HHS this week strung together a series of announcements that aim to push the field further down the value path. On Monday, Secretary Sylvia Burwell unveiled an ambitious timeline to tie a growing percentage of Medicare dollars to quality and outcomes. Yesterday, CMS announced plans to rethink some of the regulatory burden under Stage 2 Meaningful Use. Many Stage 2 requirements are building blocks for moving to a value-based system. And today, ONC detailed a plan to achieve greater interoperability, which is essential if providers are going to improve care coordination.
For industry IT vet Pamela McNutt, the announcement that CMS is eyeing ways to ease some of the regulatory burden under Stage 2 is welcome news.
“I think a lot of us are saying, ‘Thank you. You listened,’ ” says McNutt, senior vice president and CIO at Methodist Health System, Dallas.
In a blog post yesterday, Patrick Conway, M.D., CMS’ deputy administrator for innovation and quality and chief medical officer, said that the agency will pursue rulemaking to reduce the reporting period to achieve Stage 2 to 90 days, down from 365 days. The rulemaking will also seek to “realign” meaningful use to the calendar year, allowing “hospitals more time to incorporate 2014 edition software into their workflows and to better align with other CMS quality programs.”
For hospitals, that would mean reporting dates started Jan. 1, rather than Oct. 1, 2014. McNutt says that the proposed change would give hospitals time to perfect operations needed to meet the stringent requirements found in Stage 2. For instance, hospitals must show that at least 5 percent of patients use a portal to view, download or send their health information to another provider.
But there are some sizeable hurdles to jump: Can you get an accurate clinical summary from doctors to post to the portal? How do you engage patients to use the portal?
Another significant challenge to meeting Stage 2 has been getting, installing and testing software updates. The added time being proposed by CMS would create some breathing room, McNutt says, quickly adding that hospitals should not view this as a time to take the foot off of the gas pedal.
“This would be a gift to operationalize workflows and better align with Stage 2,” she says. “Nobody should slowdown. Meeting these measures is hard.”
On the interoperability front, ONC today released its roadmap and plans to accelerate standards development. The roadmap aims to ensure that a “majority of individuals and providers” effectively share data “at a nationwide level” by 2017. By 2024, ONC hopes that we’ll have a “learning health system” where interoperability allows patients, providers, researchers and others to truly engage in population health management.
“This is a much-needed playbook for each and every health IT professional,” stated Russell Branzell, president and CEO of the College of Healthcare Information Management Executives. "Now, health care providers and health IT developers have a single source of truth, with an extensible process to align clinical standards towards improved interoperability, efficiency and patient safety. While we have made great strides as a nation to improve EHR adoption, we must pivot towards true interoperability based on clear, defined and enforceable standards."
The roadmap lays out four near-term goals:
- Establish a coordinated governance framework and process for nationwide interoperability.
- Improve technical standards and guidance for sharing and using a common clinical data set.
- Advance initiatives for sharing health information according to common standards, starting with a common clinical data set.
- Clarify privacy and security requirements.
Pam Arlotto, president and CEO of consultancy Maestro Strategies, says that the HHS announcements mirror activity taking place in the field. More and more, she says, hospital leaders are looking beyond the “check the box” mentality of Meaningful Use Stage 1 and are instead thinking about the business imperative of moving to a value-driven model. Interoperability, patient engagement, quality measures are all integral to that transition.