CNEA Report Question 6

6. Now that we have an idea of CMS’s thinking about “meaningful use”, based on your experience, can you comment on whether you would have changed your implementation approach because of these incentives? Are they realistic for clinics to achieve?

I don’t believe there is much that we would have changed in terms our implementation plans (at least for the initial 2011 year), based on the recent preliminary release of the “meaningful use” definition.

Because we are a government funded organization we are required to report on many of the quality measures that are listed for the objectives/goals. 2011 Measures required such as; % diabetics with A1c under control, hypertensive patients with BP under control, smoking cessation, recorded BMI’s, colorectal cancer screenings, immunizations, females over 50 with annual mammograms, labs etc. are all criteria that we already generate reports for in some fashion so it would not be difficult to modify these to adhere to these specifications. In addition a CCHIT certified EHR application should already accomplish many of the “functional” goals listed, which for us, NextGen does.


There are, however, areas that we do need to work on such as; % patient’s access to PHI and access to patient-specific educational resources. These types of requirements can be addressed with NextGen’s NextMD which is a patient portal and is something we are considering. I think in addition some of this will naturally be addressed simply by advancements made in consumer informatics. Sites such as Microsoft’s Health Vault or Google Health are growing in popularity and it is difficult to determine how far these will go in being interoperable with EHR’s.

Another interesting site is ER Card. The information that’s provided on ER Card is stored on their secure database. In essence when you bring that card to your provider or clinic etc., it basically looks like a credit card with a USB flash drive attached to it, it is secure, but also when you plug that in you supply the user ID and password to your provider then it accesses your medical records on their secure encrypted database. It’s available all the time, 365 days a year and if you don’t have a physician that has access to or has some problems with it, the information is also available by fax or phone and straight through a web browser. This is just an interesting, novel concept on the way to have access and have the ability to maintain your own Personal Health Record. Ideas like this bring up some very interesting questions about how this whole process is progressing. Part of the problem for planning for PHR’s is that we just can’t know or keep up with the technological advances being made and we are going to need help from the government in regards to HIE’s, RHIO’s and the NHIN and how these are all going to play a part in the definition of “meaningful use” .

Longer term aspects of the “meaningful use” definitions from 2013 and beyond also have some areas that are difficult to plan or manage for without knowing how the advances will occur. For instance, offering patient-provider messaging capability or the use of home health monitoring devices or telemedicine in general are ideas we have thought about and would like to implement, however the problem again relies on external forces that we can’t predict. We are currently in the process of working with the Telehealth project through UC Davis which may be a significant factor in some of our rural locations being able to have access to the “backbone”. Some of our clinics and certainly patients have low bandwidth or intermittent access at best. It is hard for us to plan for something like this without having the necessary information to make sound decisions.

We are currently involved with aggregating our data with public health agencies so this shouldn’t be anything that we have any problems addressing. As this is already a very important part of our daily routines I do believe that we are prepared to respond to most of the requests for surveillance data.