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Thursday, March 31, 2011

Thoughts on Goal II of the ONC HealthIT Strategic Plan

Goal II: Improve Care, Improve Population Health, and Reduce Health Care Costs through the Use of Health IT
Objective A: Support more sophisticated uses of EHRs and other health IT to improve health system performance
OK, so here is where clinical decision support starts to play a role.  Stage 1 of Meaningful Use required use of a clinical decision support rule, and most believe that CDS (which I've written just a few posts about) will play a much bigger role in Stage 2.  I'm engaged in two different CDS projects related to this objective, and I'm feeling pretty good about where both are heading.
Since I'm not a provider, I'm not seeing outcomes from the HITRC program, but if you are going to be developing best practices, you need to start communicating them, and that's never been a government strong point, as I've mentioned previously.
It's painful they put in the 5010 rule and switch ICD-10-CM in as part of developing administrative efficiencies.  Yes, they will make for eventual efficiencies but these are long-term, not short term investments, and in the short term they compete directly with Goal 1 objectives and stratagems  Eligibility and enrollment initiatives do seem to be having some momentum and they might be headed in the right direction, but payer side stuff is not my forte.  I'm not hearing huge complaints, and that IS a good sign.
Objective B: Better manage care, efficiency, and population health through EHR-generated reporting measures
Quality measures need to be baked into, not bolted on to care afterwards.  Our current measures are still after the fact.  e-Measurement is one solution, but I much prefer e-Guidelines that have measurement baked in.
Objective C: Demonstrate health IT-enabled reform of payment structures, clinical practices, and population health management
The ACO rule is coming soon to a Federal Register near you (like now).  In the meantime, Beacon Communities and other pilot projects are definitely paving this road and moving ahead rapidly if my own experience is any guide.  Unfortunately, there won't be much time to see what the Beacon's manage before we have rules of the road being developed.  Cart before the horse?  Strategically, it's too soon to tell.  Legislatively, I think  deadlines for regulation were already set.  Payment reform issues are beyond my usual realm of discussion here.
Objective D: Support new approaches to the use of health IT in research, public and population health, and national health security
OK, so the first think they talk about in stratagem 1 is stratagem 2.  The key challenge I heard from State public health officials last year was how grant funding from CDC simply encourages silo mentalities.  Grants for Immunization infrastructure cannot be used for cancer registry work, et cetera.  So even though both would benefit from common infrastructure for, let's say, a master patient index, the funds cannot be shared.  Let's rethink that.  Then on point two, we recapitulate infrastructure investment.  I want to make a point about infrastructure.  If the road can only be used by green buses, it isn't infrastructure, unless those green buses are carrying a major portion of the traffic, and they aren't.  I think we need to start looking at how common infrastructure can be used across the various silos of public health.  That would be truly radically new approach.
Finally, we get into the aggregation and reuse of data for research (Stratagem II.D.3).  A standards colleague recently stated, some goals are aspirational, and others are operational.  Well, when I read this particular section, I definitely aspirated.  My deep sigh was that the strategy in this section seems to be that motherhood is great and apple pie tastes excellent.  I would agree with both of those statements, but they don't do a single thing to answer the question of how to make it possible.  Are we spending more on programs like eMERGE, caBIG or CTSA?  That would be doing something.  Recognizing that we need to do something and that it is a good idea is NOT really doing anything.  So, what are we doing?

.. I'll take up this thread again after a brief word on proposed ACO regulations  ...

1 comment:

  1. Thanks Keith. Great point about infrastructure (and the lack of reusable infrastructure) and your "green bus on highways" analogy was very well stated. I don't know how you read so fast -- I'm just getting around to starting on this, and hope to blog too about it.