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Long-Awaited "Meaningful Use" Definition Published
In late December, the Centers for Medicare and Medicaid Services (CMS) published its proposed rule to describe the electronic services providers must offer and the reporting requirements they must meet to demonstrate they are making meaningful use of electronic health records (EHRs). Under the 2009 economic stimulus package, physician practices and hospitals that show they make meaningful use of EHRs will quality for incentive payments from Medicare and Medicaid beginning in 2011; by 2015, providers that do not demonstrate such meaningful use will be subject to reduced payments under Medicare.

In announcing the rule, CMS said its goal is to advance "the contributions certified EHR technology can make to improving health care quality, efficiency, and patient safety." The agency hopes to encourage providers to use EHRs that enable decision support for certain conditions, give patients access to self-management tools, review comprehensive patient data, and improve health outcomes. Requirements focusing on those criteria would be phased in between the time the rule is adopted and 2013.

In addition, the Office of the National Coordinator for Health Information Technology released an interim final rule describing the required certification standards for EHR technology.

Both rules were entered into the Federal Register on January 13; there is a now 60-day period for public comment. Officials will then consider revisions and issue final rules for meaningful use and EHR certification in the spring.

Surveys: Most Physician Practices with EHRs Ready for "Meaningful Use"; Hospitals Less Prepared
About 85 percent of ambulatory care providers reported that the electronic health record (EHR) system their practices currently use has the functionality that will be needed to help them demonstrate "meaningful use" of EHRs, according to a new survey by the Orem, Utah–based research firm KLAS. KLAS interviewed more than 1,400 health care providers about their EHR systems from 26 different vendors.

The survey referred to the preliminary recommendations for meaningful use as issued by the federal Health Information Technology Policy Committee in July 2009. It sought to explore whether most EHRs now in use in physician practices have the capacity and functionality in place to meet the proposed federal requirements.

Another survey by the Falls Church, Virg.–based Computer Sciences Corp. found that the health information technology in use in many hospitals is likely to fall short of "meaningful use" requirements. The survey asked executives from 58 hospitals across the nation to report on their level of readiness on 50 indicators, grouped into five categories: use of a certified product, current use of capabilities for meaningful use, standards adoption, quality management and reporting, and privacy and security protection.

Two-thirds of surveyed hospitals identified gaps that could prevent them from meeting the meaningful use requirements. Only one-quarter of hospitals meet 70 percent or more of all the readiness indicators.

Levels of readiness are highest in the areas of privacy and security protection, and weakest in terms of current use of specific EHR capabilities. For example, while about 70 percent of hospitals have EHR systems with capacity for computerized physician order entry (CPOE), only about 8 percent routinely use CPOE. Most quality reporting still relies on the manual review of patient records, rather than electronic review.

Not surprisingly, small hospitals are less likely to be ready to meet meaningful use requirements than larger institutions.

Hospitals Steadily Improve Quality of Care, Report Finds
Between 2002 and 2008, U.S. hospitals significantly improved health care quality by more consistently delivering recommended care for heart failure, heart attack, and pneumonia, according to the Joint Commission's 2009 Annual Report on Quality and Safety. The report includes data from more than 3,000 accredited hospitals. It found:

  •  In 2008, the composite measure of heart attack care was 96.7 percent, up from 86.9 percent in 2002—an improvement of 9.8 percentage points. 
  •  In 2008, the composite measure of heart failure care was 91.6 percent, up from up from 59.7 percent in 2002—an improvement of 31.9 percentage points.
  • In 2008, the composite measure of pneumonia care result was 92.9 percent, up from 72.3 percent in 2002—an improvement of 20.6 percentage points.

Hospitals also demonstrated steady improvement on measures of surgical care between 2005 to 2008. Performance on two measures of quality relating to care for childhood asthma—defined as providing relievers and systematic corticosteroids—was in the 99th percentile after only one year of measurement.

The report emphasizes that while hospitals averaged performance of 90 percent or more on most individual quality measures, further improvement is needed. It pointed to two measures introduced in 2005 for which performance is still relatively weak:

  • In 2008, performance averaged 52.4 percent for provision of fibrinolytic therapy within 30 minutes of arrival to heart attack patients.
  • In 2008, performance averaged 60.3 percent for provision of antibiotics to intensive care unit pneumonia patients within 24 hours of arrival.

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