LAS VEGAS — Well, there goes the kids' college tuition fund. Instead of following my reporter instincts and betting that the federal government would indeed release Stage 2 meaningful use regulations during the biggest health IT show of the year, I succumbed to skepticism expressed by a few people in the conference hall that an announcement was still a week away (largely because nothing had been published in the Federal Register. As it turns out, the delay is the result of "formatting issues" in getting it posted to the web. Anyone else see the irony in that?) Oh well. There's always the mint I'll make from the $20 I'm plunking down on the Cubs to win the World Series.
What a way to end my week at HIMSS12 though — with some actual news. ONC chief Farzad Mostashari, M.D., delivered this morning's keynote, explaining the government's goal in continuing to push for digitizing health care. He offered few specifics about the proposed reg, sticking more to a more global view of how health IT can improve care, which isn't really anything new to the HIMSS crowd. During a press briefing afterwards, however, Mostashari delved into specifics of the proposal, which he says offers flexibility to providers and vendors. The proposal seeks to extend the deadline for Stage 1 to 2014, which was actually announced late last year. It would also let providers spend two years in each stage — so, two years in Stage 1, two years in Stage 2, ditto for Stage 3.
The proposal places a pretty high emphasis on a number of initiatives aimed at improving patient care, such as medication safety by requiring specific use of electronic medication matching. There are also bolstered requirements on patient engagement.
Significantly, the proposal pushes for greater interoperability among EMR systems and lays down a marker for the use of standards. Mostashari said that we can't continue to wait for standards to magically appear. The proposal would require single standards in areas like problem lists, medication lists and immunizations. The goal here is to ensure that disparate systems can talk to each other and send data seamlessly between providers.
As it turns out, information exchange and standards came up in nearly all of my meetings this week. CIOs and vendors are trying to get beyond the point of simply moving data from one location to the other and providing useful, actionable information. That can't really be done without standards, they say. It's something that Marc Probst, CIO and vice president of information systems at Intermountain Healthcare, is passionate about. He explained his concerns during an interview on Wednesday:
Probst said he hopes that the push to get health IT installed on an accelerated timeframe doesn't actually work against the goal of ensuring that physicians (and patients) can access useful information. His comments were echoed by several attendees who listened to Mostashari's keynote — that the emphasis needs to be on deploying systems smartly and in a way that will improve care.
On a related topic, I had the chance to talk with Doug Thompson, senior research director at The Advisory Board Company about some research he's been doing with HIMSS Analytics around EMRs and quality. The groups are studying hospitals that have achieved Stage 6 and 7 on the HIMSS EMR adoption model. They found that the hospitals are making progress on several quality and safety fronts. Thompson says that it is really the first time that anyone has looked not only at Stage 6 and 7 hospitals, but at the entire EMR. Previous reports looked mainly at individual components of EMRs, Thompson says. The next step is for researchers to do a deep dive with the hospitals and find best practices that can then be shared with the field.
Finally, that idea of studying the effectiveness of health IT and getting best practices to the field is something that AHRQ has been exploring for several years. I sat down for a chat with Jon White, M.D., who directs health IT issues at the research agency late yesterday. He noted that AHRQ has actually been funding work in health IT for decades, dating back to some of the earliest efforts at places like Intermountain Healthcare. Several of AHRQ's recent research efforts looking at the effectiveness of HIT are available for public consumption. He said that it's important to remind ourselves that health IT is a tool, a means to an end, not the end in and of itself.
His ideal vision for an HIT system is this: that people want to use it — so systems are built in a way that people are eager to log on; it puts the patient back at the center of the care process; and, importantly, it improves quality.
And that is really the message that Mostashari tried to drive home. "We are on track to make meaningful use out of meaningful use," he said.
Matthew Weinstock is senior editor of H&HN. You can reach him at mweinstock@healthforum.com.
