"There are not many clinical applications out there today that are robust enough to produce the types of reports that we are talking about," he says. "So what we are doing is building a clinical business intelligence system that allows us to report on these measures in real time." THR already has an electronic medical record in all but two of its 13 hospitals and boasts an 80% to 90% utilization rate for CPOE, but it's just now starting to build the clinical business intelligence system, says Marx. "And we are ahead of many of our peers."
Physicians are going to be challenged to meet the quality reporting requirements, as well—perhaps more so than hospitals. Eligible professionals have quality measures broken down by specialty. For example, there are 10 quality measures for cardiology, eight for pulmonology, six for oncology, and 29 for primary care.
But many physicians—even those with EMRs—don't capture clinical data in a discrete format, says Chris Macmanus, partner and practice leader in the Healthcare Information Technology practice of Tatum LLC. For example, some physicians groups chose to upload lab reports as an image in their EMR rather than using a version that captures discrete data from lab findings, Macmanus explains. "Is their EMR fully electronic? Absolutely. Does it meet the need for discrete data for meaningful use? Absolutely not," he says, predicting there will be a lot of reinstallations or software upgrades to physician practice EMRs.
Some healthcare executives are also concerned about the focus of the quality measures. Members of the Health IT Policy Committee were critical that CMS didn't include the recommendation that physicians generate progress notes for each patient visit and document the recording of advanced directives for elderly patients, for example.
"We have been tethered to whatever data has been available, and that data typically has been claims and administrative data," said Paul Tang, MD, co-chairman of the committee's meaningful use work group and chief medical information officer of the Palo Alto Medical Foundation, during a committee meeting Jan. 13. "Most of the existing endorsed quality measures are based on that kind of data," he says. "The rationale from CMS was that it wouldn't contribute to care coordination, [but] there certainly is a lot of feeling that it may," he said.
Hanson is concerned that CMS appears to have focused more on the traditional way healthcare is delivered on a per-procedure basis in the requirements. "I'm not saying that we should add more to this, in fact, the reverse, but we need to be thoughtful as we look at a broader approach of care through accountable-care organizations or bundled payments with physicians and between hospitals and rehab and nursing facilities."
The issue of community and public health is one of the stated goals of meaningful use, says Hanson, "but my sense is this early stage is more focused on traditional medicine."