“In some ways, quality measures as they exist are process measures,” said John D. Halamka, MD, during his closing keynote HIMSS Virtual Conference presentation.
Stage 2 will see the introduction of outcomes orientation, and Stage 3 will move to outcome measures, which measure the wellness of a patient instead of how many tests were ordered for a given patient, said Halamka, an emergency room physician and CIO of Beth Israel Deaconess Medical Center and Harvard Medical School, chair of the U.S. Healthcare IT Standards Panel (HITSP) and co-chair of the HIT Standards Committee.
During his discussion, Halamka examined meaningful use Stage 1 standards and challenges, and the Stage 2 and 3 planning already in progress.
Measuring quality in Stage 1 is one challenge, he said. “If you look at the way the quality measures are defined, they are very specific” and standards-based, but “it’s not completely common that SNOMED and RxNORM are underlying vocabularies in the EHR. The vendor or the user has to map the code to those vocabularies in the product you are using. I hope we’ll start seeing downloadable crosswalks that will make this slightly easier in the future.”
Many EHR vendors are front-ending their problem lists with software that will show what codes correspond, and “that’s probably going to be more and more commonplace,” said Halamka. For example, Kaiser’s recently released translation-enabling technology includes native physician-friendly problem list terminology mapped to ICD-9 and SNOMED, he said, and it can be translated to patient-friendly natural language for when data are transmitted to patients.
“The hope is that this will be placed in a free, nationally hosted web site, so vendors and everyone will have one-stop shopping for all vocabularies that you need for free.” However, intellectual property protection is an issue, according to Halamka.
Privacy and security of data transmission are current challenges as well. “Medicity, Axolotl, Covisint, Surescripts [and other entities] offer mechanisms for getting data around.” The problem is the proprietary nature of solutions, he said. “We might see slightly more chaos in the data transmission space” instead of things calming down in the coming year. “Ultimately, there may be multiple mechanisms for sending data around,” he said.
“In the case of state HIEs, each may come up with their own approach. I hope as we go forward that we can skinny down all the possibilities that exist in the marketplace as we hear from the marketplace what is working. It’s hard to know what that will be: Let the market mature a little bit, let’s get implementations exchanging data, then let’s see if we can codify a limited number of ways to get data from point A to point B.”
Stage 2 and Stage 3 meaningful use requirements will need a much more community-focused approach, Halamka said. This will likely include expanded patient engagement and information sharing–and with EHRs today, “it’s challenging. I suspect that for patient engagement, we’re going to migrate away from copies and summaries and get more to PHRs and instantaneous access to data online.”
The ONC is concerned about the success of meaningful use Stage 1, “and if it turns out much of America can’t achieve meaningful use Stage 1, then more rigorous criteria are not a good idea,” he said. The ONC is expected to further refine the requirements and do a second-quarter 2011 checkpoint to see how it’s going.
Stage 1 programs start in January, attestation will begin in April, and the first incentive dollars will be awarded in May, Halamka said. “The implication for many of us is that you better make sure you have the capacity to do all these quality measures January through March.”