Developing an effective framework for driving healthcare quality improvements proves a multifaceted, complex endeavor, and although EHR systems can play a positive role in the task, much of the technology still misses the mark. That was just one of several concerns put before the U.S. Senate Committee on Finance June 26.
Policymakers heard testimony from four industry officials, representing both the public and private sectors, on how best to move forward with healthcare quality.
One concern referenced repeatedly by both policymakers and those testifying pertained to the sheer number of quality measures the Centers for Medicare & Medicaid Services (CMS) uses. Committee Chairman Max Baucus, D-Mont., pointed out that CMS uses more than 1,000 different measures in its quality reporting and payment programs.
"There are an awful lot of measures out there," said Mark McClellan, MD, senior fellow at the Brookings Institution, in his testimony. Rather than have the some 1,100 measures, many of which are not used consistently across systems, he called for fewer, more outcome- and patient experience-oriented measures.
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When asked by Sen. John Thune, R-S.D., whether EHRs hold promise for not only producing data but also reporting on these measures, McClellan said they do have potential, but there are significant roadblocks.
"First of all, many of the traditional electronic record systems haven't been very well-designed," McClellan said. Thus piecing the data together from many different sources and being able to track specific patients in the correct manner proves difficult, he explained.
Second, McCLellan pointed out that meaningful use incentive payments are linked to whether the provider has a system capable of things like tracking patients over time and then potentially reporting it on quality measures, but not actually doing it. "One way to better align the payments that providers are receiving and further the goals of getting better quality information out — especially around outcomes and improving the quality of data — [is] to move toward meaningful use payments and other payments that really do support doctors in using their systems to put this data together and then reporting on it from their electronic record systems," he said.
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Also testifying at the hearing was Elizabeth A. McGlynn, director of Kaiser Permanente's Center for Effectiveness and Safety Research, who next weighed in on Thune's EHR question. "I would agree that the promise is there," she said, but then referenced the disparity in systems utilized by larger healthcare systems, such as Kaiser, versus those systems implemented by small physician practices, which often don't have the capabilities to extract the right data and then report on it. "I think it's a harder climb [for them] because frankly [their systems] aren't optimized for this use right now," McGlynn added.
David Lansky, president and CEO of Pacific Business Group on Health — which represents large healthcare purchasers including GE, Wal-Mart and Boeing — told the committee: "The nation does not yet have the information infrastructure needed to support a viable healthcare marketplace." Lansky called on the federal government to go beyond the EHR incentive programs and work toward developing a framework on care coordination and long-term care outcome measurements.
When asked by Sen. Orrin Hatch, R-Utah, to help identify where improvements can be made to deliver better outcomes, Lansky responded by emphasizing the power of incentives. "Our view is that if the market rewards [providers] for better results because we measure and expose outcomes, they will be brilliant in finding the best ways to achieve those results," Lansky asserted.
In his view, now that adoption for health IT systems has soared, these systems should only be considered a secondary solution in addressing healthcare quality. "Most of the breakthroughs in care, recently, have not been with new technologies but with deploying the right kinds of people to the bedside to the home," he said. For Lansky, it's crucial to "have the measurement requirement be stringent, demanding, understandable to the public."
Many ideas were put forth during the hearing, but the complexity of an issue — such as healthcare quality — was apparent through myriad questions policymakers posed to those testifying, along with the often complex and one-size-does-not-fit-all responses.
There was one clear takeaway, however, which was that not all data holds value. It's about reporting on the right measures, and although many disagreed on what those measures look like, all agreed it was time to re-evaluate practices and put the best foot forward.