At the second meeting of HHS’s HIT Policy Committee today, the committee’s Meaningful Use (MU) Workgroup offered a proposal that represents some important strides forward. From an overarching perspective, we can see progress in the fact that engaging patients and families is now one of the primary four or five goals for how “meaningful use” of HIT can transform health care.

The HHS Office of the National Coordinator (ONC) for HIT distributed a matrix along with the presentation by MU workgroup co-chairs Paul Tang and Farzad Mostashari. One of the five health outcomes policy priorities is “Engage patients and families,” and the associated care goal is “Provide patients and faimiles with access to data, knowledge, and tools to make informed decisions and to manage their health.”

Interestingly, when Mostashari presented the “achievable vision for 2015,” the slide advocated for “All patients have access to their own health information.” But Mostashari said, “All patients have access to the information they need to have.” I think the latter describes a broader set of information needs and would do more to meet the health outcomes policy priority.

For the 2011 objectives, Tang stated that the MU Workgroup’s “goal is to capture in coded format and to report health information and to use that information to track key clinical conditions.” By 2013, the goal becomes “guide and support care processes and care coordination,” leaving “achieve and improve perofrmance ans support care proceses and on key health system outcomes” by 2015.

The 2011 objectives under engage patients and families:

• Provide patients with electronic copy of — or access to — clinical information (including lab results, problem list, medication lists, allergies) per patient preference (e.g., through PHR) for outpatient (OP) and inpatient (IP) care
• Provide access to patient-specific educational resources (OP/IP)
• Provide clinical summaries for patients for each encounter (OP/IP)

For 2013:

• Offer secure patient-provider messaging capability (OP)
• Provide access to patient-specific educational resources in common primary languages (OP/IP)
• Record patient preferences (e.g., preferred communication media, advance directive, health care proxies, treatment options) (OP/IP)
• Documentation of family medical history (OP/IP)
• Upload data from home monitoring devoices (OP)

For 2015:

• Access for all patients to PHR populated in real time with data from EHR (OP/IP)
• Patients have access to self-management tools (OP)
• Electronic reporting on experience of care (OP/IP)

Many of these elements derive from the document that the Consumer Partnership for eHealth developed (a process in which the IxCenter was involved), though there are some areas where some improvements in the ONC document would go a long way toward driving better care. Some of these points were made during the meeting by HIT Policy Committee member Christine Bechtel, which I voiced support for during the public comment period, and I also added some of my own (or expanded on themes raised by Christine) there and here.

• Certainly, some of the elements should be moved up — earlier in the timeline (e.g., secure messaging, patient access to self-management tools & decision support, and electronic reporting on experience of care).
• The access to electronic information needs to be “timely” (a word that should be added); timely applies both to the speed at which it is made available and the ability to get information targeted to the consumer’s particular moment in care.
• Incorporation of data generated by the consumers themselves beyond just what can be uploaded from electronic monitoring devices (per the 2013 criterion).
• There should be more attention to consumer information tools (beyond just narrowly definted personal health records) and more clarity around the kinds of tools that consumers need — not just self-management tools but also decision support tools and tools that facilitate effective & efficient communication to improve the infrastructure for participatory medicine.

Finally, although clinical summaries are mentioned in this section, there are more ways in which improving care coordination (one of the other key five goals identified by the committee along with: engaging patients and families; improve quality, safety, efficiency, and reduce health disparities; improve population & public health; and ensure adequate privacy & security protections for personal health information). Specifically, the stated care goal for “improve care coordination” is “exchange meaningful clinical information among professional health care team.” Given that, for many of the measures proposed in the care coordination section, there is substantial research to support exchanging clinical information with patients and families improves care, reduces readmissions, etc., there should be an explicit inclusion of patients & families in that exchange.

If you also would like to share your comments with ONC, instructions for doing so are here.

This entry was posted on Tuesday, June 16th, 2009 at 4:49 pm and is filed under EHRs, Engaging Consumers, Health Care Reform, Inside the Beltway, PHRs. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.