They can’t do it alone – ONC needs everyone’s input!

By Patricia Flatley Brennan, Director, Project HealthDesign.

It’s no secret to anyone in the HIT field that meaningful use is an important concept.  We at Project HealthDesign want to make meaningful use really useful for patients – and now ONC has given us the opportunity to help shape the objectives and measures for Stages 2 (2013) and 3 (2015).

Let’s look first at the goals of Stage 2 and Stage 3. 

• By 2013, meaningful use of HIT should guide and support care processes and care coordination.
• By 2015 meaningful use of HIT should yield measurable improvements in quality, safety and outcome of care processes (including enhanced quality measures and extensive decision support) at the individual and population level and enriched tools for patient self -management. 

CMS proposes new rule making in these areas over the next year, and our voices need to be heard!

We start by listening to what we’ve been told by lay people who have participated in Project HealthDesign activities to date. 

• Make sure my doctor knows about and has access to my data.
• Make sure my data are secure, but don’t overdo the privacy lock up. 
• Use technologies that reduce the burden on me to remember to collect data, and help my doctor and I see patterns in the data I collect.
• ABOVE ALL: Let me tell my doctor what is important to me, in my words, and help me in reporting what my doctor wants to know.

We’ve also been listening to the physicians, nurses, public health workers and other clinicians tell us that they want to better understand their patient’s story.

• Don’t just dump a lot of data on me.
• Make sure I can practice in a legally safe manner, and not worry that some little bit of critical information is hidden in some computer file that I need to wade through. 
• ABOVE ALL: Let me understand what is important to the patient and how I can enlist them in being an active participant in their care.

The techies have also weighed in.

• They are ready with solutions, like sensors and networks, but want to be sure there is a market for software and a protection from liability. 
• Distributed computing, apps and clouds may finally be robust enough for health care – but we’re not sure they can really scale.
• ABOVE ALL: Give us clear standards that we can build to and insure that our products, solutions and apps can be certified.

We need your help to make sense out of all of this noise, so that we can tell ONC how to make meaningful use really useful for patients.  What priorities would you set? What can’t wait, and must be included as core objective criteria for Stage 2. What can wait for Stage 3? ABOVE ALL, how can Stage 2 build on the experience unfolding under Stage 1 efforts, and set the stage (so to speak!) for Stage 3?

Weigh in on a few objectives listed below – a simple, “yes, I’m with you,” or “No, don’t waste our time,” will be enough to get us started in looking at these possible specific recommendations.

1. Provide clinical decision at the point of care (including the home) for diabetes management
2. Standardize bar coding on the packaging of dispensed medication so that patients can use scanners for medication reconciliation and administration.
3. Using acceptable identity management and data security protocols, upload calibrated data in a standard format for weight, blood pressure and blood glucose from home monitoring devices to third party platforms.
4. Require all cell phones whose owners have registered them to receive public health alerts
5. Create a generalized data structure to receive automatically captured or self-report information about activity (exercise, sleep, walking, restfulness), at an individually-determined frequency
6. YOUR IDEAS HERE!

Soon I’ll be back with you to pose a new set of objectives and criteria.

Comments

[Deven McGraw]

Because I sit on the Health IT Policy Committee, which will provide recommendations on the criteria for the next stages of meaningful use, I also am dying to hear from Project HealthDesign grantees on measures that can be built into the meaningful use program to provide incentives for the incorporation of patient generated data, including ODLs, into EHRS and the care process.

One thing to keep in mind: much of the rest of the health care system is way behind where the Project HealthDesign grantees are with respect to meaningfully engaging the patient as part of the care process. So think about some simple measures that help "put the shovel in the ground" and will enable providers to get started on a pathway to accepting data from patients as part of treatment and care management.

I'll provide an example of what I'm talking about: I think we need to ensure that the electronic medical record systems that physicians, clinicians and hospitals are purchasing have the technical capacity to send data to, and receive data from, patients. To ensure that this technical functionality is mandatory, we need to come up with meaningful use criteria that will trigger the need for technical compliance. Perhaps one possibility for stage 2 is to "demonstrate the capacity to incorporate electronic information from patients into the EHR." This could then lead to a more robust requirement in Stage 3 to be actively incorporating patient-generated information into EHRs.

These are just suggestions - but hopefully helpful in thinking about a stepwise plan for achieving the greater adoption of practices that are second nature to Project HealthDesign grantees.