Meaningful Use

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For Mahidol University Faculty of Social Sciences and Humanities's class on November 2, 2014

Text of Meaningful Use

  • 1. Meaningful Use of EHRs:A U.S. Public Policy Case StudyNawanan Theera-Ampornpunt, M.D., Ph.D.Department of Community MedicineFaculty of Medicine Ramathibodi HospitalNovember 2, 2014SlideShare.net/Nawanan nawanan.the@mahidol.ac.thExcept where referredto or copied fromother works

2. U.S. Public Policy Related to eHealth1991: IOMs CPR Report published1996: HIPAA enacted2000-2001: IOMs To Err Is Human &Crossing the Quality Chasm published2004: George W. Bushs Executive Orderestablishing ONCHIT (ONC)2009-2010: ARRA/HITECH Act &Meaningful Use regulations 3. Landmark IOM Reports(IOM, 2000) (IOM, 2001) (IOM, 2011) 4. Patient Safety To Err is Human (IOM, 2000) reported that: 44,000 to 98,000 people die in U.S. hospitals each yearas a result of preventable medical mistakes Mistakes cost U.S. hospitals $17 billion to $29 billionyearly Individual errors are not the main problem Faulty systems, processes, and other conditions lead topreventable errorsHealth IT Workforce Curriculum Version3.0/Spring 2012 Introduction to Healthcare and Public Health in the US: Regulating Healthcare - Lecture d 5. Landmark IOM Reports: Summary Humans are not perfect and are bound to makeerrors Highlight problems in U.S. health care systemthat systematically contributes to medical errorsand poor quality Recommends reform Health IT plays a role in improving patientsafety 6. Political Support Behind Health IT...We will make wider use of electronic records and otherhealth information technology, to help control costs and reducedangerous medical errors.Source: Wikisource.org Image Source: Wikipedia.orgPresident George W. BushSixth State of the Union AddressJanuary 31, 2006? 7. U.S. Adoption of Health ITAmbulatory (Hsiao et al, 2009) Hospitals (Jha et al, 2009)Basic EHRs w/ notes 7.6%Comprehensive EHRs 1.5%CPOE 17% U.S. lags behind other Western countries(Schoen et al, 2006;Jha et al, 2008) Money and misalignment of benefits is the biggest reason 8. American Recovery & Reinvestment Act (ARRA) Economic Stimulus Legislation Contains HITECH Act (Health Information Technology forEconomic and Clinical Health Act) ~ 20 billion dollars for Health IT investmentsGoals:1. Boost economy (economic health)2. Widespread adoption of Health IT (clinical health)Quality Patient Safety Costs 9. President Obama Backs Health IT...Our recovery plan will invest inelectronic health records and new technologythat will reduce errors, bring down costs,ensure privacy, and save lives.President Barack ObamaAddress to Joint Session of CongressSource: WhiteHouse.gov February 24, 2009 10. U.S. National Leadership on Health ITOffice of the National Coordinator for Health Information Technology(ONC -- formerly ONCHIT)David Blumenthal, MD, MPPNational Coordinator forHealth Information Technology(2009 - 2011)Farzad Mostashari, MD, ScMNational Coordinator forHealth Information Technology(2011 - 2013)David Brailer, MD, PhDNational Coordinator forHealth Information Technology(2004 - 2007)Robert Kolodner, MDNational Coordinator forHealth Information Technology(2006 - 2009)Karen B. DeSalvo, MD, MPH, MScNational Coordinator forHealth Information Technology(2014)Photos courtesy of U.S. Department of Health & Human Services 11. HITECH Act &Meaningful Useof EHRs 12. HITECH ActBlumenthal D. Launching HITECH. N Engl J Med. 2010 Feb 4;362(5):382-5. 13. Meaningful Use of EHRs Use of Certified EHR Technology (CEHRT) byproviders (eligible professionals, eligible hospitals& critical access hospitals) to achieve significantimprovements in care Financial incentives & penalties 14. Incentives for Eligible Professionals (Doctors) Medicaid incentives for eligible professionals Maximum $63,750 over 6 years beginning in 2011 Medicare payments for eligible professionals Maximum $44,000 over 5 years 15. Incentives for Eligible Hospitalshttp://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/MLN_TipSheet_MedicareHospitals.pdf 16. Meaningful Use of A PumpkinMeaningful Useof a PumpkinPumpkinImage Source & Idea Courtesy of Pat Wise at HIMSS, Oct. 2009 17. Meaningful Use of EHRs: ONCs 3-Stage ApproachStage 1- Electronic capture ofhealth information- Information sharing- Data reportingStage 2Use of EHRsto improveprocesses ofcareStage 3Use ofEHRs toimproveoutcomesBetterHealthBlumenthal D, 2010 18. Components of Meaningful Use Regulations Medicare & Medicaid Incentives for Meaningful Use of EHRs Centers for Medicare and Medicaid Services (CMS) Rule on Standards, Implementation Specifications &Certification Criteria Certification Programs Office of the National Coordinator for Health IT (ONC) 19. Meaningful Use Incentives: Stage 1Proposed Rule(Jan. 2010) 23 Criteria for Hospitals to Pass 25 Criteria for Professionals (Clinics) to PassPublic Hearing Pace & Scope: too ambitious, demanding, inflexible Few providers would likely qualify -> Little adoptionFinal Rule (2011) Core Objectives (14 criteria for Hospitals, 15 for Professionals, required) Menu Set (10 criteria, pick 5)Blumenthal D, Tavenner M. The meaningful use regulation for electronic health records. N Engl J Med. 2010;363(6):501-4. 20. Meaningful Use Stage 1 CriteriaBlumenthal D, Tavenner M. The meaningful use regulation for electronic health records. N Engl J Med. 2010;363(6):501-4. 21. Meaningful Use Stage 1 CriteriaBlumenthal D, Tavenner M. The meaningful use regulation for electronic health records. N Engl J Med. 2010;363(6):501-4. 22. Meaningful Use Stage 1 CriteriaBlumenthal D, Tavenner M. The meaningful use regulation for electronic health records. N Engl J Med. 2010;363(6):501-4. 23. Meaningful Use Stage 1 CriteriaBlumenthal D, Tavenner M. The meaningful use regulation for electronic health records. N Engl J Med. 2010;363(6):501-4. 24. Some Selected Meaningful Use Stage 1 Final Rule:Core Objectives Electronic capture of information Demographics Vital signs Medication list Allergies Problem list Smoking Medication order entry Drug-allergy & drug-drug interaction checks Patient access to/copy of health information 25. Some Selected Meaningful Use Stage 1 Final Rule:Menu Set Drug formulary checks Lab results incorporation into EHRs Generate lists of patients by specific conditions Medication reconciliation Electronic reporting to governmental agencies Advanced directives for elderly patients Patient reminders for certain services (for clinics) Patient access to health information (for clinics) 26. Final Rule on Standards & Certification Criteria (Selected) Content Exchange Standards HL7 CDA Release 2 & CCD NCPDP SCRIPT Vocabularies SNOMED CT LOINC RxNorm Security NIST-certified encryption algorithms Etc. 27. Stages & Timeline of Meaningful Usehttp://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2Overview_Tipsheet.pdf 28. Evolution of Meaningful Use Objectives in Each Stage 2011 Definition Stage 1: 14 Core Objectives for Hospitals 15 Core Objectives for Professionals Pick 5 of 10 Menu Set Objectives 2013 Definition Stage 1: 12 Core Objectives for Hospitals 13 Core Objectives for Professionals Pick 5 of 10 Menu Set Objectives 29. Evolution of Meaningful Use Objectives in Each Stage 2014 Definition Stage 1: 11 Core Objectives for Hospitals 13 Core Objectives for Professionals Pick 5 of 10 Menu Set Objectives for Hospitals Pick 5 of 9 Menu Set Objectives for Professionals 2014 Definition Stage 2: 16 Core Objectives for Hospitals 17 Core Objectives for Professionals Pick 3 of 6 Menu Set Objectives 30. Meaningful Use Stage 2 Objectives (2014)for Eligible Professionalshttp://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2Overview_Tipsheet.pdf 31. Meaningful Use Stage 2 Objectives (2014)for Eligible Professionalshttp://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2Overview_Tipsheet.pdf 32. Meaningful Use Stage 2 Objectives (2014) for Hospitalshttp://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2Overview_Tipsheet.pdf 33. Meaningful Use Stage 2 Objectives (2014) for Hospitalshttp://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2Overview_Tipsheet.pdf 34. Critique:Lessons for ThailandDisclaimer: Personal opinions of the speaker 35. Lesson #1Clear aim toward improved quality &efficiency of health care. 36. Lesson #2Large health IT initiatives requireleadership from the highest levelof government. 37. Lesson #3To achieve widespread health ITadoption, substantial financialinvestment is necessary. 38. Lesson #4Leadership from a nationalorganization with health informaticsexpertise is vital to success. 39. Lesson #5Criteria for Meaningful Use shouldbe evidence-basedto the extent possible. 40. Lesson #6Criteria for incentives should berealistic and flexible. 41. Lesson #7Criteria for incentives should beevolutionary. 42. Lesson #8Accept local diversity in technologies& requirements.Dont aim for homogeneousenvironment. 43. Lesson #9Leverage existing standardsto the extent possible.Dont reinvent the wheel. 44. Lesson #10Acknowledge that more than onelevel of interoperability needs to beachieved. 45. Lesson #11A policy that attempts to move toofast or be too dynamic will greatlyburden providers 46. Lesson #12Meaningful Use focuses too muchon functionality, with questions ontrue interoperability, and with littleattention on usability, ease of use &provider acceptance of technology 47. Take Home Message Adoption of health IT still work in progress, evenin developed countries We can learn something from other countries We need to do something, soon. Dont forget to build the workforce!! 48. Useful Online Resources www.healthit.gov www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html www.hims