Meaningful Use: Does Physician Participation Move the Needle on Quality Metrics?

INTRODUCTION: To determine the association between pattern of participation in the Meaningful Use (MU) initiative and self-reported clinical quality metrics. METHODS: We used state-level Medicaid electronic health record (EHR) incentive program data to categorize physicians based on receipt of MU payments (single year vs. multiple years) and self-reported quality metrics from 2011 to 2016. RESULTS: Among 4,198 participating physicians, only 36% received more than one EHR incentive payment. Physicians participating for a single year had better cancer-screening metrics. By comparison, physicians who participated for multiple years reported better medication-related metrics and chronic disease management metrics. CONCLUSIONS: Nature of participation may have varying degrees of influence on types of clinical quality metrics. Sustained participation may support management of chronic conditions. Administrative claims data will help to elucidate our findings.

Sensitivity of Claims-Based Algorithms to Ascertain Smoking Status More Than Doubled with Meaningful Use.

BACKGROUND: The "meaningful use of certified electronic health record" policy requires eligible professionals to record smoking status for more than 50% of all individuals aged 13 years or older in 2011 to 2012. OBJECTIVES: To explore whether the coding to document smoking behavior has increased over time and to assess the accuracy of smoking-related diagnosis and procedure codes in identifying previous and current smokers. METHODS: We conducted an observational study with 5,423,880 enrollees from the year 2009 to 2014 in the Truven Health Analytics database. Temporal trends of smoking coding, sensitivity, specificity, positive predictive value, and negative predictive value were measured. RESULTS: The rate of coding of smoking behavior improved significantly by the end of the study period. The proportion of patients in the claims data recorded as current smokers increased 2.3-fold and the proportion of patients recorded as previous smokers increased 4-fold during the 6-year period. The sensitivity of each International Classification of Diseases, Ninth Revision, Clinical Modification code was generally less than 10%. The diagnosis code of tobacco use disorder (305.1X) was the most sensitive code (9.3%) for identifying smokers. The specificities of these codes and the Current Procedural Terminology codes were all more than 98%. CONCLUSIONS: A large improvement in the coding of current and previous smoking behavior has occurred since the inception of the meaningful use policy. Nevertheless, the use of diagnosis and procedure codes to identify smoking behavior in administrative data is still unreliable. This suggests that quality improvements toward medical coding on smoking behavior are needed to enhance the capability of claims data for smoking-related outcomes research.

Assessing the value of the Meaningful Use Clinical Summary for patients and families with pediatric asthma.

Electronic clinical summaries are innovations supported by the Electronic Health Record Incentive Program, known as "Meaningful Use" (MU). The MU clinical summary documents the shared understanding of the plan of care for patients and assists families in managing asthma-related health care. The purpose of this analysis was to identify the communicative value of the summaries to patients and families. Readability measurements, content analysis, and descriptive statistics were employed in a review of twenty clinical summaries and compared with provider encounter notes. The average age of the patients from whom we collected clinical summaries was six years old. The average reading level of the summaries was ninth grade. Neither summaries nor health education contained visual images. There was a total of nine different asthma diagnoses. A full list of diagnoses was present in 45% of summaries. The average medications per patient was 5.75, and there were multiple medication changes noted (dosage adjustment, add, discontinued). Allergies, vital signs, and smoking status were reliably reported (99-100%). Provider orders present included medication, follow up, and return to the clinic instructions. The plan of care was replicated on 45% of summaries. There was variable reporting of various asthma guidelines. Opportunities to improve the clinical summary include using plain language to promote readability, action, understanding, and health literacy, training providers to standardize their documentation and include asthma action plans, and configuring EHR settings to ensure diagnoses and plan of care is carried over from provider notes to the summary.

Complexity of Chronic Conditions' Impact on End-of-Life Expense Trajectories of Medicare Decedents.

OBJECTIVE: The aim of this study is to determine if the pattern of monthly medical expense can be used to identify individuals at risk of dying, thus supporting providers in proactively engaging in advanced care planning discussions. BACKGROUND: Identifying the right time to discuss end of life can be difficult. Improved predictive capacity has made it possible for nurse leaders to use large data sets to guide clinical decision making. METHODS: We examined the patterns of monthly medical expense of Medicare beneficiaries with life-limiting illness during the last 24 months of life using analysis of variance, t tests, and stepwise hierarchical linear modeling. RESULTS: In the final year of life, monthly medical expense increases rapidly for all disease groupings and forms distinct patterns of change. CONCLUSION: Type of condition can be used to classify decedents into distinctly different cost trajectories. Conditions including chronic disease, system failure, or cancer may be used to identify patients who may benefit from supportive care.

Relating Complexity and Error Rates of Ontology Concepts. More Complex NCIt Concepts Have More Errors.

OBJECTIVES: Ontologies are knowledge structures that lend support to many health-information systems. A study is carried out to assess the quality of ontological concepts based on a measure of their complexity. The results show a relation between complexity of concepts and error rates of concepts. METHODS: A measure of lateral complexity defined as the number of exhibited role types is used to distinguish between more complex and simpler concepts. Using a framework called an area taxonomy, a kind of abstraction network that summarizes the structural organization of an ontology, concepts are divided into two groups along these lines. Various concepts from each group are then subjected to a two-phase QA analysis to uncover and verify errors and inconsistencies in their modeling. A hierarchy of the National Cancer Institute thesaurus (NCIt) is used as our test-bed. A hypothesis pertaining to the expected error rates of the complex and simple concepts is tested. RESULTS: Our study was done on the NCIt's Biological Process hierarchy. Various errors, including missing roles, incorrect role targets, and incorrectly assigned roles, were discovered and verified in the two phases of our QA analysis. The overall findings confirmed our hypothesis by showing a statistically significant difference between the amounts of errors exhibited by more laterally complex concepts vis-à-vis simpler concepts. CONCLUSIONS: QA is an essential part of any ontology's maintenance regimen. In this paper, we reported on the results of a QA study targeting two groups of ontology concepts distinguished by their level of complexity, defined in terms of the number of exhibited role types. The study was carried out on a major component of an important ontology, the NCIt. The findings suggest that more complex concepts tend to have a higher error rate than simpler concepts. These findings can be utilized to guide ongoing efforts in ontology QA.

Nurses' Attitudes Toward Meaningful Use Technologies: An Integrative Review.

Nurses comprise the largest segment of the healthcare workforce. As such, their perceptions of any new technology are important to understand, as it may ultimately mean the difference between acceptance and rejection of a product. The three-stage meaningful use program is intended to help improve and standardize data capture and advance clinical processes to improve patient and population outcomes in the US. With more than 471 000 healthcare providers having already received meaningful use incentive payments totaling more than $20 billion as of June 2015, it is critical to understand how these technologies are being viewed and utilized in practice. Understanding nurses' attitudes toward healthcare technology may help drive acceptance, as well as maximize the inherent potential of the new technologies toward improving patient care. Thus, the purpose of this integrative review is to highlight what is known about nurses' attitudes toward meaningful use technologies.

[Documentation quality of histopathology reports of prostate needle biopsies: a snapshot]. / Dokumentationsqualität histopathologischer Befundberichte von Prostatastanzbiopsien : Eine Momentaufnahme.

BACKGROUND: A standardized assessment of findings from prostate needle biopsies in pathology is of great importance for the individual recommendations for therapy of patients with prostate cancer. To this end criteria were developed which are formulated as recommendations in the S3 guidelines for prostate cancer and in joint instructions of the Bundesverband Deutscher Pathologen (BDP, "National Association of German Pathologists") and the Deutsche Gesellschaft für Pathologie (DGP, "German Society of Pathology"). In this article the findings from tumor positive prostate needle biopsies taken from various institutes in Germany, were investigated exclusively to determine to what extent the recommended parameters were followed. MATERIAL AND METHODS: The study encompassed the findings from 91 patients with a mean age of 65.3 years from whom an average of 9.3 biopsy samples from different regions of the prostate were submitted. All diagnosed tumors corresponded to a standard type adenocarcinoma according to the classification of the World Health Organization (WHO) which was detected in an average of 2.5 biopsy regions per patient. The assessment was made from H & E stained serial sections which was supplemented in 11 (12.1%) cases by special staining methods and in 40 (44%) cases by immunohistochemical staining techniques. The length of the needle biopsy was documented in 88 (96.7%) cases and the tumor spread also in 88 cases. The tumor stage was reported in 16 cases (17.6%). RESULTS: The Gleason grading score (GS) was reported in all 91 cases whereby the old GS was explicitly used in 1 case and the modified GS in all other cases. The allocated GS ranged from 4 to 10 whereby 8 cases were graded as ≤5, 46 as GS grade 6, 27 as GS grade 7 and 10 as GS >7. Out of 45 cases with several positive biopsy samples, 38 were uniformly graded (84.4%), 6 out of the 7 samples which were not uniformly graded were allocated a GS of 6 or 7 and 1 sample was graded as GS 6-9. In 64 cases (70.3%) the conventional 3-stage WHO grading (n=42) and the Helpap grading (n=22) were additionally used. The WHO and Helpap grading scores were found to be highly correlated with the GS grading scores and the Union for International Cancer Control (UICC) grading scores derived from it (χ²-test, p<0.001), although surprising allocations were selected in isolated cases. CONCLUSION: In total, the only serious deficits were that in three cases (3.3%) no information was supplied on the estimated spread of the tumor in the tumor positive biopsies because this information can be decisive for therapy decisions, particularly for the selection of an active surveillance strategy. Also a relatively large number of cases were assigned a GS score ≤ 5 which is not recommended in the modified Gleason grading. Furthermore, translation of the GS into the other grading forms used revealed that the biological assessment of the GS showed clear differences between the various participating institutes. In conclusion, the findings of the pathologists as a rule incorporated all the parameters necessary for a therapy decision in accordance with the guidelines so that they can be considered comprehensive and completely valid apart from a few exceptions.

Augmented meaningful use criteria to identify patients eligible for lung cancer screening.

BACKGROUND: Lung cancer screening (LCS) with low-dose-radiation (low-dose computed tomography [LDCT]) saves lives. Despite recent US Preventive Services Task Force (USPTF) draft endorsement of LCS, a minority of eligible patients get screened. Meaningful use is a set of standards for electronic health records (EHR) established by the Centers for Medicare and Medicaid Services and includes reporting of smoking status. We sought to improve rates of LCS among patients treated at our institution by identifying eligible patients using augmented smoking-related meaningful use criteria. METHODS: We launched an LCS program at our institution, a National Comprehensive Cancer Network (NCCN) cancer center, in January 2013. We developed a "tobacco screen," administered by clinic staff to all adult outpatients every 6 months and entered into the EHR. This contained smoking-related meaningful use criteria as well as a pack-year calculation and quit date if applicable. Weekly electronic reports of patients who met eligibility criteria for LCS were generated, and EHR review excluded patients who had had chest computed tomography (CT) within 12 months or who were undergoing cancer treatment. We then contacted eligible patients to review eligibility for LCS and communicated with the primary treating physician regarding the plan for LCS. RESULTS: During the first 3 months of the program, 4 patients were enrolled, 2 by physician referral and 2 by self-referral. We then began to use the tobacco screen reports and identified 418 patients potentially eligible for LCS. Over the next 7 months, we enrolled a total of 110 patients. Fifty-eight (53%) were identified from the tobacco screen, 32 (29%) were self-referred, and 20 (18%) were physician referrals. Three stage I lung cancers were detected and treated. The tobacco screen was easily implemented by clinic staff and took a median time of 2 minutes to enter for current and former smokers. Lack of response to attempts at telephone contact and objection to paying out-of-pocket costs were the most common reasons for failing to screen eligible patients. CONCLUSIONS: Use of augmented meaningful use criteria containing detailed tobacco exposure history is feasible and allows for identification of patients eligible for LCS in a medical center. Barriers to LCS include lack of insurance coverage and lack of systematic referral of patients at high risk.