This past week we saw some significant controversy regarding the Meaningful Use Stage 2 Final Rule which was published late August of 2014. The controversy lies within the reporting period. The final rule requires a full 365 days of reporting. Many professional organizations feel that this is to arduous. Earlier this week Congeresswoman Renee Ellmers (R-NC) introduced The Flexibility in Health IT Reporting (Flex-IT) Act of 2014. She states:
“Health Care providers have faced enormous obstacles while working to meet numerous federal requirements over the past decade. Obamacare has caused many serious problems throughout this industry, yet there are other requirements hampering the industry’s ability to function while threatening their ability to provide excellent, focused care.”
“The Meaningful Use Program has many important provisions that seek to usher our health care providers into the digital age. But instead of working with doctors and hospitals, HHS is imposing rigid mandates that will cause unbearable financial burdens on the men and women who provide care to millions of Americans. Dealing with these inflexible mandates is causing doctors, nurses, and their staff to focus more on avoiding financial penalties and less on their patients.”
“The Flex-IT Act will provide the flexibility providers need while ensuring that the goal of upgrading their technologies is still being managed. I’m excited to introduce this important bill and look forward to it quickly moving on to a vote.”
While I applaud Congresswoman Ellmers I personally don’t feel this is the time to ease the pressure of the transformation of healthcare. As she states only 9 percent of our nation’s hospitals and 1 percent eligible healthcare professionals have demonstrated the ability to meet Meaningful Use Stage 2 requirements. While I certainly don’t argue the statistics around this issue and agree that the Meaningful Use Stage 2 measures are much more difficult to tackle but most facilities both EP & EH wait until the latter part of the reporting period to attest so I can assume that the 9% number is on the low end. The fact of the matter is that we should be properly documenting all these pieces of information regardless of an electronic record, it is just good patient care. By easing up the restrictions on meaningful use sends the message that this pivotal moment on our journey to digitize health and further transform our collective system is not as urgent as it should be. I just don’t think it is in the best interest of our patients. By limiting the reporting period to 90 days as opposed to 365 is analogous to only treating the Chest Pain patients you see over a 90 day period correctly while extrapolating that the other patients treated over the next 275 days are treated just as well. I realize that this may be an overly excessive example but I truly feel that we need to maintain the collective pressure to transform the patient care experience and focus on proper data input so patients can feel we as clinicains and the healthcare system as a whole are able to diagnose our collective patients as accurately and efficiently as possible.
I had the opportunity this week to attend the Epic user group meeting. I must tell you that the feel of collaboration around the patient care experience is nothing else I have experienced. One thing many of the attendees may not have been aware of is the increased focused on interoperability in the next couple of years. I have the unique opportunity to serve as chair of the CareEverywhere Council, a group of individuals passionate about the seamless transmission of information. Additionally I was most recently appointed to chair the CareQuality Trust Framework subgroup. It is within these two groups I will try to drive toward the three factors that will ultimately facilitate this information transfer so patients can feel just as safe in the healthcare system as they do in their own homes. I have included the The Interoperability Report 2014 Care Everywhere Network here. In short we must commit to:
- The use of industry standards
- A nationwide directory of exchange-ready providers
- Simple Rules of the Road
These rules establish a universal trust framework that outline the rights and obligations of network participants. They would give each organization confidence that it can participate in exchange activities while upholding its legal and ethical obligations to maintain the security and privacy of patient records.
Unfortunately that single set of Rules of the Road does not exist across industry, so trust must be established individually. In order to move beyond the one-to-one connections a framework of mutual trust agreements and standards needs to be in place.
With this in mind I have recently been appointed to chair the CareQuality Trust Framework WorkGroup. It is here that I will continue to work with all vendors to create a framework that expedites point-to-point patient record exchange basedon mutual trust agreements and national standards
Over the past 2+ years we haven’t done everything right. In the attached report we detail some of the touching stories of successful information transfer but also some of the issues we have uncovered. As of August Epic has exchanged over 550,000 patient records with other non-epic vendors per month!! That is a staggering number and one that is not accounted for in the many news stories on the perceived lack of interoperability.
Presently the CareEverywhere Network includes over 950 hospitals and over 21,000 clinics representing community hospitals. academic medical centers, children’s organizations, FQHC’s, safety net providers and multi-hospital systems all sharing critical patient information with individuals both on Epic and not.
Some of our lessons learned
- Patients overwhelmingly want to share their data in a secure way
- Strict adherence to fewer standards + succinct Rules of the Road + simple patient consent model = SUCCESS
- Providers attribute exchange success to integration with clinical workflows
- Nationwide exchange is practical even without a national patient identifier, and can be further improved
- Successful exchange does not have to be expensive and results in lower cost of care
- Simplify consent because the majority of patients want to securely share their data
- Simplify exchange: one standard per purpose with a single national phone book of exchange ready organizations and providers
- Continue to formally adopt nationally-defined reference terminologies to enhance utility of data incorporated into the local chart.
- Standardize how identifying information is captured to further improve patient matching between providers.
- Require public health and immunization registries to exchange directly with providers free of charge when using a single, national standard.
I look forward to my continued participation on both the CareEverywhere Governing Council as well as the new CareQuality Trust Framework Work Group.