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In MedCity News, John Halamka makes an effort to summarize as simply as possible the Quality Measures:

I’ve been asked to summarize the Quality Measures as simply as possible

a. The Core Measures for All Eligible Professionals, Medicare and Medicaid are in the Final Rule Table 7, page 287. The Measures are

• Hypertension: Blood Pressure Measurement
• Tobacco Use Assessment and Tobacco Cessation Intervention
• Adult Weight Screening and Follow-up

b. If the denominator for one or more of the Core Measures is zero, EPs will be required to report results for up to three Alternate Core Measures. The Alternate Core Measures for Eligible Professionals are in the Final Rule Table 7, page 287. The Measures are

• Weight Assessment and Counseling for Children and Adolescents
• Preventive Care and Screening: Influenza Immunization for Patients ? 50 Years Old
• Childhood Immunization Status

c. The Clinical Quality Measures for Submission by Medicare or Medicaid EPs for the 2011 and 2012 Payment Year (EPs must choose 3) are in the Final Rule Table 6, page 272 . Here’s a summary of the 44 quality measures that CMS posted last week.

d. The Clinical Quality Measures for Submission by Eligible Hospitals and Critical Access Hospitals for Payment Year 2011-2012 are in the Final Rule Table 10, page 303. The Measures are

• Emergency Department Throughput ’ admitted patients Median time from ED arrival to ED departure for admitted patients
• Emergency Department Throughput ’ admitted patients Admission decision time to ED departure time for admitted patients
• Ischemic stroke ’ Discharge on anti-thrombotics
• Ischemic stroke ’ Anticoagulation for A-fib/flutter
• Ischemic stroke ’ Thrombolytic therapy for patients arriving within 2 hours of symptom onset
• Ischemic or hemorrhagic stroke ’ Antithrombotic therapy by day 2
• Ischemic stroke ’ Discharge on statins
• Ischemic or hemorrhagic stroke ’ Stroke education
• Ischemic or hemorrhagic stroke ’ Rehabilitation assessment
• VTE prophylaxis within 24 hours of arrival
• Intensive Care Unit VTE prophylaxis
• Anticoagulation overlap therapy
• Platelet monitoring on unfractionated heparin
• VTE discharge instructions
• Incidence of potentially preventable VTE

Everything clear now?

Anyone that works in Healthcare IT knows who John Halamka is and so of course I was interested in his post of his top 10 impressions after HIMSS. It’s an interesting list and I think he does a pretty good job of looking at things from a very high level. Here they are as posted on his blog:

1. Meaningful Use is everywhere. Vendors are promising EHRs, modules, appliances, and services to help clinicians achieve it. I had dinner on Monday night in a small Indian vegetarian restaurant. Sitting next to me were 3 engineers from Bangalore who were arguing about the details of Meaningful Use in between bites of vegetable curry. I could not escape Meaningful Use anywhere!

2. Certification is everywhere. It’s particularly ironic that many vendors claimed their systems were certified, even though the certification NPRM was just released today, making compliance with the new certification process in time for HIMSS impossible.

3. Cloud computing, Software as a Service and ASP models are popular tactics to accelerate EHR rollouts. There are still lingering concerns about how to ensure privacy in a cloud environment.

4. Several firms such as Intersystems, Axolotol, and Medicity are offering HIE platforms that include many of the standards noted in the IFR. The marketplace for HIE products is just emerging and it’s hard to predict who will become the market leader.

5. The Continuity of Care Document is gaining traction. I found many vendors supporting CCD exports from their EHRs. A company called M*Modal , has developed natural language processing technology that captures dictated content in its original context (ontology-driven
rules) as a CDA document.

6. Consultants abound. It’s clear that Regional Extension Centers and Health Information Exchanges will require expertise and staffing from professional firms. They all had large booths at HIMSS.

7. 30,000 people attended, including 10,000 I did not recognize (just kidding). It’s clear to me that many IT professionals, even those with limited healthcare domain expertise, attended HIMSS to better understand how they could participate in the euphoria of HITECH stimulus dollars.

8. Self service kiosks for patient identification and self-registration are now mainstream. Just as we print our airline boarding passes, we can now use credit cards or biometrics to check into ambulatory care appointments and automatically settle all co-pay balances.

9. Image exchange in the cloud is being offered by several vendors. As I mentioned in Monday’s blog, Symantec announced an appliance for small clinician offices that cloud enables all imaging modalities using a facebook-like social networking invitation to share/view images.

10. PHRs and patient engagement are becoming more mainstream. Google and Microsoft continue to innovate in the non-tethered PHR marketplace.

One of my regular readers and commenters, DKBerry, sent me some extracts on an article by Modern Healthcare about HITSP. DKBerry also commented, “HITSP is still operational through 30 April. Despite the extension question to its future is going to hurt its mission IMO.” I think HITSP does face a very uncertain future. Here are the excerpts from the article:

“It appears the Healthcare Information Technology Standards Panel, or HITSP, has become yet another organization formed at the behest of the Bush administration that is being forced to reapply for its job under the federal government’s new heath IT authority.”

…
“That contract was set to expire Jan. 31, but HHS issued a “no-cost extension” to the contract through April 30, according to HITSP Chairman John Halamka, a physician who is chief information officer at 621-bed Beth Israel Deaconess Medical Center and at Harvard Medical School, Boston.”

…

“Halamka said the HHS contract extension through April will enable HITSP “to have a presence at the upcoming HIMSS conference (scheduled to run March 1-4 in Atlanta) and support the quality reporting activities being demonstrated in the Interoperability Showcase there.”

In addition, HITSP will host “informational conference calls” over the next few months and its Foundations Harmonization Subcommittee set a schedule of three meetings, the first being today at 10:30 a.m. ET, with two more Feb. 8 and Feb. 17 to wrap up its work.

“HITSP is not done; the lights are on,” said Liz Neiman, an ANSI spokeswoman. HITSP and healthcare IT interoperability are “a tremendous priority for ANSI,” Neiman said. “Absolutely, we’ll be going for any RFP that’s coming out. What’s really important for us is to keep the momentum going.”

Healthcare InformationWeek has an article that discusses the challenges of EMR security and privacy. A lot of the stuff is nothing new to those of us in the healthcare space. Although, it’s interesting to see how they summarize things like the goal to be full EMR by 2014 and the EMR stimulus money.

However, the article did include these interesting stats on the number of breaches that happen in healthcare and the focus IT managers put on privacy and data security in healthcare.

Healthcare providers and other health businesses aren’t stepping up to protect privacy, according to a recent study. Some 80% of healthcare organizations have experienced at least one incident of lost or stolen health information in the past year, according to the study, released this month from security management company LogLogic and the Ponemon Institute, which conducts privacy and information management research.

Also, some 70% of IT managers surveyed said senior management doesn’t view privacy and data security as a priority, and 53% say their organizations don’t take appropriate steps to protect patient privacy. Less than half judge their existing security measures as “effective or very effective.”

I was surprised that 80% of organizations have had an incident of lost or stolen health information. However, I honestly don’t see this ever changing. Stuff happens even with the very best efforts.

I did also like this quote of John Halamka about the challenge of balancing privacy and security with sharing the patient information to provide better patient care.

“You want to protect the patient’s preferences for confidentiality,” Halamka said. But you also need to get information where it’s needed. “If you come to the emergency department in a coma, and you have a record that includes psychiatric treatment, HIV, drug abuse, and other information, would you share part of it or all of it? My preference would be all of it, with the hope that emergency workers would use it discreetly, to save my life.” But other people may feel differently, Halamka said, and healthcare policy needs to serve all those needs.

I’m a little surprised that Halamka has had psychiatric treatment, HIV and drug abuse. He’s doing quite well considering that history. (that’s sarcasm in case you didn’t note it) His history aside, I’m totally with him on wanting that information available as well. However, he’s totally correct that many people wouldn’t want that stuff shared. Enabling the consumer to make that decision though is a hard nut to crack.