The administration's decisions on decision support and use functionality may ultimately determine whether the money spent achieves the quality and safety goals.
The $19.2 billion worth of healthcare technology funding in the American Recovery and Reinvestment Act will buy a lot of computers, but will it improve healthcare quality in ways that decades of proliferating quality measures and disparate outcomes have failed to do? So far, those responsible for improving the quality and safety of the patient have little to go on other than President Obama's inaugural pledge that the government would "wield technology's wonders to raise healthcare's quality and lower its cost."
The law mandates that to qualify as a meaningful user of a qualified EHR, the receiving hospitals and physicians must "submit information on clinical quality measures and other measures in a form and manner that will later be specified by the HHS Secretary." Those measures may not come until the end of the year, leaving many responsible for quality playing some educated guesses as to what the government may intend.
"I'm afraid it is too early to tell," says Nancy Foster, vice president for quality and patient safety policy for the American Hospital Association. "There is clearly an interest in making sure that the information technology acquired with the stimulus money does support higher quality and safer care." Foster says one key sign of the government's intent was the nomination of David Blumenthal, MD, as the National Coordinator for Healthcare Information Technology, given that his expertise leans toward the clinical and quality improvement area and not from the IT side.
The question that may ultimately decide whether the IT stimulus has any measurable impact on quality depends on just how far the government will go to take advantage of the EHR's benefits as a decision support tool. At minimum, Foster says, the tools will support public reporting. Or they could go deeper.
"Public reporting is an important function, but there are so many other important functions that actually have been instituted at places like Brigham and Women's or Intermountain or others where we have seen in the literature how they were really able to support clinicians in making judgments about what is the right care for them and what are the likely outcomes of that care. The closer we can get to that without making the technology so expensive that nobody can afford it will determine the effect of this legislation on quality."
Francois de Brantes, CEO of Bridges to Excellence, a nonprofit program focused on rewarding physicians for quality care, would like to see a set of use factors that will create a registry to indicate whether a patient population is being managed well by the physician.
"Certainly, the ability to pull information from the EMR on patients with chronic illnesses—which is what a registry should be able to do—and determine which ones of those are not properly managed, is one key use factor. Another should be to pull some reports from the EMR that would highlight the average BP for patients with hypertension, and A1Cs for patients with diabetes, and determine how many of them are in the poor control zone.
"Finally, a key use measure will be the extent to which the EMR is pulling data from pharmacies and labs." Taken together, all three factors "provide evidence that the physician has the reporting capabilities to understand the patient population being managed and monitor progress toward clinical goals."