Guest post by Uwe Heiss, Vice President, RAD – Research Analytics Data
With CMS poised to release Meaningful Use Stage 2 requirements in the coming weeks, anticipation is building within the health care IT community.
Stage 2 could potentially be a very big step for health care as we may start to see many of the benefits of EHRs besides just being able to do away with storage rooms full of paper. Whereas Stage 1 dealt primarily with laying the groundwork for successful implementation of a comprehensive, connected national EHR framework, Stage 2, according to information released by the ONC so far, will focus on using that framework to improve quality at the point of care.
We are proponents of electronic patient-reported outcomes (ePROs) because they improve the process of care, create better research, and take advantage of the patient perspective in care value measurement. Stage 1 didn’t have anything to say about ePROs, but we are keeping our fingers crossed that Stage 2 will lead to further use of ePROs by encouraging EHR vendors to create or adopt functionality that enables them.
So, what would we like to see in Stage 2? Here are four things we’ll be on the lookout for come release day:
Identification of a standard, patient-reported, population-wide health status measure
While the health care community has come to accept the value of patient-reported outcome measures, there is still no agreement on a standard instrument that is accessible and free to use for individual and population-wide health status measurements.
With several options available, we recommend that CMS endorse a standard and provide the framework for establishing outcomes comparability and transparency on a broad basis. By doing so, the industry will be able to more quickly take advantage of ePROs’ benefits as well as prevent setbacks by organizations that happen to pick instruments that down the road don’t become the standard.
Requirement to assess each active patient once a year for the purpose of generating a health baseline
The availability of a general health status baseline is highly valuable for understanding long-term trends and disparities in the population receiving care, as well as for assessing and guiding care of individual patients.
According to the ONC, Stage 3 will “focus on decision support for national high-priority conditions,” something that seems difficult to do without individual and population baselines.
Pre- and post-administration of the standard health status measure for all patients undergoing surgery
A surgical event represents a clearly marked treatment intervention, the outcome of which is relatively easy to assess using a pre-surgical baseline measurement and post-surgical follow-up measurements.
Surgery is one of the largest cost drivers in health care. Measuring the effectiveness of surgical interventions offers a high-impact starting point for eventually establishing outcomes measurement for all interventions. This would improve quality while helping to control costs.
Annual baseline assessment of the entire population affiliated with Accountable Care Organizations (ACOs)
ACOs will be held accountable for the health of their regional population, but how should the success of such stewardship be evaluated? Beyond establishing that the right care is delivered and that dramatic negative events are avoided, the most relevant measure is a patient-reported measure that quantifies, at the source, how well the patient is doing.
Since effective ACO care is also preventive, a comprehensive ACO compensation program will have to consider the health status for an entire ACO population, comprising both patients who are actively receiving care and those who currently do not. A standardized, patient-reported measure appears to be the best candidate for such a population-wide assessment.
As my colleague, DCS Co-founder and President Chris Weiss suggested in a previous blog entry, the key to ACO performance measurement is ePRO measurement.
We are looking forward to what CMS proposes for Stage 2. Once CMS draft requirements are published, check back with us to read our assessment.
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