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Definition of "Meaningful Use" Comes into Focus
Last week, the federal Health IT Policy Committee approved revised recommendations for a definition of "meaningful use" of electronic health record (EHR) systems. Hospitals and physicians must demonstrate that they are making meaningful use of EHR systems to receive incentive payments from Medicare and Medicaid under the terms of the American Recovery and Reinvestment Act of 2009 (ARRA).

The initial recommendations will now go to the Office of the National Coordinator for Health Information Technology and other units of the Department of Health and Human Services, which are charged with developing the detailed rules required to implement the incentive programs.

The recommendations include some two dozen requirements for use, each linked to care goals. For example, to improve the coordination of care, providers must perform medication reconciliation at relevant encounters and at each transition of care. To engage patients and their families, providers must provide patients with an electronic record of their health information upon request. To improve the quality, safety, and efficiency of care, providers must implement drug–drug, drug–allergy, and drug–formulary checks and maintain a list of current and active diagnoses, among other requirements. Providers also must submit medical claims electronically and perform electronic insurance checks.

When feasible, providers must be able to exchange health information with other providers by 2011, and participate in a national health information exchange by 2015.

Providers stand to gain significantly from the incentive payments. For example, a new study finds that, over the next six years, 45,000 office-based physicians (roughly 15 percent of the nation's 300,000 practicing office-based physicians) will qualify for incentive payments from Medicaid for use of EHRs. Researchers at George Washington University School of Public Health and Health Services used data from the 2006 National Ambulatory Medical Care Survey to determine how many physicians would be eligible for ARRA incentives based on their Medicaid patient volume. ARRA allocates $21.6 billion in increased Medicaid payments to implement EHR systems.

Texas System Launches Health IT Experiment
On July 13, the New York Times technology blog reported on Cook Children's Health Care System's use of health IT to improve patient care. The Fort Worth, Tex.–based pediatric health system, which includes a 250-bed hospital and has 350 employed physicians in 60 practices, will install a Web-based electronic health record system (built by AthenaHealth) and a data integration system (created by Microsoft) that unites inpatient and outpatient records with laboratory, radiology, and home health data at the point of care. Patient health records will be stored in Microsoft's Health Vault, enabling patients to access personal health records after they have outgrown the pediatric system.

According to blog author Steve Lohr, "the most intriguing thing Cook Children's has planned is probably its prototype Innovation Clinic." This small physician office, serving 2,000 to 3,000 Medicaid patients, will use electronic health record and other technology to help them engage families in delivering preventive care and managing chronic conditions. As an example, Cook Children's may link weather data with patient records to identify and alert asthma patients and their families when the environment puts them at risk. "We expect practices like this to help prevent medical crises and significantly reduce visits to the emergency room," said Rick Merrill, president and CEO of the health system. Providers will be paid annual capitated fees for each patient.

Small practices have lagged behind in adoption of health IT since they often cannot afford the technological infrastructure or expertise to implement it. According to Lohr, "Cook Children's is betting that the new technology will help the clinic improve care management and curb costs, which is the outcome-oriented approach that the [Obama] administration seeks."

2008 State Snapshots: Mixed Reviews Across the Nation
This month, the Agency for Healthcare Research and Quality published its annual review of health care quality across the nation, drawn from the National Healthcare Quality Report, which was published in May. The 2008 State Snapshots find wide performance variation across the nation, with no one state emerging as a model of high performance. The State Snapshots examine quality on three dimensions: type of care (preventive, acute, and chronic), care setting (hospitals, ambulatory, nursing home, and home health), and clinical area. For the first time, the Scorecards include information on asthma rates and potentially preventable hospitalizations related to the condition.

Last month, the U.S. Department of Health and Human Services (HHS) published state-by-state reports on the quality and costs of care. The reports examine issues such as the increasing cost of family health insurance premiums and the impact of failing to invest in preventive care that are, according to HHS Secretary Kathleen Sebelius, a "clear demonstration that there are problems with health care in every state."

Hospital Compare Adds Readmissions Data
For the first time, the Centers for Medicare and Medicaid Services (CMS) has posted on its public reporting Web site, Hospital Compare, 30-day hospital readmission rates for Medicare patients who have experienced heart attack, heart failure, or pneumonia. Hospitals' performance is described as "better than U.S. national rate," "no different than U.S. national rate," or "worse than U.S. national rate." There are also comparisons to the average readmission rates in each state. Users can drill into particular measures to view graphs showing hospital-specific readmission rates. The rates, which are based on three years' worth of data, are risk-adjusted to account for clinical and demographic factors.

CMS also updated other data for 30-day mortality, process-of-care measures, and measures of hospital patient experiences.

The Commonwealth Fund Web site,, has posted the new data for the process-of-care and hospital patient experiences measures and will post mortality and readmission rates later this year.

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