AMDIS 2014: ONC wants to shift the conversation to measuring and improving quality

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OJAI, CALIF.--While the Office of the National Coordinator for Health IT (ONC) is certainly concerned about issues such as standards and certification criteria, health IT safety and interoperability, during the June 18 opening session of the annual AMDIS Physician-Computer Connection Symposium. Jacob Reider, MD, the office's chief medical officer, chose to focus a lot of attention on the issue of quality improvement and how to measure it.

“We would like to shift the conversation away from a set of quality measures and towards the capability to measure and improve,” Reider told the audience of CMIOs. “We … would like you to be able to improve the quality of care. We would like you to be able to measure the quality of care you provide in your organizations.”

Healthcare organizations should be thinking about how health IT can help support these kinds of activities rather than focus on the reporting of some random quality measure. “This will take a while for us to make this turn,” he said. “We would love your support in helping to educate those who are focused on a specific clinical quality measure as if that measure is the be all and end all of how we are going to improve care. As I often say to the quality measurement folks, giving all the kids a C- doesn’t make them better students. We need to empower them and help them be successful in quality improvement.”

Those efforts should not only include measurement, Reider said, but decision support as well.

Later on, in answering a question from the audience about the issue of value, Reider returned to this theme. “Congress is thinking about the way it is going to pay for healthcare and value—whatever that is—is an important component of how it wants to pay for care rather than volume. We need a way to empower our community to measure value accurately, especially if Congress is going to change the way we pay for things.”

Reider also talked about other areas in which ONC is playing a role, such as usability. “We are looking very critically at what is ONC’s role in improving the usability of products that are out there,” he said. The problem is that while users want the government to do something in this area, IT developers are resistant to government intervention.

As far as Meaningful Use is concerned, Reider told the group that ONC and CMS are working towards getting a Meaningful Use (MU) Stage 3 rule published this fall. And, unsurprisingly, many of the questions from the CMIOs attending the conference had to do with MU.

One CMIO brought up the fact that very few hospitals and physicians have attested to Meaningful Use Stage 2 this year and also lamented that his organization is having to expend a lot of resources in the form of money and skilled personnel to meet certain measures “to the exclusion of other things, which quite frankly for us would be more meaningful.”

Reider responded that one could look at the numbers of attestations and wonder whether the program is a failure. The other way of looking at it, he pointed out, is that one wouldn’t expect providers and hospitals to have attested to Stage 2 yet in substantive numbers since the reporting period for a hospital is July 1 to Oct. 1, and Oct. 1 to Jan. 1 for eligible providers.

He did acknowledge, however, that the numbers are low “and we know why that is—we know that to some degree the systems weren’t ready yet.” And with that in mind, he said, CMS recently published a proposed rule that provides eligible hospitals and providers more flexibility in how they use certified EHR technology to meet MU.

Reider also presented the attendees with a “reading list” which included ONC’s recently released three-, six- and 10-year agendas for achieving an interoperable health IT data  infrastructure, and spent some time talking about the 10-year agenda’s “learning health system.”

Learning from the care delivery system by incorporating research, and/or real-time questions that can be asked of the data so the care about to be provided can be better understood, is the ultimate goal of a learning healthcare system, Reider said, adding that while clinical decision support (CDS) will be an important part of that process, it’s not the CDS we think of today with its alerts and reminders. This CDS, he said, “leverages both a patient’s information and patients like them at the point of care.”