HHS’s Health IT Policy Committee 2011 Draft Meaningful Use Objectives and Measures for Public Comment

The HITECH Act of the American Recovery and Reinvestment Act of 2009, signed by President Obama on February 17, 2009, provides an electronic health record (EHR) adoption incentive program for healthcare providers who adopt certified electronic health records and use them in a meaningful way to improve patient care. The incentive program begins in January 2011 and terminates at the end of 2014 for new adopters of certified electronic health record technology.

HHS’ Health Information Technology (IT) Policy Committee released on June 16, 2009, two documents pertaining to the definition of “meaningful use” for public comment by 5 PM ET, Friday, June 26, 2009. These documents are the Meaningful Use Preamble and Meaningful Use Matrix, available here. Information on providing public comment is available online, along with other information on the HIT Policy Committee and its activities.

In our previous posting on Meaningful Use, we outlined Health Outcomes Policy Priorities and Care Goals, and described the Meaningful Use Preamble and Meaningful Use Matrix. In this posting, HIPAA.com reproduces the draft recommendation 2011 Objectives and Measures for each of the five Health Outcomes Policy Priorities. We recommend that you review the previous posting prior to examining the 2011 Objectives and 2011 Measures. Remember, the deadline for public comment is 5 PM ET, Friday, June 26, 2009.

Meaningful Use Matrix

The meaningful use matrix outlines in Column 1 of eight columns five Health Outcomes Policy Priorities (P), and in Columns 3 and 4 2011 Objectives (O) and 2001 Measures (M), respectively.

(P) Improve quality, safety, efficiency, and reduce health disparities

» (O) Use CPOE for all order types including medications (OP, IP)

» (O) Implement drug-drug, drug-allergy, drug-formulary checks (OP, IP)

» (O) Maintain and up-to-date problem list (OP, IP)
Generate and transmit permissible prescriptions electronically (eRX)(OP)

» (O) Maintain active medication list (OP, IP)

» (O) Record primary language, insurance type, gender, race, ethnicity (OP, IP)

» (O) Record vital signs including height, weight, blood pressure (OP, IP)

» (O) Incorporate lab-test results in EHR (OP, IP)

» (O) Generate lists of patients by specific condition to use for quality improvement, reduction of disparities, and outreach (OP)

» (O) Send reminders to patients per patient preference for preventive/follow-up care (OP, IP)

» (O) Document a progress note for each encounter (OP)

» (M) Report quality measures, including

» % diabetics with A1c under control (OP)

» % hypertensive patients with BP under control (OP)

» % of patients with LDL under control (OP)

» % of smokers offered smoking cessation counseling (OP, IP)

» (M) % of patients with recorded BMI (OP)

» (M) % eligible surgical patients who received VTE prophylaxis (IP)

» (M) % of orders entered directly by physicians through CPOE

» (M) Use of high-risk medications in the elderly (OP, IP)

» % of patients over 50 with annual colorectal cancer screenings (OP)

» (M) % of females over 50 receiving annual mammograms (OP)

» (M) % patients at high-risk for cardiac events on aspirin prophylaxis (OP)

» (M) % of patients with current pneumovax (OP)

» (M) % eligible patients who received flu vaccine (OP)

» (M) % lab results incorporated into EHR in coded format (OP, IP)

» (M) Stratify reports by gender, insurance type, primary language, race, ethnicity (OP, IP)

(P) Engage patients and families

» (O) Provide patients with electronic copy of—or electronic access to—clinical information (including lab results, problem list, medication lists, allergies) per patient preference (e.g., through PHR)(OP, IP)

» (O) Provide access to patient-specific educational resources (OP, IP)

» (O) Provide clinical summaries for patients for each encounter (OP, IP)

» (M) % of all patients with access to personal health information electronically (OP, IP)

» (M) % of all patients with access to patient-specific educational resources (OP, IP)

» (M) % of encounters for which clinical summaries were provided (OP, IP)

(P) Improve care coordination

» (O) Exchange key clinical information among providers of care (e.g., problems, medications, allergies, test results)(OP, IP)

» (O) Perform medication reconciliation at relevant encounters (OP, IP)

» (M) Report 30-day readmission rate (IP)

» (M) % of encounters where med reconciliation was performed (OP, IP)

» (M) Implemented ability to exchange health information with external clinical entity (specifically labs, care summary and medication lists)(OP, IP)

» (M) % of transitions in care for which summary care record is shared (e.g., electronic, paper, eFax)(OP, IP)

(P) Improve population and public health

» (O) Submit electronic data to immunization registries where required and accepted (OP, IP)

» (O) Provide electronic submissions of reportable lab results to public health agencies (IP)

» (O) Provide electronic syndrome surveillance data to public health agencies according to applicable law and practice (IP)

» (M) Report up-to-date status for childhood immunizations (OP)

» (M) % reportable lab results submitted electronically (IP)

(P) Ensure adequate privacy and security protections for personal health information

» (O) Compliance with HIPAA Privacy and Security Rules and state laws

» (O) Compliance with fair data sharing practices set forth in the Nationwide Privacy and Security Framework [released by HHS’ Office of the National Coordinator for Health Information Technology on December 15, 2008, and available on the HIPAA.com site]

» (M) Full compliance with HIPAA Privacy and Security Rules

» (M) An entity under investigation for a HIPAA privacy or security violation cannot achieve meaningful use until the entity is cleared by the investigating authority

» (M) Conduct or update a security risk assessment and implement security updates as necessary.

The 2011 Objectives are described in the Meaningful Use Matrix header to Column 3 as follows:

“Goal is to electronically capture in coded format and to report health information and to use that information to track by clinical conditions.”

The Meaningful Use Preamble elaborates further:

“Although some recommended measure used to assess meaningful use in 2011 may apply to specific chronic diseases, the recommended 2011 objective are meant to establish a foundation for affecting a more comprehensive set of health outcomes in the future…. In identifying potential criteria for ‘meaningful use’ of an electronic health record, it became apparent that that there are considerable gaps in EHR-generated measures available to monitor key desired policy outcomes (e.g., efficiency, patient safety, care coordination)…. [T]hese measures will not be required for Medicare and Medicaid incentive payments until 2013….”

The Health IT Policy Committee

“is seeking feedback on how to best frame these measures including measurement of key public health conditions, measuring health care efficiency, and measuring the avoidance of certain adverse events. These comments will be used to help revise the recommended measurement strategy to include more extensive and refined outcome measures for ‘meaningful use’ in 2013 and beyond.

Remember, if you have a contribution to make concerning the definition of meaningful use, your comments should be submitted no later than 5 PM ET, on Friday, June 26, 2009. Instructions for submission are at the at the site shown at the healthit site shown at the beginning of this posting.