Back when I worked in manufacturing, there was a saying that went:
What gets measured gets done. What gets rewarded gets done well.
Healthcare escaped the "quality revolution" that swept through many other industries in the 80s and 90s. That is about to change. When manufacturing changed from a culture and reward structure that focused on quantity (build to the numbers) and incorporated quality metrics into the evaluation and compensation packages of leadership, we saw a dramatic improvement in quality. As I heard it stated once, "It's amazing what you can accomplish when management is paying attention." Management pays attention when their performance reviews, bonuses and promotional opportunities are influenced by achieving quality metrics.
ARRA requires HCOs to report 27 Quality Measures to CMS to qualify for "meaningful use" financial incentives.
Some of the ARRA Quality Measures seem to be pretty straightforward. For example, there is a requirement to report "The percent of orders entered directly by physicians through CPOE." We all know that the error rate is greater when physicians write out orders and someone else enters the data for them than it is with CPOE. CPOE has significant advantages over the manual order writing system. As a local radio commercial says "even McDonalds doesn't use paper orders in 2009." So, one measure of how effectively an organization is using its EHR will be the CPOE Percentage.
Another measure is to report the percent of smokers offered smoking cessation counseling. This is the sort of measure that I have an issue with. So, you offer them counseling. Big Deal. Since we are concerned with outcomes, a better measure would be "the percent of smokers that quit smoking." Just measuring whether you offered smokers counseling reminds me of those kids camps where every kid gets a ribbon for showing up, so that we don't hurt their feelings.
We know that once CMS has this data, it will be made public. And then organizations will be able to compare their scores against their competitors (yes, virginia, hospitals do compete with each other). Also, consumers will be able to look at the scores for hospitals and doctors and use this as a determining factor in deciding where to take their health care business.
An important component of any Quality Management System is specifying what is to be measured. If there is any ambiguity in the description of what is to be measured, we will end up with inconsistent results and will be "comparing apples to oranges."
HL7 is balloting a Healthcare Quality Measures Format (HQMF). I did some work helping to put the document together.
http://www.hl7.org/V3ballot/html/domains/uvqm/uvqm.htm#
Showing posts with label arra. Show all posts
Showing posts with label arra. Show all posts
Thursday, August 20, 2009
Monday, May 25, 2009
More on Meaningful Use
I wrote earlier about what Meaningful Use is and why it is important. Recall that providers will be reimbursed for purchases of certified HIT products and that they will then recieve financial incentive for the "meaningful use" of that technololgy, but all that the legislation says is that meaningful use is:
1. ePrescribing
2. participation in an HIE
3. submission of quality measures
The importance of the definition is that it is the first step in a process that involves many others.
1. The HIT Standards committee will need to select the standards and implementation guides that support meaningful use
2. The certification body (which may be CCHIT, but HHS has not confirmed this) will need to align its certification criteria with these
3. Vendors may need to adjust their EHR Systems to ensure that it meets the criteria. This may require recertification.
4. HealthCare Organizations (HCOs) that already have technology in place may need to upgrade or adjust their systems so that they can meet the meaningful use criteria. Those organizations that do not have EHRs in place will likely wait until the vendors have caught up with the certification criteria before they begin implementing.
Until the definition is published, we can guess at what they mean, and try to be ready for it.
Money becomes available for the purchase of "certified" EHR systems in October, 2010. So, the timing is extremely tight.
These dates are from the recovery.gov website:
http://www.recovery.gov/?q=content/program-plan&program_id=5299
Standards Rulemaking: Recovery Act §3004 (B) (1) - No later than December 31, 2009, HHS shall adopt and publish an initial set of standards, implementation specifications, and certification criteria. The rulemaking for this initial set of standards, implementation specifications, and certification criteria may be issued on an interim, final basis. Fully competitive contract awards will be utilized to support the impact analysis.
Milestones:
Complete Draft Rule/ Regulatory Impact Analysis. Start: 05/01/2009 End: 08/26/2009
Submit for HHS Clearance. Start: 08/26/2009 end: 09/25/2009
Clear OMB (up to 90 day process) Start: 09/25/2009 End: 12/24/2009
Publish in Federal Register. Start: 12/24/2009 End: 12/31/2009
So, if the HIT Standards Committee is to meet the deadline of submitting the list of standards that are required to support “meaningful use” (August 26), the definition has to be published very, very soon.
1. ePrescribing
2. participation in an HIE
3. submission of quality measures
The importance of the definition is that it is the first step in a process that involves many others.
1. The HIT Standards committee will need to select the standards and implementation guides that support meaningful use
2. The certification body (which may be CCHIT, but HHS has not confirmed this) will need to align its certification criteria with these
3. Vendors may need to adjust their EHR Systems to ensure that it meets the criteria. This may require recertification.
4. HealthCare Organizations (HCOs) that already have technology in place may need to upgrade or adjust their systems so that they can meet the meaningful use criteria. Those organizations that do not have EHRs in place will likely wait until the vendors have caught up with the certification criteria before they begin implementing.
Until the definition is published, we can guess at what they mean, and try to be ready for it.
Money becomes available for the purchase of "certified" EHR systems in October, 2010. So, the timing is extremely tight.
These dates are from the recovery.gov website:
http://www.recovery.gov/?q=content/program-plan&program_id=5299
Standards Rulemaking: Recovery Act §3004 (B) (1) - No later than December 31, 2009, HHS shall adopt and publish an initial set of standards, implementation specifications, and certification criteria. The rulemaking for this initial set of standards, implementation specifications, and certification criteria may be issued on an interim, final basis. Fully competitive contract awards will be utilized to support the impact analysis.
Milestones:
Complete Draft Rule/ Regulatory Impact Analysis. Start: 05/01/2009 End: 08/26/2009
Submit for HHS Clearance. Start: 08/26/2009 end: 09/25/2009
Clear OMB (up to 90 day process) Start: 09/25/2009 End: 12/24/2009
Publish in Federal Register. Start: 12/24/2009 End: 12/31/2009
So, if the HIT Standards Committee is to meet the deadline of submitting the list of standards that are required to support “meaningful use” (August 26), the definition has to be published very, very soon.
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