Stage 2 Meaningful Use:
Preparing an Advocacy Strategy
The Consumer
Partnership for eHealth
February 23, 2012
CPeH Advocacy Strategy for Stage
2 MU: Agenda
Survey: How Consumers Trust and Value Health IT
Goals of the Consumer Platform and the NQS
Review of Stage 1 MU Criteria
CPeH Priorities for Stage 2
Discussion: CPeH Advocacy Strategy and Comments
Survey: How Consumers Trust and Value
Health IT
Goals of Survey Survey
1.
Understand consumer perceptions of EHRs and paper
records in the areas of trust and value
–
Shed light on things that could help them embrace more widespread use
of EHRs
2. Measure existing levels of patient trust in how providers
use paper systems and EHRs
–
Develop profiles of consumers most and least worried about health IT
privacy
3. Inform future definitions of Meaningful Use and other
policies/programs related to health IT
4. Establish a baseline for measuring experience with
Meaningful Use and health IT-enabled aspects of health
reform over time
Methodology
Conducted online survey within U.S. August 3-22, 2011
Total respondent pool of 1,961 adults who:
Have ongoing relationship with a care provider
Know what kind of record system—electronic or paper—this provider uses
(Sample represents about 56% of all U.S. adults)
Sample weighted to be demographically representative of
adult U.S. population, and to account for bias inherent in
online surveys
58.8% (1,153) in EHR systems; 41.2% (808) in paper systems
Survey also offered in Spanish; conducted an over-sampling of
Hispanic respondents (n=227)
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Key Findings:
Patients See Value in EHRs
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EHRs Better at Helping
Physicians Deliver Care
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EHRs Also Better at Helping People
Personally
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Online Access Increases
Perceptions of Value and Trust
Among the 26% of EHR respondents with online access to their
health information, respondents are more likely to say:
EHR is useful to them personally for key elements of care (understand
condition, keep up with medications, maintain healthy lifestyle, etc.)
EHR has a positive impact on quality of care
EHRs are useful to their provider (correcting errors records, avoid medical
errors, etc.)
They trust their provider to protect patient rights
They are well informed by their provider about how medical information is
collected and used
Hispanic respondents with online access are more likely
(+15%) to say it increases their desire to do something to
improve their health
2/3 of paper respondents want online access, and even more
Hispanic adults in paper systems do – close to 3/4
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Patients Generally Trust EHRs
More Than Paper Records
Both groups of respondents rated EHRs higher than paper
systems in complying with patients’ rights and enhancing
elements of privacy
These rights/elements include:
Giving patients confidence information is safe
Complying with privacy laws/rules
Giving patients more control over to whom info is disclosed for purposes
beyond direct care
Allowing patients to see a record of who has had access to their info
Helping patients earn trust in how information is handled
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Privacy Concerns Remain
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Detailed Privacy Analysis
Created a “Privacy Segmentation” to:
Identify segments of population most and least worried about health IT
privacy
Understand what demographic sub-groups make up each segment
Explore relationship between trust and value
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Detailed Privacy Analysis
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There is a Relationship Between
Privacy Concerns and Perceived
Value of EHRs
Compared to the “worried,” EHR respondents who are more
comfortable with privacy issues are:
25% higher in saying the EHR has had a positive impact on the quality of
their care
33% higher in saying the system is useful in complying with
privacy/confidentiality laws and regs
9% higher in saying they are satisfied with their record system
Similar results among “Comfortable” paper respondents
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Who are the Most Privacy Worried?
Among EHR respondents:
Men
Those earning less than $35K a year
Those aged 35-46
Those living in the South
Among paper respondents:
Men
College educated
Those aged 35-46
Those living in East or West
Those with sensitive health conditions were evenly distributed
across all segments
Consumers Want Doctors to
Use EHRs
3 out of 4 paper respondents say it would be valuable if
their doctor adopted an EHR
EHRs far outpace paper in perceived impact on overall
quality of care
73% of EHR respondents say their doctor’s use of an EHR has a positive
impact on quality of care
Compared to only 26% of paper respondents
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Key Policy Recommendations
To make the survey actionable, we provided Policy
Recommendations
Three main categories:
Consumer education/engagement campaigns
Functional and privacy requirements for the Meaningful Use program
Guidance for broader federal programs (Accountable Care Organizations,
Medical Homes, etc.)
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Meaningful Use Recommendations
Promote functionalities that support improving patients’
perceptions of value and trust in Stages 2 and 3 of
Meaningful Use
Specifically: care coordination, online access, secure messaging and the
ability of patients to contribute data to their record and to download their
own health information
Further, functionalities must ensure convenience and enable
robust privacy and security education.
Promote and demonstrate functionality relating to EHR
“accounting of disclosures” reports, indicating when and to
whom a HIPAA-covered entity has disclosed an individual’s
health information
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For more information
At www.nationalpartnership.org/hit:
Full Report
Executive Summary
Topline Data
Survey Instrument
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CPeH Advocacy Strategy for
Stage 2 Meaningful Use
Consumer Platform Vision – Health
IT Will Enable Consumers to Be:
• Agents of Change
– Participating in policy-making and governance
– Speaking up and conversing with our providers about priorities and goals
– Taking action to meet goals
– Providing feedback about experiences of care
• Informed Decision-makers
– Selecting a provider
– Seeking and using information tailored to specific needs
• Sources of Verification and Contextual Information
–
Sharing needs preferences and values, as well as health goals
–
Identification and correction of errors in medical record
• Integrators of Health into Daily Lives
–
Patient self-management support
–
Simplified and improved access to the health care system
The National Quality Strategy
Aims:
Better Care
Healthy People/Healthy Communities
Affordable Care
Priorities:
Ensuring that each person and family is engaged as partners in their care
Promoting effective communication and coordination of care
Promoting the most effective prevention and treatment
Working with communities to enable healthy living
Making quality care more affordable
Making care safer
Progressive Staging of
Meaningful use
Recap of Stage 1 Meaningful Use
Structure
EPs fulfill 20 functional criteria (unless exclusions apply) and
submit 6 quality measures
3 Core
3 Selected from list
Eligible hospitals fulfill 19 functional criteria (unless
exclusions apply) and submit 15 core quality measures
Some functional criteria are core, others are menu
Providers can defer up to 5 menu criteria
Attestation by survey
Recap of Stage 1 meaningful use
Most critical criteria from consumer perspective:
CORE
RELG data collection
Reporting of quality measures
Provide electronic copy of health information to patients upon their request
Provide e-copy of d/c instructions (upon request) and clinical office summaries to
patients
Menu
Record advance directives (hospitals only)
Generate lists of patients by condition
Reminders to patients
Timely electronic access to health info for patients (EPs only)
Patient-specific education resources
Medication reconciliation
Summary care record for care coordination
Recap of Stage 1 Meaningful Use
Disappointments from Stage 1:
Timely electronic access to health information is menu
Provision of discharge instructions, while core, is only “upon patient request”
Age restrictions on requirement to send patient reminders
Weak exchange criteria
No requirement to actually USE demographic data
OMB standards for RELG, rather than IOM standards
Refusal to explicitly state that providers that willfully violate federal and state
privacy laws will be ineligible for incentives
What we have learned from
Stage 1 MU Implementation
Stage 1 criteria weren’t as challenging as providers
feared
33,595 Medicare EPs attested, only 355 unsuccessful
All 842 EHs that attested were successful
Elements thought to be tough easily achieved (e.g., CPOE)
Providers have the most difficulty with criteria that:
Require them to create or modify workflows (e.g., after visit summaries)
Involve care coordination
Are related to reporting measures of clinical quality
Quality Measurement is by far the biggest challenge
Deferral and Exclusion Rates for Stage 1
Criteria
Objective
Deferral rates
for EPs
Deferral rates
for EHs
Summary of care transitions
85%
93%
Send reminders to patients
77%
NA
Medication reconciliation
56%
75%
Syndromic surveillance
70%
79%
Patient education resources
49%
62%
Patient reminders
77%
N/A
Patient lists
27%
34%
Objective
Exclusion rates
for EPs
Exclusion rates
for EHs
E-copy of health information
75%
68%
Office visit summaries
2%
N/A
E-copy of discharge summaries
N/A
59%
EHR Incentive Programs
December 2011 Totals
Registrations
Medicare EPs
Medicaid EPs
Medicaid/Medicare Hospitals
Total
December-11
8,996
9,614
200
18,819
YTD
123,921
49,051
2,834
176,049
Payments
Medicare EPs
Medicaid EPs
Medicaid/Medicare Hospitals
(Medicare Payment)
Medicaid/Medicare Hospitals
(Medicaid Payment)
December-11
$95,546,870
$64,239,678
YTD
$274,590,000
$362,010,379
$369,136,265
$1,052,839,955
$165,141,069
$787,466,254
Total
$694,063,883
$2,533,689,145
Implementation of
Medicaid meaningful use
Medicaid providers are attesting to
adoption, implementation and use
As of January 2012
42 states had launched their Medicaid programs
33 states had disbursed incentives
As of Stage 2, Medicaid providers will have
to attest to Meaningful Use
What we Know About Early Adopters
Thresholds were greatly exceeded, but every
threshold had some providers on the borderline
Not much difference between EP and hospitals
Not much difference among specialties in
performance, but there were differences in
exclusions
CPeH Recommendations for
Stage 2 MU
Transition all “menu” criteria to core.
Require “view and download” as step toward real-time
access to portable information.
Require offering of online secure patient messaging as core
criterion
Tie requirement of summary of care record to electronic
exchange requirement.
Require use of demographics to stratify quality reports and
submission of summary-level stratified reports to CMS.
Hold providers accountable for actual usage of a patient
portal.
CPeH Recommendations for
Stage 2 MU
Require recording of a longitudinal care plan
Apply advance directives criterion to EPs and EHs and
require content
Require sending of reminders without age restrictions
Require incorporation of lab data into EHRs
Require use of experience-of-care surveys
Require a means for patients to flag and correct data
Ensure that Stage 2 MU includes key functions to support
Stage 2 quality measures
Discussion: What are CPeH’s
Priorities for Stages 2 and 3?
Keeping in mind the Consumer Vision and the National
Quality Strategy, what are:
CPeH’s expectations for the end of incentive years
Critical Advancements for Stage 2 in order to get there
CPeH Advocacy Strategy
Webinar discussions
Input and expertise from all CPeH members
Blog input
Talking points
Individual member comments
Hill briefings
Administration briefings
State-based advocate involvement
Other ideas?
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