Monday, June 15

Meaningful Use - Is the Patient in the Room?

Meaningful Use Draft Definition

According to multiple sources
"David Blumenthal, MD, National Coordinator for HIT, will make public a “first draft” of the definition of “meaningful use” on June 16th when the ONC HIT Policy Committee meets. After releasing this first draft, the ONC will compile public comments as well as input from both the HIT Policy Committee and the HIT Standards Committee and will place a definition of “meaningful use” in a regulation, called an “interim final rule,” to be published in the Federal Register by December 31, 2009.

Is the patient in the room? What is their view of Health IT and "Meaningful Use"?

Since the Policy Committee will be announcing a meaningful use "draft" tomorrow I just wanted to ensure that we proactively include the patient/consumers voice in this process. One of the primary reasons that complex software system implementations fail is because you fail to identify, educate and engage a critical stakeholder (like patients) at the beginning of the change management process. If you really want a high quality, safe, effective, patient centered health care system we need to pro-actively include their voice in the process.

Are we for example including the needs of the 1 in 9 women, like my Mom, who will be diagnosed with Breast Cancer in meaningful use? What form does interoperability take for someone with a chronic condition vs for the harried young parent who needs vaccination records for the kids to go to camp? Are we looking outside of the walls of the practice where 90% of health care takes place?

Building on the work that came out of "A 2020 Vision of Patient-Centered Primary Care" (Journal of General Internal Medicine, Oct. 2005), and the plan advanced by The Commonwealth Fund's Karen Davis, Ph.D., Stephen C. Schoenbaum, M.D., and Anne-Marie J. Audet, M.D., I would like to gently offer the following draft from a patient point of view.

Attributes of Patient-Centered Care and the role of Meaningful use of Health IT to achieve that.

1. ACCESS - Systems are designed with consumers in mind and provide expanded access to care and 24/7 access to information. Ex) Patients can easily make appointments and select the day and time using mHealth or web based tools but aren't expected to become the medical professions admins. E-mail and telephone consultations are offered and telemedicine access to specialists is available in rural areas
2. ENGAGEMENT - Health IT is designed so that patients the option of being informed and engaged partners in their care. Ex) Provide information on treatment plans, preventive and follow-up care reminders, access to medical records, assistance with self-care, and counseling both in person and remotely via technology like the web, text messaging or mobile health. Patients, consumers and family members will be pro-actively included in the design, development and use of any health information technology system.
3. CLINICAL INFORMATION SYSTEMS - support high-quality care, practice-based learning, and quality improvement and are developed with patients needs in mind. Practices maintain patient registries; and adapt treatment practices based on patients differing needs for information, treatment. Patients have easy access to lab and test results; and receive text message reminders , decision support, and information on recommended treatments along with their providers if they desire. Ex) Clinical information systems in the form of an EMR are integrated with personal health records (PHR) in the same way that you can download your bank statement into quicken and then create a new document.
4. CARE COORDINATION - Specialist care is coordinated is with the patient and his/her family, and systems are in place to prevent errors that occur when multiple physicians are involved. Post hospital follow-up and support is provided.There is a free flow of communication among patients, physicians, nurses, and other health professionals. Duplication of tests and procedures is avoided and cost data is shared with patients. HIT will include the use of registry's, clinical alert systems and quality outcomes to monitor our care individually as well as for population health.
5. QUALITY AND FEEDBACK LOOPS- Practices take advantage of patient surveys to learn from patients and inform treatment plans and patients have access to quality and outcome measures for their medications, providers, hospital and procedures. The system will no only rewards physicians for improving clinical performance, but also for conducting patient surveys and acting feedback to improve care.
6. LOCATION - Tools will allow care to be be delivered where we live via mobile phones, sms, the web and not solely in a providers office
7. SAFETY, SECURITY AND PRIVACY - ealth IT can be used meaningfully only if the caregiver and patient trusts it to deliver the services and information he/she needs to help make sound decisions at the point of care, and if the patient trusts it to protect his privacy. We expect that the systems will keep our data secure but when desired liquid so we can easily share with other's we designate. We retain the right to continue to receive care even if we opt out sharing our data. If sharing our data gives it value for secondary users we expect to share in any compensation.

It is just a quick draft as an example of how to lay the template of patient - centered care over the meaningful use discussion.

According to John Halmakla The ONC HIT Policy Committee will discuss a matrix of meaningful use, standards, certification criteria, and meaningful use measures at their June 16th meeting.

The Quality Workgroup will review this matrix and edit/amend it with appropriate accepted/recognized standards over the next 60 days.

I'm confident that CCHIT will continue to be the leading HIT certification organization in the US, but its certification criteria will evolve. Th

The Certification Commission on Health Information Technology (CCHIT) will also have Town Calls Scheduled to Gather Input on New Paths to Certification under ARRA on June 16th at 1 p.m. ET
“New Paths to Certification: Dialog with the Open Source Community”
Dial-In Number: (866) 900-5706
Conference ID: 15249954

and another one the next day June 17th
Wednesday, Jun 17, 2009 11:00 AM (EDT)
“New Paths to Certification”
Dial-In Number: (866) 900-5706
Conference ID: 15316708

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