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To show Meaningful Use and qualify for government EHR incentives, hospitals and eligible professionals that are beyond the first year of the program in 2014 -- whether in stage 1 or stage 2 -- will have to submit quality data to CMS, rather than just attesting to it. Consequently, their EHRs will have to be able to generate quality data in a specific format with specified data elements for each CQM. Moreover, to be certified for Meaningful Use in 2014, EHRs must be capable of collecting data for all CQMs.
Starting in 2014, hospitals must report on 16 of 29 measures. Eligible professionals (EP) have to report on nine of 64 measures.
These requirements pose a formidable challenge to EHR vendors, which must re-program their products and field test the measures before 2014. Earlier this year, the EHR suppliers were unhappy because they had no opportunity to comment on the e-measure specs (which had not yet been released) during the rulemaking process on Meaningful Use stage 2. But after CMS announced the specs on Oct. 26, Ginny Meadows, a spokesperson for the EHR Association, which represents the vendors, told InformationWeek Healthcare that "we've seen a lot of good movement forward" on some of the issues the vendors are concerned about.
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Meadows, who is executive director of the program office for McKesson Provider Technologies, noted that CMS had reduced the number of inpatient measures it had originally proposed for stage 2, and 15 of the final CQMs are essentially the same ones that are required in stage 1.
Speaking for McKesson, she said, "Most of our providers will probably choose those 15 measures and add one other they're interested in. So we're starting with the first set of 16 measures and making sure they're implemented in our beta software, and then we'll continue adding measures until we have them all. And we'll add them in a way that it won't affect the software, so customers won't have to do complete upgrades.
"On the EP side, it's more challenging because there are so many measures to implement. But they're not as complex as the inpatient measures. So most vendors are trying to implement as many of those measures as possible."
Both vendors and providers complained about the many inaccuracies and errors in the e-measure specs for MU stage 1. Although it's too early to know how accurate the current specs are, Meadows said, "There was initial testing done prior to release of the e-measure specifications, so we're hoping we won't find as many issues as we did with stage 1."
The new e-specs include "value sets" -- standardized clinical terms maintained by the National Library of Medicine -- that all measure developers and vendors must use. Meadows views that as a "positive" because right now, each measure developer can use its own terminology to describe medical concepts. The value sets will remove those variations. "So you know if you implement that value set, you're going to implement it for any of the measures, because they're all going to use the same one. So it's a great step toward standardization," said Meadows.
From the provider standpoint, however, there are still major problems in collecting and reporting quality data. For example, the American Hospital Association (AHA) pointed out, in its comments on the Meaningful Use stage 2 proposed rule, that hospitals had had trouble reporting on CQMs in stage 1 because gathering the data required a lot of workarounds, interrupting workflow and burdening clinicians.
Meadows said that the key stakeholders are working on solutions to this problem. The National Quality Forum, she said, recently convened an "e-measure feasibility project" that will solicit input from providers, vendors and measure developers. CMS and the Office of the National Coordinator of Health IT (ONC) are also involved, she said.
The e-measure feasibility project, she explained, "will look at the data elements and the processes and workflows required by an e-measure, and will come up with a good way of determining how feasible it is to collect that data within an EHR. That will address a lot of the concerns that AHA had about having to change workflow and make providers do things that typically weren't part of their care process."
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