In the end, if the government plan works as it could, a physician should be able to create a report that shows, for example, how many congestive heart failure patients have not been seen in a month. "If the physician can't do that, then the EMR is nothing more than an electronic version of a paper record," de Brantes says. "The objective here is to have a patient management tool that focuses on overall patient population health. The good EMRs of today can do this, and the government shouldn't spend a nickel on an EMR that can't."
The regulations almost certainly will include far more reporting from physicians than had been done previously under such programs as the voluntary Physician Quality Reporting Initiative, de Brantes says. By providing the tools, the government works around the physician barrier that pulling data from paper medical records is too time-consuming and expensive. "Part of proof of use should be the ability to report, and yes, the feds should be requiring far more robust reporting than there is today, but designed intelligently. Let's face it—PQRI is a joke. Reporting three measures that the physician is free to select? That's almost an insult at a time when costs continue to rise and the value of healthcare dollars continue to deteriorate."
So what is a hospital or physician group to do while waiting for more guidance from CMS? De Brantes says a first step for physicians would be to create a real and robust dashboard of the practice's overall performance as well as the performance of the individual physicians. Foster says that timing will be crucial as hospitals deal with the administration's hurry-up-and-wait posture. Bide your time for guidance from CMS on meaningful use, but bear the pressure of adopting a qualified EHR by January 2011 to collect the most reimbursement.
Hospital leaders understand that whatever the government issues in the way of implementing regulations to the HITECH Act are only a piece of meeting the patient care goals that are unique to each hospital.
"It is this delicate balance between understanding what must be included—which will come from the feds in the implementing regulations—and what would likely be the most important capacities to include if you are looking to support higher quality and safer care," Foster says. Could those two goals coexist? "They could. I just don't know if they will."
The visceral fear in much of healthcare quality is that more measures have only created more measures, and not better quality. Like the school district that wraps its curriculum around the year-end standardized test, what may get lost is meaningful improvement. The law not only gives the HHS secretary authority to set the initial set of parameters for meaningful use and measures, but also authorizes the secretary to "improve the use of electronic health records and healthcare quality over time by requiring more stringent measures of meaningful use."
De Brantes is hopeful that by selecting measures that enable physician improvement and create interoperability, the IT infusion can have an impact on quality.
"This can be the beginning of a very different healthcare delivery system."