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Meaningful Use Stage 3: A First Review

Preliminary recommendations for Stage 3 of Meaningful Use were released this month by The Office of the National Coordinator for HIT.  The timeline is on track to deliver final recommendations to HHS in May of 2013. While implementation is over 3 years away, the proposed rules are notable because they will require providers and vendors to begin considering implications to their road maps now. Here’s our high-level take on fulfilling the new proposals:

1.  Information exchange among providers will have to be mandated to gain more participation.   
We aren’t making enough progress in this area without incentives.   EHR vendors and providers won’t be able to continue with a siloed approach.  The recommendations build upon Stage 2, now proposing that measurement of care plans and clinical summary documents be exchanged in the care transition process, forcing document exchange between providers and vendors.  Hopefully, this will drive providers to share information and reduce duplicate care efforts for the benefit of patients.

2. Clinical decision support and dashboard functionalities are gaining ground as drivers of clinical performance.  
The recommendations propose 15 decision-support interventions related to 5 clinical quality measures – a large jump from the 5 interventions recommended in Stage 2.  Proposals include presenting real-time dashboards with specific patient conditions for quality improvement, reduction of disparities, research, or outreach.   Vendor certification will require the ability to: track how providers respond to intervention logic; flag preference-sensitive conditions; and provide decision support materials.  The direction toward a Shared Decision Making process between patient and physician is significant.

3. Patient engagement is strongly emphasized but won’t be easy from a technical perspective.  
Finally, patients and families can include information in the EHR.  Although this will be challenging, it should enhance EHR functionality.  Vendors will have to make it feasible to merge documents into the EMR and accept downloads from mobile and medical equipment applications.  Much of this will require new technical specifications.  Furthermore, there is lack of industry-standard data sets for patient-generated data so much of it is text-based, which is difficult to incorporate into outcome measures. 

4. Standardizing population health initiatives isn't easy. 
We’re still struggling with population health standards because of the fragmentation of states’ capabilities and the delay in health information exchanges.  There seems to be lack of good market knowledge on what states are using for their public health databases and documentation requirements for care management. 

At first glance it may appear that the Meaningful Use initiatives are moving slowly, but the committees are likely proposing as much advancement as they feel is possible in an environment of fee- for-service, multiple provider regulatory initiatives, and an upcoming election.  Progress will be closely followed.

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