HIT Policy Committee frames flexible meaningful use measures

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George Hripcsak, MD, co-chair of the HIT Policy Committee's Meaningful Use Workgroup, presented an approximate timeline for meaningful use measurements yesterday during a meeting of the HIT Policy Committee, held to discuss pending meaningful use definitions in relation to specialty practices and small providers. In laying out the timeline, Hripsak noted that not all potential objectives and measures will be appropriate for all U.S. healthcare facilities.

During the meeting, Committee Chair David Blumenthal, MD, who also runs the Office of the National Coordinator for Health IT (ONC), asked what common themes the committee thinks should be upheld in the final definition.

Paul Tang, MD, vice chairman of the committee and co-chair of the Meaningful Use Workgroup, noted that progressive work on meaningful use has been done under extreme time pressures. “[We] understand…that we won't get it perfect the first time necessarily, but want…to make sure we keep track of issues that are not perfectly resolved,” Tang stated. Two of these issues, Tang said, are how the committee accounts for the variation of a health professional’s specialties and how the committee accounts for the variation in the capacity of providers to adopt meaningful use EHRs.

“The bottom line is that we need to work on the 2013 measures with the idea of making them available in mid-2010,” said Hripcsak.

In his presentation, Hripscak outlined the approximate meaningful use timeline as follows:

  • Fourth Quarter 2009/First Quarter 2010: Conduct informational hearings to inform 2013 and 2015 criteria development.
  • Second Quarter 2010: Work with HIT Standards Committee to ascertain availability of relevant standards.
  • Mid-2010: Refine 2013 meaningful use criteria.
  • Fourth Quarter 2010: Assess industry preparedness for meeting 2011 and initial 2013 meaningful use criteria.

“Not every objective and measure will necessarily have to be met by every professional covered by the law,” said Hripscak. Therefore, he noted, a mapping has to occur to determine which professionals are able to comply with which measurements.

Logically, Hripscak said, definable groups of measures, effectiveness and professionals are needed to map between these groups. The workgroup’s early focus was on primary care physicians because of their effect on the healthcare population and recognizing, he stated, that much of the quality measurement development work has been in primary care versus specialty care.

During Hripscak’s presentation, core measurements for all providers were placed in a “simple framework." Under this framework, all providers will use computerized provider order entries as a process measure. For a quality measure, all providers will avoid utilization of high-risk medications to the elderly and as an efficiency measure, a percentage of patient encounters with insurance eligibility confirmed is needed. Additionally, a small second set of adult, pediatric and specialty measures were provided in the framework.

However, there are inherent issues in the process of determining defined groups, Hripscak said. “We don't want to create a million sets of primary care measures,” he said. “We should probably use the denominator of the measure to decide what the population is within primary care and not have a lot of groups.”

Committee member Neil Calman, MD, said that the main issue concerning the groupings is the fact that providers play different roles with different patients. “This is not just on the fringes,” Calman stated. “It's at the core of how medicine is practiced in this country. A lot of people call themselves specialists and are not board-certified…This will be a hard line to draw, we need to create flexibility at the patient and provider level, as to what the expectations are in terms of quality reporting.”

While all providers will be held responsible for all measurements and objectives, Hripscak clarified that yesterday's decision is not finalized.

Currently, the Meaningful Use Workgroup’s plan is to edit their framework based on testimony from the HIT Policy Committee’s presenters submitted to ONC, create a matrix that maps objectives and measures to professionals and circulate back for feedback. The Workgroup is in the process of revising recommendations for the 2013 meaningful use objectives, according to the HIT Policy Committee.