Panel backs phased-in standards for electronic records

A federal advisory panel today endorsed the idea of phased-in clinical quality standards and data capture measures for electronic health records (EHRs) as governed under the economic stimulus law. The records would start simply and grow more detailed over time.

An an example of the concept, doctors and hospitals in 2011 could be asked to simply attest that they are measuring patients’ body mass index, which is an indicator of obesity. By 2013, those providers might be required to give electronic documentation on the percentage of patients measured for the body mass index and the percentage of patients counseled on how to reduce obesity-related health problems.

Also, in 2011, the providers may be able to simply exclude a specific patient from their dataset by writing in a reason -- personal, medical or system-related -- why the patient ought to be excluded. By 2013, all patient exclusions should be automatically generated by the EHR system.

The Health Information Technology Standards Committee today adopted those recommendations from its Clinical Quality Workgroup. The panels are advising the Health and Human Services Department on standards for certification and the "meaningful use" of EHRs. HHS will distribute up to $45 billion in funding from the stimulus law to providers who meet those standards, starting in 2011.

Under the “meaningful use” framework developed thus far, providers will have to collect patient data into standardized data sets and they also will have to engage in sharing the data with government agencies in formats that offer measures of clinical quality and performance and, in aggregate, population health outcomes and public health.

The standards group today approved 30 measures for performance, including 23 endorsed by the National Quality Forum (NQF). They include the percentage of diabetes patients whose disease is under control, the percentage of smokers offered counseling to stop smoking, and the percentage of prescriptions transmitted electronically.

Another recommendation was to require either using the existing ICD-9 Medical Codes to show a patient diagnosis, or, optionally, the more advanced Systemized Nomenclature of Medicine vocabulary for 2011. By 2015, there will be incentives for all providers to be using SNOMED.

Also to be developed are standards to measure patient engagement, including benchmarks for whether patients understand their treatment options, and measures for “comfort care,” said Janet Corrigan, chairwoman of the workgroup and president of the NQF.

Another necessary step is to harmonize the clinical quality standards so they can be applied in many care settings, including hospitals, ambulatory care facilities and nursing homes, Corrigan said.

The standards panel has been meeting monthly since it was created by Congress under the economic stimulus law. In addition to standards for clinical quality, it is looking at clinical operations as well as privacy and security standards.