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Stage 3 Meaningful Use: Is Enough, Enough?

health-care-professionals-standing-togetherWith the 114th Congress now seated, one of the first bi-partisan bills to hit the floor is the Flexibility in Health IT Reporting Act of 2015. The bill, which was originally submitted in September 2014 in response to low attestation rates to Stage 2 meaningful use, proposes an abbreviated reporting period — from the current 365-day requirement to 90 days — to ensure that hospitals and other healthcare providers continue their progress toward EHR integration and meaningful use deadlines.

In a press release Congresswoman Renee Ellmers, R-NC said, “There is a tremendous need for our healthcare providers to have flexibility in meeting HHS' stiff deadlines, and this is precisely why I am reintroducing the Flex-IT Act.” In response to the announcement, reports HIT Consultant, American Hospital Association Executive Vice President Rick Pollack noted, “The health care field is faced with many major challenges and changes, all hitting at the same time. We need to be practical and responsible in terms of implementation timetables. That’s why hospitals need flexibility.”

Yet, even as industry stakeholders unite behind this legislation, debate about the effectiveness of meaningful use has been on the rise. 

The Next Stage of the Meaningful Use Journey

Late last year, during the American Medical Informatics Associations (AMIA) 2014 Annual Symposium, discussions exposed a lack of consensus on what should be the focus of meaningful use. According to a Healthcare Informatics blog, much of the debate stems from two opposing sets of recommendations.

1. Institute of Medicine Recommendations

An Institute of Medicine report entitled “Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2” recommends 12 measures be captured in meaningful use requirements.

  • Alcohol use
  • Race/ethnicity
  • Residential address
  • Tobacco use
  • Depression
  • Physical activity
  • Education
  • Financial strain
  • Neighborhood median income
  • Intimate partner violence
  • Social isolation
  • Stress

The first four measures on the list are already widely collected. Most providers agree that the additional measures could improve their ability to treat individuals and manage population health. In addition, the data, once de-identified, could become a valuable asset for public health organizations. But are providers — who already find the burden of lengthy assessment tools overwhelming — likely to welcome the responsibility for collecting even more data? Moreover, will providers have the right resources — especially related to the social measures like exposure to financial strain or domestic violence — to take action?

IOM committee member and assistant professor in the Department of Medical Informatics at Columbia University George Hripcsak, M.D., agrees that the burden on providers must be addressed. “The technology is only part of getting it implemented. We need to decide where and how to collect and review the data.”

2. AMIA’s EHR 2020 Task Force and the JASON Task Force

Both the EHR 2020 Task Force and the JASON Task Force suggest that the Office of the National Coordinator for Health IT (ONC) should hold off on adding to meaningful use reporting criteria, instead focusing on interoperability and development of a more robust, API-based architecture for health IT. Both task forces, Healthcare Informatics blog notes, indicate that hospitals and other healthcare providers need some breathing room to focus on EHR integration and meaningful use deadlines — without have more requirements added to the mix.

Michael Zaroukian, M.D., AMIA task force member and chief medical information officer of Sparrow Health System said, “We have enough EHR functionality in place now to advance quality and value.” Instead, they’d like the ONC to focus on reducing data entry and reporting burdens while promoting interoperability.

Finding Answers from Other Sources

In order to maintain the focus on EHR integration and meeting meaningful use deadlines, one option for reducing the data collection burden on clinicians while still gaining the insights outlined by the Institute of Medicine report is to take advantage of de-identified or syndicated data in consumer research. 

There exist national data compilers with rich health care data at the zip code, household, and individual level, gathered from publicly available or consumer opt-in sources.  The PatientBond Consumer Diagnostic is a reference based on PatientBond's national study of health care consumers, and the 2015 study is being fielded as this article goes to posting. This ambitious study covers nearly all the topics suggested by the Institute of Medicine above, and an extensive amount of health care consumer insights stemming from the study will be available in February 2015.

Psychographic Segmentation and its Practical Application in Patient Engagement and Behavior Change

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