Hi,
As I mentioned before I have been asked to testify at the NCVHS
Hearing on Meaningful Use. As far as I know I am the only FOSS
representative there (although I know that Dr. Billings from Medsphere
is planning on attending, can anyone else make it?)
I have just received more specific questions from the NCVHS.
Please use this thread to discuss these points inline. Also please
recognize that I am specifically representing FOSS as opposed to
Health IT generally, so making general points does not help me as much
as making specific points about what implications FOSS
community/licenses/process has for a question.
Regards,
--
Fred Trotter
http://www.fredtrotter.com
NCVHS Hearing on Meaningful Use
April 28-29, 2009
Question for Panel Input
Panel 1: Vision of Health and Health Care Transformed
1. What are the critical characteristics and enablers of a safe,
patient-centric, high-quality health care system that optimizes
patient outcomes?
2. What have been the major barriers to system-level improvement in
the health care system?
3. How can incentives programs best be structured to support health reform?
Panel 2: Meaningful Use Capacity/Functionality in EHRs
1. What EHR capacities/functionalities are absolutely required to
enable a safe, patient-centric, high-quality health care system that
optimizes patient outcomes?
2. What are the critical EHR functionalities (e.g., e-prescribing,
decision support, problem list management) of which providers should
be required to demonstrate use in order to be earn an incentive as a
“meaningful user” of certified EHR technology in 2011? Should the
functionalities or other specific requirements to meet the statutory
“meaningful use” criteria be different or specific to provider type
(i.e., eligible professionals, hospitals)?
3. Are these functionalities supported in current certified EHR
products? If not, what are the gaps?
4. What additional functionalities would be most important to require
providers use by 2014 or 2015?
Panel 3: Meaningful Use Capacity/Functionality in Health Information Exchanges
1. What are the ways in which health information exchange enables a
safe, patient-centric, high-quality health care system that optimizes
patient outcomes?
2. What will the health information exchange landscape look like in
2011 (e.g., penetration of operational HIOs, e-prescribing networks),
and how would that enable or constrain meaningful information exchange
requirements?
3. What would be the trajectory over time of increasingly robust
requirements for information exchange as more opportunities for
exchange become available?
4. How might the incentives criteria be constructed so as not to
penalize providers in areas not serviced by HIOs, and how would this
change over time?
Panel 4: Meaningful Use Capacity/Functionality in Quality Reporting
1. What are realistic goals for certified inpatient and ambulatory
EHRs to achieve with respect to capture, retrieval, and reporting of
data needed for quality measurement and informed clinical decision
making in 2011?
2. What is the trajectory over time toward a “quality data set” to
enable broader standardization of electronic data capture and
reporting with EHRs needed to support clinical care and quality
measurement? Describe the end goal and any interim milestones,
barriers and enablers?
3. What other infrastructure or policy requirements need to be
considered for HHS to enable and prepare for the sharing of electronic
data for quality measurement?
4. Insofar as quality measures reporting using EHRs would be to State
or Federal agency designated repository, what if any potentially
practical mechanisms or other implications for assuring accuracy,
validity, and privacy of submitted data should be considered?
Panel 5: Path to Meaningful Use Capacity for Vendors
1. What is the “time to market” cycle from adoption of standards to
installation across the client base? How does that enable or
constrain criteria for 2011 for eligible professionals? Hospitals?
Later years?
2. What are vendors’ expectations with respect to increased product
demand in 2011 and after, and how do they expect to meet it? What are
potential risks (for example, need for additional technical support to
assure successful implementations) and how can they be mitigated?
3. How will vendors need to adapt their product development and
upgrade cycles to synchronize with progress toward increasingly robust
requirements for meaningful use, information exchange, and quality
reporting?
4. What changes are anticipated in the vendor marketplace between now
and 2016 as a result of the incentives?
Panel 6: Path to Meaningful Use Capacity for Providers
1. What do providers see as the critical EHR functionalities to enable
a safe, patient-centric, high-quality health care system that
optimizes patient outcomes?
2. What are the critical success factors needed for robust
participation in the incentive programs by eligible professionals in
2011? By hospitals? What factors would promote continued
participation in later years?
3. What are provider perspectives on potential barriers to health IT
adoption and what are their major concerns? What education and tools
could mitigate them?
4. Are there specific anticipated impacts on small providers? Rural
providers? Providers with significant Medicaid populations? Early
adopters?
5. How will providers need to adjust their business processes and
product refresh/version upgrade cycles to adapt to the requirements
over time?
Panel 7: Meaningful Use and Population/Public Health
1. What is your vision of population/public health practice in an era
when the health care of all Americans is supported by EHRs?
2. What high priority population/public health data needs can be
advanced by EHR functions and health information exchange?
3. What specific requirements for meaningful EHR use, including
information exchange, will most significantly benefit population
health?
4. How can public and population health needs/requirements translate
into meaningful use criteria that are practical to implement for 2011?
How might they affect or be affected by the path to 2016 and beyond?
Panel 8: Path to Meaningful Use Capacity for CMS, States, Other Payors
1. What are the most important policy issues associated with
implementing the Medicare and Medicaid incentives programs (e.g.,
setting 2011 criteria high enough while still assuring widespread
participation)?
2. What are the challenges associated with coordinating meaningful use
policy and operations across Medicare and Medicaid in 2011 and as
requirements become more robust over time?
3. What are the critical success factors associated with provider
participation in the incentives programs, in 2011 and later years?
4. How will other health plans be affected by the incentives programs,
and how can they contribute to increased meaningful use?
5. What is the role of states in promoting meaningful use of health IT?
Panel 9: Certification and Meaningful Use: EHR Product Certification
1. What role does certification, in general, play in promoting meaningful
use?
2. What are the strengths and weaknesses of the current CCHIT
certification processes, particularly as they relate to the promotion
and measurement of meaningful use?
3. How do the statutory requirements of ARRA/HITECH change how we
should think about certification?
4. How should the certification process work in 2011, and how should
it develop over time in support of increasingly robust requirements
for meaningful users in 2016 and later?
5. In an ideal circumstance, would multiple Secretarially recognized
certification programs or bodies be available?
Panel 10: Measuring Meaningful Use
1. What are the strengths and limitations of the various methodologies
provided in the statute for demonstrating meaningful use (attestation,
submission of claims with appropriate coding, survey, reporting of
quality measures, or other means)? Based on this, what are the most
feasible and reliable measurement methods to ascertain compliance with
these requirements for meaningful EHR use and associated incentives?
2. The third criterion for a provider to be determined to be a
meaningful user is the reporting of quality measures using EHRs.
What, if any, additional standards are needed to enable providers to
report and CMS/States to successfully accept quality measures from
EHRs? Are the needs different for measures applied to different
settings (e.g. hospital or physician office)?
3. 3. How could the various methodologies be combined to establish an
implementable mechanism for 2011, as well as a trajectory to enhanced
reporting and accountability over time?
4. What mechanism would be most appropriate (e.g., electronic
mechanisms, least burdensome, most precise, etc.) to measure and
verify a provider’s use of EHR functionality and conduct of
information
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