yet I have not yet seen any system where providers felt the EHR facilitated accurate medication reconciliation and their records could be trusted as correct representations of what patients were supposed to be taking.
Even if meaningful use is viewed as having no direct applicability to provider usability, poor usability leads to a garbage in, garbage out situation. Bad information will make real-time clinical assistance from an EHR ineffective and potentially dangerous and similarly vitiate the value of information exchanged between systems. If we want EHRs to facilitate better care, we cannot afford to continue ignoring provider usability in Meaningful Use regulations.
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•How can we best leverage EHRs to support quality improvement (QI) and accelerate the QI work of providers and organizations under the meaningful use program?
please see “ONE Recent Example:” below
•How can we improve the availability of “small data”— the data that providers and patients can use in real time to improve their decision making and improve quality?
provide all Patient Data in either a standard Relational DataBase (not in most EMR’s)
or a text based markup format, such as XML: so that any modern Computer App can access the data
•How do we build and deploy “plug and play” clinical quality and decision support functionality in EHRs and data systems?
not feasable at this time as “plug and play” assumes an interaction with a “modern” EMR,
very few exist. e.g. Consider Time Travel, “where do I land my 747 Airliner in 1800 era earth ?”
What types of measures foster accountability for care outcomes and concurrently support tactical quality improvement at the provider and organizational level?
please see “ONE Recent Example:” below, ie use the organization’s existing measures,
Information Technology is the tool that helps the User achieve whatever task they choose.
Information Technology creates the Screw Driver, the idea for the Screw came from some pragmatic Worker, do NOT confuse the tool with the task.
•How can we use the meaningful use program to promote data liquidity and transparency across care settings and payors?
Maybe report outcomes from the meaningful use program. In my “ONE Recent Example:” below; I look at the ratio of the # of Renal Patients with drug regimens outside the policy guidelines to the total # of Patients (Census) in the Hospital.
•How can we best leverage patient reported data to improve care?
please see “ONE Recent Example:” below
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
please see “ONE Recent Example:” below
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
ONE Recent Example:
SCOPE: HOSPITAL INPATIENT CARE
CLINICIAN: HOSPITAL PHARMACIST
MEAINGFUL USE (MU): Right Information, to the Right Clinician, in the Right Presentation, at the Right Time
I would recommend the recent article: “Escaping the EHR Trap — The Future of Health IT” — NEJM http://www.nejm.org/doi/full/10.1056/NEJMp1203102.
Step 1. Patient Data
This article desribes the first hurdle to implementing MU : Patient Data Access.
The majority of the Hospital EMR sytems are based on the original MUMPS 1970’s system
from Mass General Hosp. These systems all have a hierarchical DataBase, NOT a relational
DataBase (which didn’t exist in 1970). The article also describes the EHR business model
as an attemp to enforce exclusivity, such as a “local monopoly”. Hence these EHR systems
are designed to thwart Data Exchange to anything outside the EHR. Unfortunately these are
archaic (1970) systems and have great difficulty in implementing MU type functionality, hence staying within the EHR is not a good option. My solution to the Patient Data Access problem was to have the EHR generate a Text report (file), as even a 1970 EHR can generate text.
Step 2. Create a Relational DataBase
Create a process that transfers the desired Patient Data from the text file source to populate a Relational DataBase. Or see Microsofts Amalga offering, which will map Patient data from the heirarchial DataBase to its SQL Relational DataBase. I just used Microsoft Access which was available on all the PC’s at my Hospital.
Step 3. Meaningful Use: Right Information, to the Right Clinician, in the Right Presentation, at the Right Time
The a priori assumption was that Information Technology will assist the Clinician in decisions. I looked at Policy & Procedure documentation to find things that are NOT being done within the EHR system, some sort of paper/work around process.
I choose a Renal Dosing Policy that mandates a daily review of the drugs ordered for Patients with reduced Renal Function. Basically I automated/modeled this existing Policy.
Using the raw data, Age,Ht,Wt,Lab Values as inputs to process and then output a comprehensive list of Patients with the drugs that should be evaluated for dosing changes and provide drug regimens to consider. This is done on demand at least once daily by the Clinician. The process/logic/presentation is beyond the capability of the existing 1970 EHR.
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Patients are seen and treated by our health system “in the moment” and care, including prescriptions, are short term focused. Many drugs are which are initially prescribed end up being taken for many years or decades without consideration for the long term effects for the patient. We need to develop a beter body of knowledge on the long term effects of drugs and make reevaluation a standard part of patient care.
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