The HIT Policy Committee’s Quality Workgroup should take a less-is-more approach to developing Meaningful Use Stage 2 and 3 reporting requirements, according to committee member and Epic Systems Corporation CEO Judy Faulkner.
“I am nervous that the government is going to get into the EHR design business,” said Faulkner, who spoke following the workgroup’s presentation to the full committee. “In many cases, Group A likes something, but Group B doesn’t, and perhaps Group C doesn’t like it either — I worry that we are becoming Group A and expecting Groups B, C and D to like what we did.”
Faulkner also said she was concerned about the burden Meaningful Use’s Stage 1 quality reporting requirements are already placing on EMR vendors. “If you have a vendor who is in good shape, they still need 7,000 hours of work,” to make the necessary changes.
She also noted that tweaking software is just the beginning of what vendors must do in response to the requirements — after a rewrite, they must go back to their customer base and either retrofit the software currently in use or initiate a complete upgrade. “That’s a lot of time — development, testing and retrofitting — my feeling is that we need to be careful about these committees not becoming the design committees for what the country will do. We must try to keep our requirements more general so they can do it their own way and have it work.”
The quality workgroup — chaired by National Coordinator for HIT David Blumenthal, M.D., and co-chaired by David Lansky President and CEO of the Pacific Business Group on Health — is charged with providing recommendations on clinical quality measures for Stage 2 and 3 with a focus on Meaningful Use; ensuring that the measures are appropriate and applicable to a broad range of providers; and requiring that each measure use data that can be feasibly collected within the EHR.
Neal Calman, president of the Institute for Family Health and a committee Member, said he was worried that having a uniform set of quality measures would cause some organizations to stop important work to focus on government-mandated measures.
“The concern I have is that if you develop measures that are broadly set out and not particularly relevant to improvement activities in an organization, it diverts energy from those activities. This is not an additive game — once you set out measures, you get organizations to function around those measures, and they may not be relevant to each organization,” said Calman.
Marc Probst, CIO at InterMountain Healthcare and a committee member, echoed Calman by suggesting each measure should be “locally useful.”
Areas the workgroup will be looking for measures include: Patient and Family Engagement; Population Health/Public Health; Safety; Care Coordination; Overuse/Underuse/Appropriate Care; Disparities; and Patient-Focused Episodes of Care.
While providers may not see new requirements as “additive,” vendors don’t either, according to Faulkner. With a limited amount of resources at their disposal, they must make choices about what to do. The workgroup must consider that it will be, to some degree, making those choices for the vendor community. Faulkner wanted it to consider all the possible tasks EHR vendors could direct their efforts toward, then prioritize among that wide universe.
“It’s hard to prioritize when you are only looking at one item at a time, such as when we just look at quality measures or Meaningful Use. When we are trying to figure out what’s important for our country with those, we are not — at the same time — understanding what percent of vendors’ time is taken on them. Did we adversely effect EHRs with all those things (we required) if we knew what else might have been on the list? (Because of what we are requiring), what doesn’t get done that should have been done?” asked Faulkner. “Prioritizing without knowing the full range of possibilities can really give you wrong answers.”