Doug Rufer, Director Technical Marketing and Clinical Sales Engineering, Carestream
By now, you have probably been feverishly working to meet compliance with Stage 1 Meaningful Use and right around the corner, Stage 2 is set to begin in 2014. If you have been keeping up with the latest news on Stage 2, you are surely aware the requirements have suddenly become more difficult and are continuing to increase in complexity.
Stage 2 Meaningful Use requires higher thresholds than Stage 1 (for example, requiring that more than 80% of unique patients have their vital signs recorded as opposed to 50% from Stage 1). Additionally, two very important changes take center stage that will drive future stages of this program: 1) patient engagement by providing them access to their medical records (allowing access, download, and transmission of that data) within 4 business days of their care and; 2) EHR system interoperability (i.e. data exchange). But are these requirements being enacted too quickly and is our healthcare system ready for the change?
Chart via. http://cms.gov
Patient Record Access
At a recent healthcare IT conference, many attendees expressed their concerns over providing patients access to their information, not that they shouldn’t have access but will providers be overwhelmed by questions from their patients? An interesting outcome, in a few pilot programs, was patients actually do prefer to have access to their information. As a general rule, most providers have found that their patient’s are not continually calling and asking them questions at all hours of the day and the questions they do ask are more focused on allowing the provider to advise them on how to improve their outcomes.
Another concern that surfaced was meeting the objective requirements that the patient actually access their information. Not only is it important that a tool be provided for patient access (portal solutions are now required by certified EHR vendors for patient record access), but to meet the measure, the site has to verify that 5% of their patients actually do access their information. The good news is the CMS reduced this threshold so obtaining the 5% measure requirement should be much more attainable during this stage.
The bottom line is this: providing patients with better access to their health information allows them to ask better questions to their providers. No longer are we in an era where the patient takes the word of the provider as “gospel” but they are truly, actively engaged in their care maintenance and delivery and can now collaborate with their provider for the best possible outcomes. This is a key goal of the program and one which, over time, will help bridge the gap that has historically existed between patients and providers.
Data Exchange and System Interoperability
Another area of concern was with vendors being properly prepared for data exchange. Although there are well established standards today, data exchange is costly and time consuming for many facilities. Data exchange needs to become more fluid and simplified to allow patient data to be exchanged from one IT system to another. This is critical for providing better patient care and lowering the cost of healthcare. Health Information Exchanges (HIEs) are being established throughout the country to accommodate the exchange of patient information. The HIEs purpose is to facilitate the exchange of key information which grants providers in other locations access to important patient information. This allows them to make better decisions on patient care and eliminate costly repeat procedures.
Finally, imaging of all types (radiology, cardiology, etc.) needs to focus on access as well. These imaging systems have traditionally been silos of information. Now that patient data will be accessible through HIEs nationally, imaging needs to be taken into consideration on how to share patient images when their imaging record may span across multiple organizations and PACS systems, yet be readily available with their patient health data.
Accountability and Making Sense of Meaningful Use
At the end of the day, the goals driving Meaningful Use were made simply to lower the cost of healthcare, provide better communication and collaboration among healthcare facilities and practitioners, and improve patient outcomes. The program set three initial stages to accomplish this goal: 1) Stage 1 was meant to capture data; 2) Stage 2 is meant for use and data sharing in a meaningful way and; 3) Stage 3 plans to focus on data analysis and using the data to improve clinical outcomes (Stage 3 has not yet been finalized, however).
To accomplish the goals of Stage 3, a new model must emerge in the delivery of care and this is taking place with the rise of ACOs and Population Health Management. ACOs are meant to establish, through a group of providers and physicians, an accountability for the care they provide. In other words, there’s a shift from “fee for service” to a model where the caregiver is encouraged to deliver higher outcomes and is incentivized to provide this level of care. Population Health Management is health outcomes by a group of individuals that aims to improve the outcomes of an entire population, not just the individual. Population Health is getting a lot of attention because concentrating on an entire population creates a model to impact costs of care delivery over time.
When factors beyond a single patient are taken into consideration (such as socioeconomic status, environment, and resource distribution of care), and programs can be put into place to improve certain diseases or conditions within that population by equalizing access to the care, the long-term effects will be lower healthcare costs.
We live in an era that has the most robust access to care and technology to help improve more lives than ever before in history. But costs have spiraled out of control making access to care difficult for those who need it most. Getting a jump on this trend by looking at key patient data and outcomes across a population, in time, can help bring these costs back under control. Managing population health will help drive down costs of chronic conditions within a given population by better understanding the drivers for such a condition and developing and administering preventative programs early on. All this can only be achieved by capturing data, having open access to the data, and the right tools to analyze it. So the next time you are struggling with the “why” behind capturing data and the fuss of this program, know you are on the forefront of changing the delivery of patient care in the future, and that in and of itself, is a goal worth striving for.