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Does meaningful use need an overhaul?

Brian Eastwood | July 1, 2014
Five years after the HITECH Act, the meaningful use incentive program for electronic health record (EHR) software may be in trouble.

GAO sees two problems here. From a technical standpoint, organizations historically collected and calculated CQMs by hand. Only later was the "chart abstraction process" modified for EHR systems. Not all data needed for reporting quality measures is collected by EHR systems; as a result, it's not part of the typical clinicians' everyday workflow.

"Until HHS establishes and implements a comprehensive strategy to ensure the reliability of CQMs collected using certified EHRs, it will be unclear whether the department's plans are sufficient to address the concerns," the GAO report says. "Therefore it will be uncertain when the CQM data can be reliably used to help assess provider performance, improve quality and adjust provider payments."

That points to the second, and arguably larger, concern early returns suggest that attesting for meaningful use doesn't improve care quality on its own. The GAO points out that meaningful use cites 26 specific strategic goals related to EHR adoption but not a single specific goal pertaining to improving quality, efficiency and patient safety.

To be fair, ONC and CMS have long said that improving quality through the use of shared health data is the focal point of stage 3 (with stage 1 focused on collecting data and stage 2 on sharing that data). "However," GAO writes, "establishing outcome-oriented performance measures before results are expected is a valuable practice to ensure that the agencies can make program adjustments as needed and are prepared to monitor outcomes and to establish baseline values, which can be useful for developing performance targets and assessing progress toward goals."

It's little wonder, then, that accountable care organizations avoid EHR vendors, having found third parties better served to meet their various care management, reporting and risk stratification needs. If the ACO model represents the future of care delivery in the United States with groups of providers embracing more coordinated care and leaving the fee-for-service world behind will the majority of today's hospitals and eligible providers, and their inadequate but nonetheless certified EHR systems, be left behind?

Restructured ONC Ready for Business

The five-plus years since the HITECH Act, an eternity in the technology world, represent little more than the blink of an eye for government. As Tate puts it, building the EHR Incentive Program and writing the meaningful use regulations embodied an "entrepreneurial spirit" of sorts.

Now, though, it's time to grow up. The ONC gets this; in Tate's words, its "collapsed bureaucratic structure," announced in June in response to the expiration of HITECH Act funding, makes it look less like a startup and more like an established business. (The agency now has 10 offices instead of 17.)

One doesn't reach the "established business" phase without succeeding and, for its faults, the ONC and meaningful use have succeeded in getting providers to use electronic records. The aforementioned CDC report notes that EHR use more than doubled between 2007 (35 percent) and 2012 (72 percent) and has quadrupled since 2001 (18 percent). In addition, research from SK&A shows that small medical offices are using EHR systems, in part because an increasing number of vendors offer software for small and even solo practitioners.


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