Specialists Provide Input on Care Coordination

What would a care coordination quality measure look like?

That’s one of the questions Meaningful Use Work Group Chairman Paul Tang, M.D., put to panel members at a May 13 public meeting focused on care coordination among specialists, primary care, care managers and patients.

Tang sought input on how the work group could come up with a few critical measures that would facilitate team-driven care and coordination among providers.

Representatives of multiple specialist organizations shared ideas about how meaningful use requirements could help with care coordination. Other speakers described their members’ overall concerns about the meaningful use program. Ever since Stage 1 was developed, many specialist groups have argued that separate meaningful use criteria need to be developed with specific goals more relevant to specialties. The Office of the National Coordinator for Health IT has decided that creating so many criteria would require too much work and create an overly complicated system to manage and update.

Ann O’Malley, M.D., M.P.H., senior researcher at the Center for Studying Health System Change in Washington, D.C., suggested that measures related to care coordination could focus on the percentage, timeliness and quality of referrals or consultations. “Maximizing clinicians’ use of EHRs for care coordination requires EHR vendors to adopt meaningful use criteria that support timely, accurate and clinically relevant data exchange, particularly for the end-user at point of care,” she noted in her written testimony to the work group.

Michael Chiang, M.D., chair of the Medical Information Technology Committee of the American Academy of Ophthalmology (AAO), noted that EHRs have the potential to improve how data registries are used to track quality measures by automating manual entry of data into specialist Web sites. Data could be captured and uploaded into registries such as the Ophthalmic Patient Outcomes Database, he noted in written testimony. “Decision support tools, longitudinal patient data collection, and quality improvement are best supported by a registry overlay on the EHR.”

Chiang added that many AAO members are concerned that the meaningful use guidelines are too extensive and aggressive, particularly when considering the workflow and needs of specialists. “If the criteria do not become more flexible, it may deter specialists, including ophthalmologists, from EHR adoption,” his testimony continued. “For example, the high reporting thresholds currently proposed for Stage 2 raise concerns that the threshold can be easily missed if the objective that needs to be reported is something that is not performed regularly by the specialist.”

Virna Little, Psy.D., LCSW-r, senior vice president for Psychosocial Services and Community Affairs at the Institute for Family Health in New York City, noted that behavioral health providers have not been included in the incentive programs for health IT, creating a barrier for the inclusion of mental health in the sharing of data and referral information. But she suggested that the use of Web-based community provider portals could help multiple providers develop and implement longitudinal care plans for patients. The shared use of electronic health record systems permits communication between primary care, hospital, and substance abuse providers, she added. The inclusion of a physician portal in mental health EHRs is critical to accomplish this goal, but unfortunately, to date many of the EHRs designed for community mental health providers do not have this feature, Little added.