During a meeting held to fine-tune the questions, workgroup members slogged through each of those points, often attempting to locate the usually sought balance of empowering patients and increasing safety on the one hand, with not overburdening healthcare providers on the other.
The group also sought to avoid unintended consequences. For example, a discussion of clinical-decision support — the element of CPOE thought to hold the greatest value — raised the point of how relevant primary-care medication-related warnings may be to specialists. The goal of the exercise was to ensure that specialists aren’t forced to endure “alert fatigue,” or being bombarded by useless warnings which then cause them to ignore all.
“With regards to the elderly, (gerontologists) use dosages and medications that primary care provider might not use, so they wind up getting triggers that aren’t relevant,” said Neal Calman, M.D., president and CEO of The Institute for Family Health. “As these things are developed, we need to make sure that specialists are not being harassed by messages that would be relevant to a primary but not their specialty.”
On this point, however, David Bates, M.D., Chief of the Division of General Internal Medicine and Primary Care at Brigham & Women’s Hospital, and James Figge, Medical Director, Office of Health Insurance Programs, New York State Department of Health, disagreed. They felt that rather than being pestered by the alerts, specialists would benefit from them.
With such a difference of opinion, it was agreed this was one area ripe for public comment. “The question is what do people know out there about best practices? How do we make this more relevant to the specialty areas?” said Calman.
Another area of extensive debate and discussion was around discharge summaries, in terms of how they should be provided to patients and even what they should contain. Again, the workgroup debated the level of detail it should inject in regulations.
On the side of being prescriptive was Christine Bechtel, vice president of the National Partnership for Women & Families, who feared providers might “take the easy way out,” by sending far from all the relevant information if not required to include certain data. Favoring a less detailed approach was George Hripcsak, Co-Chair of the workgroup, and professor and interim chair of Columbia University’s Department of Biomedical Informatics.
Suggested Bechtel, “Let’s ask what definition would work well.”
One area the workgroup does not want the public to focus is its Stage 3 measures, also contained in the matrix, even though Stage 2 should be thought of as a stepping stone to that final stage, according to comments by HIT Policy Committee Co-Chair Paul Tang, M.D., and National Coordinator David Blumenthal, M.D.
According to Tang, the Stage 2 request for comment could go out this week, with responses due within 30 days. Like Stage 1, he said, “This one is still under a short timeline because we want to get out our final recommendation this summer. That will give CMS and ONC time to prepare their Notice of Proposed Rulemaking (NPRM) by end of year, so they can then issue the final rule in middle of next year.”