Stage 2 Meaningful Use: Preparing an Advocacy Strategy. The Consumer Partnership for ehealth

Transcription

1 Stage 2 Meaningful Use: Preparing an Advocacy Strategy The Consumer Partnership for ehealth February 23, 2012

2 CPeH Advocacy Strategy for Stage 2 MU: Agenda Survey: How Consumers Trust and Value Health IT Goals of the Consumer Platform and the NQS Review of Stage 1 MU Criteria CPeH Priorities for Stage 2 Discussion: CPeH Advocacy Strategy and Comments

3 Survey: How Consumers Trust and Value Health IT

4 Goals of Survey Survey 1. Understand consumer perceptions of EHRs and paper records in the areas of trust and value Shed light on things that could help them embrace more widespread use of EHRs 2. Measure existing levels of patient trust in how providers use paper systems and EHRs Develop profiles of consumers most and least worried about health IT privacy 3. Inform future definitions of Meaningful Use and other policies/programs related to health IT 4. Establish a baseline for measuring experience with Meaningful Use and health IT-enabled aspects of health reform over time

5 Methodology Conducted online survey within U.S. August 3-22, 2011 Total respondent pool of 1,961 adults who: Have ongoing relationship with a care provider Know what kind of record system electronic or paper this provider uses (Sample represents about 56% of all U.S. adults) Sample weighted to be demographically representative of adult U.S. population, and to account for bias inherent in online surveys 58.8% (1,153) in EHR systems; 41.2% (808) in paper systems Survey also offered in Spanish; conducted an over-sampling of Hispanic respondents (n=227) 5

6 Key Findings: Patients See Value in EHRs 6

7 EHRs Better at Helping Physicians Deliver Care 7

8 EHRs Also Better at Helping People Personally 8

9 Online Access Increases Perceptions of Value and Trust Among the 26% of EHR respondents with online access to their health information, respondents are more likely to say: EHR is useful to them personally for key elements of care (understand condition, keep up with medications, maintain healthy lifestyle, etc.) EHR has a positive impact on quality of care EHRs are useful to their provider (correcting errors records, avoid medical errors, etc.) They trust their provider to protect patient rights They are well informed by their provider about how medical information is collected and used Hispanic respondents with online access are more likely (+15%) to say it increases their desire to do something to improve their health 2/3 of paper respondents want online access, and even more Hispanic adults in paper systems do close to 3/4 9

10 Patients Generally Trust EHRs More Than Paper Records Both groups of respondents rated EHRs higher than paper systems in complying with patients rights and enhancing elements of privacy These rights/elements include: Giving patients confidence information is safe Complying with privacy laws/rules Giving patients more control over to whom info is disclosed for purposes beyond direct care Allowing patients to see a record of who has had access to their info Helping patients earn trust in how information is handled 10

11 Privacy Concerns Remain 11

12 Detailed Privacy Analysis Created a Privacy Segmentation to: Identify segments of population most and least worried about health IT privacy Understand what demographic sub-groups make up each segment Explore relationship between trust and value 12

13 Detailed Privacy Analysis 13

14 There is a Relationship Between Privacy Concerns and Perceived Value of EHRs Compared to the worried, EHR respondents who are more comfortable with privacy issues are: 25% higher in saying the EHR has had a positive impact on the quality of their care 33% higher in saying the system is useful in complying with privacy/confidentiality laws and regs 9% higher in saying they are satisfied with their record system Similar results among Comfortable paper respondents 14

15 Who are the Most Privacy Worried? Among EHR respondents: Men Those earning less than $35K a year Those aged Those living in the South Among paper respondents: Men College educated Those aged Those living in East or West Those with sensitive health conditions were evenly distributed across all segments

16 Consumers Want Doctors to Use EHRs 3 out of 4 paper respondents say it would be valuable if their doctor adopted an EHR EHRs far outpace paper in perceived impact on overall quality of care 73% of EHR respondents say their doctor s use of an EHR has a positive impact on quality of care Compared to only 26% of paper respondents 16

17 Key Policy Recommendations To make the survey actionable, we provided Policy Recommendations Three main categories: Consumer education/engagement campaigns Functional and privacy requirements for the Meaningful Use program Guidance for broader federal programs (Accountable Care Organizations, Medical Homes, etc.) 17

18 Meaningful Use Recommendations Promote functionalities that support improving patients perceptions of value and trust in Stages 2 and 3 of Meaningful Use Specifically: care coordination, online access, secure messaging and the ability of patients to contribute data to their record and to download their own health information Further, functionalities must ensure convenience and enable robust privacy and security education. Promote and demonstrate functionality relating to EHR accounting of disclosures reports, indicating when and to whom a HIPAA-covered entity has disclosed an individual s health information 18

19 For more information At Full Report Executive Summary Topline Data Survey Instrument 19

20 CPeH Advocacy Strategy for Stage 2 Meaningful Use

21 Consumer Platform Vision Health IT Will Enable Consumers to Be: Agents of Change Participating in policy-making and governance Speaking up and conversing with our providers about priorities and goals Taking action to meet goals Providing feedback about experiences of care Informed Decision-makers Selecting a provider Seeking and using information tailored to specific needs Sources of Verification and Contextual Information Sharing needs preferences and values, as well as health goals Identification and correction of errors in medical record Integrators of Health into Daily Lives Patient self-management support Simplified and improved access to the health care system

22 The National Quality Strategy Aims: Better Care Healthy People/Healthy Communities Affordable Care Priorities: Ensuring that each person and family is engaged as partners in their care Promoting effective communication and coordination of care Promoting the most effective prevention and treatment Working with communities to enable healthy living Making quality care more affordable Making care safer

23 Progressive Staging of Meaningful use

24 Recap of Stage 1 Meaningful Use Structure EPs fulfill 20 functional criteria (unless exclusions apply) and submit 6 quality measures 3 Core 3 Selected from list Eligible hospitals fulfill 19 functional criteria (unless exclusions apply) and submit 15 core quality measures Some functional criteria are core, others are menu Providers can defer up to 5 menu criteria Attestation by survey

25 Recap of Stage 1 meaningful use Most critical criteria from consumer perspective: CORE Menu RELG data collection Reporting of quality measures Provide electronic copy of health information to patients upon their request Provide e-copy of d/c instructions (upon request) and clinical office summaries to patients Record advance directives (hospitals only) Generate lists of patients by condition Reminders to patients Timely electronic access to health info for patients (EPs only) Patient-specific education resources Medication reconciliation Summary care record for care coordination

26 Recap of Stage 1 Meaningful Use Disappointments from Stage 1: Timely electronic access to health information is menu Provision of discharge instructions, while core, is only upon patient request Age restrictions on requirement to send patient reminders Weak exchange criteria No requirement to actually USE demographic data OMB standards for RELG, rather than IOM standards Refusal to explicitly state that providers that willfully violate federal and state privacy laws will be ineligible for incentives

27 What we have learned from Stage 1 MU Implementation Stage 1 criteria weren t as challenging as providers feared 33,595 Medicare EPs attested, only 355 unsuccessful All 842 EHs that attested were successful Elements thought to be tough easily achieved (e.g., CPOE) Providers have the most difficulty with criteria that: Require them to create or modify workflows (e.g., after visit summaries) Involve care coordination Are related to reporting measures of clinical quality Quality Measurement is by far the biggest challenge

28 Deferral and Exclusion Rates for Stage 1 Criteria Objective Deferral rates for EPs Summary of care transitions 85% 93% Send reminders to patients 77% NA Medication reconciliation 56% 75% Syndromic surveillance 70% 79% Patient education resources 49% 62% Patient reminders 77% N/A Patient lists 27% 34% Objective Exclusion rates for EPs E-copy of health information 75% 68% Office visit summaries 2% N/A E-copy of discharge summaries N/A 59% Deferral rates for EHs Exclusion rates for EHs

29 EHR Incentive Programs December 2011 Totals Registrations December-11 YTD Medicare EPs 8, ,921 Medicaid EPs 9,614 49,051 Medicaid/Medicare Hospitals 200 2,834 Total 18, ,049 Payments December-11 YTD Medicare EPs $95,546,870 $274,590,000 Medicaid EPs $64,239,678 $362,010,379 Medicaid/Medicare Hospitals (Medicare Payment) $369,136,265 $1,052,839,955 Medicaid/Medicare Hospitals (Medicaid Payment) $165,141,069 $787,466,254 Total $694,063,883 $2,533,689,145

30 Implementation of Medicaid meaningful use Medicaid providers are attesting to adoption, implementation and use As of January states had launched their Medicaid programs 33 states had disbursed incentives As of Stage 2, Medicaid providers will have to attest to Meaningful Use

31 What we Know About Early Adopters Thresholds were greatly exceeded, but every threshold had some providers on the borderline Not much difference between EP and hospitals Not much difference among specialties in performance, but there were differences in exclusions

32 CPeH Recommendations for Stage 2 MU Transition all menu criteria to core. Require view and download as step toward real-time access to portable information. Require offering of online secure patient messaging as core criterion Tie requirement of summary of care record to electronic exchange requirement. Require use of demographics to stratify quality reports and submission of summary-level stratified reports to CMS. Hold providers accountable for actual usage of a patient portal.

33 CPeH Recommendations for Stage 2 MU Require recording of a longitudinal care plan Apply advance directives criterion to EPs and EHs and require content Require sending of reminders without age restrictions Require incorporation of lab data into EHRs Require use of experience-of-care surveys Require a means for patients to flag and correct data Ensure that Stage 2 MU includes key functions to support Stage 2 quality measures

34 Discussion: What are CPeH s Priorities for Stages 2 and 3? Keeping in mind the Consumer Vision and the National Quality Strategy, what are: CPeH s expectations for the end of incentive years Critical Advancements for Stage 2 in order to get there CPeH Advocacy Strategy Webinar discussions Input and expertise from all CPeH members Blog input Talking points Individual member comments Hill briefings Administration briefings State-based advocate involvement Other ideas? 34