Providers Burdened With Too Many Measurement Requirements, Panel Says

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Federal programs to encourage the use of health information technology and improve the delivery of health care threaten to bog down providers with too many obligations to measure quality and performance outcomes, a panel of health care industry experts said June 28 at the National Health IT and Delivery System Transformation Summit.

Keith J. Figlioli, senior vice president for health care informatics at Premier Inc., said providers are being asked to measure performance and outcomes in so many different ways that they “are not really measuring anything.”

Figlioli said requiring providers to concentrate too much of their time on measurement reporting gets in the way of doing real clinical work, including doing better at coordinating and improving care for patients.

Instead, he said, federal policies for accountable care organizations, for example, should focus on simpler measures for population health indicators.

Mark J. Segal, vice president for government and industry affairs at GE Healthcare IT, said measuring performance and outcomes is essential to managing organizations. But, he added, the measures must “matter to the policy of the organization.”

“There's only so much capacity for measurement,” Segal said, and federally mandated measurement requirements should not “crowd out the organic needs of the organization.”

In other words, health care organizations should measure performance and outcomes in areas that have clinical significance for their practices and can aid in care delivery improvements, Segal said.

Likewise, Segal said performance and outcome measures should be generated from data already in electronic health records and should rely on data entered for clinical purposes, not data entered into systems solely to support measurement reporting requirements.

Figlioli noted that many EHR developers have not devoted much time to designing EHR products for the purposes of reporting quality and performance measures. Rather, the applications have been designed almost entirely with clinical support functions in mind. Now those vendors are trying to “catch up” with “meaningful use” requirements for quality reporting and measurement, he said.

Health IT Needs for ACOs

The panelists agreed that it is not clear what IT capabilities accountable care organizations will need to successfully participate in the Medicare Shared Savings Program and advance in the areas of coordinating patient care among multiple providers in multiple settings.

The Centers for Medicare & Medicaid Services in April published a proposed rule (76 Fed. Reg. 19528) defining requirements for ACOs, including performance and quality measurement mandates, for participation in the Medicare Shared Savings Program. A leading health IT group in comments to CMS on the proposed rule said performance measurement and technology requirements for ACOs were too stringent and should be amended (see previous article).

Segal said the health care delivery community must evaluate what health IT should be able to do to support care coordination and clinical decisionmaking, in particular.

He also said technology tools should help providers “make patients sticky to the organization,” meaning health information technologies should help providers more easily track patients among other providers and care settings.

Segal said that while it is not fully known what the IT needs of ACOs are, or will be in the future, he said an “innovation engine” is in place to identify and meet provider needs.

He said he expects the private marketplace, as well as the federal meaningful use program, to generate solutions to IT needs as they arise among providers participating in ACOs.

William Bria, chief medical information officer for Shriners Hospital for Children in Tampa, Fla., noted that ACOs would need IT support beyond the functions of EHRs.

For example, health information exchange capabilities will be important to connecting providers in different practice locations.

By Kendra Casey Plank