An in-depth review of 12 AHRQ funded meaningful use stage 3 projects to watch that will help shape MU stage 3 final objectives.
In partnership with the Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare and Medicaid Services (CMS), AHRQ is working to support rapid cycle research on stage 3 of the Meaningful Use (MU) incentive program. To achieve this rapid cycle research, AHRQ solicited research applications to evaluate proposed meaningful use stage 3 objectives where 12 applications were awarded grants or contracts.
The objective of these projects is to “evaluate the proposed objectives and propose strategies for improving the objectives at the policy level, EHR innovations that would support meeting the proposed objectives, and suggestions for primary care practices to increase the value of meaningful use objectives,” according to AHRQ. Key findings from these projects will be reported by June 2014 and will be taken into consideration during the regulatory process to finalized stage 3 objectives.
Here are 12 Meaningful Use stage 3 projects that will help increase the value of the MU objectives:
1. Assessing Readiness, Achievement & Impact of Stage 3 Care Coordination Criteria (Michigan)
The study will conduct a survey of primary care practices that have attested to Stage 1 MU; conduct qualitative and quantitative analyses on experiences in implementing Stage 3 care coordination measures; and evaluate the perceived impact on care coordination. The findings are expected to ensure that final Stage 3 care coordination criteria are evidence-based and set targets that are both achievable and result in substantial gains. They will also guide practices on optimal strategies for using EHRs to improve care coordination. This project will fill critical knowledge gaps to inform MU policy and practice implementation.
2. Using the Electronic Medical Record to Identify and Screen Patients at Risk for Delirium (Iowa)
At the start of the project delirium risk factors will be identified from the EMR among hospitalized patients who are 64 years or older. A prediction rule of delirium will be created and implemented into the EMR so that patients at higher risk are identified for screening. This rule will be evaluated and validated to ensure accuracy of the predication model. After validation, the team will develop another clinical decision support tool that will prompt clinicians to document delirium in the problem list for patients with a positive delirium screen. The team will also conduct a survey to evaluate nurses’ and physicians’ satisfaction.
This project’s resulting EMR-facilitated screening program will increase the recognition of delirium in the inpatient population, with the goal to decrease health care costs and improve patient and family satisfaction. By identifying patients at high risk, the program will allow for both prevention of delirium and earlier treatment and resolution. This project will fill critical knowledge gaps to inform MU policy and practice implementation.
3. Care Coordination Enabled by Health Information Technology: What Will It Take? (District of Columbia)
This project will examine the feasibility, measurability, and clinical acceptance of six proposed stage 3 objectives related to care coordination including reconciliation and tracking of referrals, care transition record, and use of information for patient engagement and clinical decision making. The project brings together the National Committee for Quality Assurance (NCQA), the American Academy of Family Physicians National Research Network, and the New York City Department of Health and Mental Hygiene.
The project will use a mixed-methods approach including clinician surveys as well as case studies to look at the implementation of care coordination activities relevant to the above aims. Results will be vetted with a panel of EHR vendors. The project team will make recommendations for potential revisions to the proposed MU Stage 3 objectives and measures and for changes in EHR certification criteria; provide examples of successful workflows; and provide information on barriers to implementation. The findings will inform the Federal government about the proposed MU objectives and how to measure their achievement by ambulatory care setting providers. This project will fill critical knowledge gaps to inform MU policy and practice implementation.
4. DEVISE: Data Exchange of Vaccine Information between an Immunization Information System and Electronic Health Record (New York)
Since 2009, Columbia University has been synchronizing its immunization data with the New York Citywide Immunization Registry, an Immunization Information System (IIS), into the hospital immunization registry which is linked to the electronic health record (EHR). IISs are population-based systems that collect and centralize immunization data from immunization providers at the regional or State level. All 50 States, five cities, and the District of Columbia operate an IIS. The bi-directional exchange of immunization data into a local EHR, as Columbia has been doing, makes that information available to clinicians at the point of care, potentially leading to better documentation and a reduction in under- and over-immunization.
The specific aims of this project are to:
Assess the impact of immunization exchange from a regional IIS to a local EHR on under- and over-immunization of low-income urban children and adolescents.
Assess the impact of immunization exchange from a regional IIS to a local EHR system on completeness of documentation of immunization status in the EHR.
A retrospective study will look at the records of approximately 15,000 children. Under- and over-immunization in children will be examined in the 6-month period before and after implementation of the bidirectional exchange of this data. In addition, the impact of completeness of documentation of immunization status in children with visits post-implementation of bidirectional exchange will be assessed by comparing immunization status, with and without inclusion of IIS information. This project will fill critical knowledge gaps to inform MU policy and practice implementation.
5. Evaluation of Meaningful Use Objectives (Maryland)
This project evaluates hospital readiness to implement two of the MU3 proposed objectives for eligible hospitals related to care coordination: 1) acknowledging receipt of external information and providing referral results to the requesting provider; and 2) providing electronic notice of significant health events to key members of a patient’s care team.
Hospitals in Maryland and Arkansas will be enrolled in the project, covering a range of urban, rural, and critical access hospitals. In a preparatory phase, a group of MU experts will analyze the proposed objectives for discrete data functional and workflow elements. These elements will be subsequently used to measure MU3 implementation readiness and develop a “readiness index”. Finally, guidelines to achieve these care coordination objectives among eligible hospitals with similar MU3 readiness indices will be developed.
The results of this project are intended to: help policymakers adjust or enhance the proposed MU3 objectives; help hospital administrators and information technology staff to plan appropriately for MU3 implementation and use the project’s MU3 guidelines to facilitate implementation; and help researchers to utilize the concepts developed in the studied care coordination objectives for other MU3 objectives. These outcomes will provide ways to increase benefits for patients, providers, and similar health care organizations.
6. Evaluation of Stage 3 Meaningful Use Objectives: Analysis in North Carolina and Tennessee (North Carolina)
This project aims to obtain feedback from hospital and ambulatory clinic sites about the draft Stage 3 MU objectives in the areas of CC and PFE, the EHR innovations needed to support the objectives, and the anticipated value provided to organizations from these objectives. The project team will work with medical practices and hospital settings affiliated with University of North Carolina Health Care (UNCHC) and Vanderbilt University Medical Center.
The specific objectives of this project are to determine:
How the evaluated Stage 3 MU objectives can be improved at the policy level.
The EHR innovations that would support meeting these Stage 3 MU objectives.
The factors associated with increasing the value for hospitals and ambulatory practices of implementing these objectives.
Following data collection activities and qualitative data analysis, findings will be synthesized in a final report and presentation. This input is intended to ensure that the Stage 3 objectives are valuable to both patients and providers as they seek improved quality, safety, efficiency, and effectiveness of care. This project will fill critical knowledge gaps to inform MU policy and practice implementation.
7. Evaluation of Stage 3 Meaningful Use Objectives: Analysis in Oklahoma and the District of Columbia (Virginia)
This project will identify and explore concerns that providers may have with the overall usability and effectiveness of their EHRs and MU by testing the implementation of a subset of proposed objectives in diverse care settings. These objectives include assessment of: the recording of health history and electronic notes; providing patient education materials; using secure messaging; sharing summary of care records; returning information with referring providers; using clinical decision support; and using structured lab data. Hospitals and medical practices from the Children’s National Medical Center (CNMC) and those partnering with the Oklahoma Foundation for Medical Quality, Inc. (OFMQ) will participate in the project and field-test the objectives.
The project will utilize a modified rapid cycle evaluation approach and provide immediate feedback to study participants. The evaluation and feasibility assessment will include a combination of quantitative metrics and qualitative methods. Quantitative data will be acquired from existing EHR systems at the participating practice sites. Qualitative data will be collected through assessment tools, interviews, and workflow studies to evaluate components of use including staff engagement, vendor issues, workflow integration, potential innovations, feasibility, and access.
Expected outcomes of this study include the potential refinement of the final MU 3 objectives by policymakers and potential enhancements to EHRs through recommended innovations.
These outcomes, combined with suggested strategies for accelerating buy-in from the provider community, are expected to yield broader adoption of MU 3 that will ultimately enhance the use of EHRs to improve health and health care. A final report will present an overall understanding of common themes and implications noted during the project. Findings from this project will fill critical knowledge gaps to inform MU policy and practice implementation, and address the Agency for Healthcare Research and Quality’s goal of successful implementing Stage 3 MU metrics.
8. Evaluation of Stage 3 Meaningful Use Objectives: Analysis in Pennsylvania and Utah (Massachusetts)
This project examines the feasibility of selected proposed objectives in these domains; the EHR enhancements required to implement them; workflow, policy and other barriers to implementation; and their alignment with strategic objectives and initiatives in the testing sites. Two health systems, Intermountain Health Care and Geisinger Health System, will field-test a sample of the objectives and provide ongoing feedback on the implementation process. The project team will also engage a panel of providers outside these two health systems for a one-time focus group to enhance findings from the two primary sites.
The project will use a rapid-cycle evaluation approach. While the measures are being implemented, qualitative data will be collected twice a month from senior staff at each of the health systems. This data will be enhanced with monthly semi-structured interviews with all participants. Data collection protocols will be continually modified based on early findings: data will be analyzed to identify and quantify emerging themes with revision of the protocols prior to the following round of data collection. The companion industry panel will consist of members from nine hospitals and health systems, and will be asked to advise the project team on likely barriers, needed EHR enhancements, and how the objectives could support their own goals in the areas of care coordination, patient engagement, and interoperability. Findings from this project will inform MU policy and potential revision to the objectives, through a final report and presentation to AHRQ and the Office of the National Coordinator for Health IT’s Health Information Technology Policy Committee.
9. Impact of Meaningful Use Patient Engagement Objectives in a Multicultural Practice-Based Research Network (Michigan)
This project will build on a prior project of AVSs, Evaluation of Computer Generated After-Visit Summaries to Support Patient-Centered Care, and evaluate the current utilization of patient engagement features of a widely implemented electronic health record (EHR) in primary care settings. The project will take place within the Southern Primary-Care Urban Research Network (SPUR-Net) in Houston Texas, which is a participating member of the Primary Care MultiEthnic Network (PRIME Net) Center of Research Excellence and Learning. Many of these clinics have implemented EHRs and actively participate in the MU EHR incentive program. SPUR-Net clinicians and researchers have conducted a number of research and practice transformation efforts on meeting MU objectives, including utilization of EHRs to meet patient engagement requirements and achieve desired outcomes among diverse subgroups of patients.
This project will fill critical knowledge gaps to inform MU policy and practice implementation.
10. Learning from Primary Care Meaningful Use Exemplars (South Carolina)
This project will assess the degree to which primary care providers using electronic health records (EHRs) are able to help their patients achieve MU clinical quality measures. It will also evaluate how high-performing practices achieve success, and propose ways that other providers may improve their practices. Finally it will develop suggestions for policymakers to improve these quality measures. The study will take place within the Practice Partner Research Network (PPRNet), a practice-based research network among primary health care providers in 38 States who use a common EHR.
A mixed-methods approach, including data analysis, surveys, and focus groups, will be used to achieve these aims. This project will propose strategies to facilitate the development of Stage 3 CQM objectives and provide suggestions for primary care practices to increase the likelihood that the MU objectives will improve the quality of the care they deliver to their patients and fill critical knowledge gaps to inform MU policy and practice implementation.
11. Pediatric Patient Engagement as a Criteria for Meaningful Use Stage 3 (Pennsylvania)
This project will evaluate the use of an asthma portal focusing on the implementation and health outcomes for children, low-income families, and children with special health care needs.
The project will use an existing asthma portal that has been developed and tested through a user-centered design process. Although many patient portals are simple vehicles for transferring information about upcoming appointments, test results, or laboratory findings, this portal provides advanced functionality by providing asthma education, collecting patient-reported outcomes, evaluating medication use and side effects, and tracking parents’ preferences and goals. The project will provide guidance on how best to implement the MU stage 3 objectives to foster patient engagement and will fill critical knowledge gaps to inform MU policy and practice implementation.
12. Best Practices For Integrating Clinical Decision Support Into Clinical Workflow (Illinois)
This project will assess the effectiveness of applying the CDS Five Rights framework to support the successful implementation of stage 3 MU CDS objectives. In addition, it will determine practice-level factors associated with implementation success. Factors such as practice size, setting, density of patients with the condition of focus, and quality improvement infrastructure will be evaluated.
The first aim will be accomplished through a prospective observational study, conducted within a national network of federally qualified health centers. To achieve the second aim, a subset of federally qualified health centers will be randomized to implement the CDS Five Rights framework with or without practice coaching support. Sites randomized to the practice coaching support arm will receive bi-monthly training and support from a practice coach with experience in CDS implementation and quality improvement.
The lessons learned from this research will help to develop health information technology systems, such as electronic health records or personal health records, which help doctors, nurses, patients, and other members of health care teams to provide high-quality care. This project will fill critical knowledge gaps to inform MU policy and practice implementation.
For more information, visit http://healthit.ahrq.gov/ahrq-funded-projects/evaluation-of-meaningful-use
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