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Testimony on "Meaningful Use" and HIT Certification

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PBGH CEO David Lansky, PhD, testified to the broad expectations that purchasers have for "meaningful use" of health information technology that is supported by the recently enacted Health Information Technology for Economic and Clinical Health (HITECH) Act.  As part of the American Recovery and Reinvestment Act (ARRA), HITECH authorized Medicare and Medicaid incentive payments and penalties to encourage physicians and hospitals to adopt and use electronic health records (EHRs).  Dr. Lansky joined national experts and key stakeholders at the April 2009 National Committee on Vital and Health Statistics Executive Subcommittee Hearing on "Meaningful Use" of Health Information Technology in the context of EHR functionality, measurement, quality reporting and certification.

Purchasers believe that a clinical information infrastructure should support:

  • Evidence-based medicine, including evaluation and monitoring of new technology;
  • Planning and evaluation of workflow and payment redesign experiments;
  • Implementation of provider measurement, recognition and payment programs - for physicians, medical groups and hospitals;
  • Aggregation of data to provide feedback to clinicians for continuous quality improvement;
  • Exchange of clinical information with patients to enhance engagement, informed decision-making and self-care; and
  • Align Medicare, Medicaid and commercial incentives.

Certification is one linked step in an improvement cycle that needs to garner better value in health care: 1) certify, 2) validate, 3) measure, 4) feedback, and 5) reward.  Noting a long history of “certifying” capabilities, but experiencing mediocre performance (managed care, hospitals, disease management), Dr. Lansky called for an expanded focus on the areas of quality deficits, high variation, inappropriate utilization, high costs in various population and insurance segments.

Citing cardiac care and measurement as an example, Dr. Lansky noted purchaser interests in the appropriate use of imaging, stress test, diagnostic catheterizations, interventions (Percutaneous coronary intervention (PCI) or stent insertion), and the need for broader outcomes measurement, including symptom relief, functioning, survival rates.  The Pacific Business Group on Health is one of the founding organizations of the National Priorities Partnership, which seeks to advance a core set of National Priorities and Goals in the areas of payment, public reporting, quality improvement, and consumer engagement.  "Meaningful use” should encompass systematic use of clinical registries to support public interest objectives such as reducing the significant quality, safety, cost variations in specialty and procedural care.

Certification criteria must address information requirements relevant to public interest concerns – outcomes, appropriateness, efficiency.  Certification should verify that EHR or registry tools deliver value. Specific recommendations have been articulated by the Markle Foundation through its Connecting for Health public-private collaborative:

  • Certify for interoperability;
  • Certify for meaningful use – i.e., that the system can report its performance of meaningful uses;
  • Certify technical aspects of privacy and security – e.g., disclosures;
  • Validate that the user has deployed key system functions after installation;
  • Pluralistic applications; and
  • Pluralistic certifiers.

Purchasers should question, "Is information being used to increase appropriate use of expensive, dangerous, varying technology?" or "Is information being used to improve quality, safety and value?"

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Jenny Hu
Policy Analyst
Consumer-Purchaser Alliance

Email: jhu@pbgh.org
Tel: 415-615-6358