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Meaningful Use Feedback for ONC and CMS – Meaningful Use Monday

Posted on November 7, 2011 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today I thought I’d cover some feedback and comments that have recently been posted on some of my previous posts. Some are feedback for ONC on meaningful use. Another suggests that more of us get involved in the meaningful use rule making process. These comments and others that I’ve ready have me wondering if I and others of my readers should be playing a more active role in helping form the meaningful use criteria.

As is evidenced by the 60 Minutes interview with Jack Abramoff last night, there’s so much messed up about Washington and the legislative process. I guess I partially see that with meaningful use and the HITECH Act and I’m sure there’s plenty more happening in Washington DC that I don’t know about.

The problem I see is that the ones interested in being actively engaged in the rule making process are those that have the most financial benefit to gain. Certainly all of us have some reason to care how our government spends money and particularly the health of our healthcare system. Unfortunately, financial benefit seems to be a much stronger motivating force to participate than the greater good.

Look at it this way. If I’m an EHR vendor that’s going to have to comply with meaningful use and use it and EMR certification to sale my product, then I have a reason to pay for someone to fly to Washington DC and be involved in the process. I could even make some reasonable argument for me as an EHR and healthcare IT blogger to make the journey to Capitol Hill to talk about what’s happening. In fact, I’m going to be in DC in December, but I’m not going there to help improve meaningful use. The idea of getting ONC and CMS or other members in Washington DC to talk with me about meaningful use and the HITECH act sounds daunting and I’m not sure it’s worth the effort for a one time event.

Does that basically mean that ONC and CMS are listening mostly to those who have a vested financial interest in meaningful use and certified EHRs?

I like many others would likely be happy to share our voice in the meaningful use stage 2 creation process. It just feels so hard to participate and with little confidence that our voice will be heard above those who are paying a lot more to have their voice played over a proverbial loud speaker. I’m sure most doctors feel this same way. Although, Dr. Koriwchak over at Wired EMR Practice was in Washington DC this last week. I’ll be interested to hear more details on his visit, but I think his visit came as part of a larger health organization. Evan Steele of SRSsoft has a good post requesting other medical organizations become more involved in the meaningful use process. Could they be an independent voice for the physicians they represent?

Enough ranting about the challenge of working with the government to shape policy. Although, a comment from Anthony Subbiah was what prompted my reaction above. The following are Anthony’s comments from my Small EHR Vendor and Specialty EHR post suggesting that EHR vendors get more involved in the process:

As a vendor who works with ONC, and having gotten to know them better, they do have the greater good in mind; and some of these hurdles are un-intended and un-foreseen. The Phase II of the meaningful use requirements are in pilot and this is a good time for the EHR vendors to work with ONC and point out the flaws which ONC will graciously accept and review. It has been interesting working with ONC and understanding their thought process goes a long way in positioning and requesting exemptions. Key here is for the EHR vendors to spend the time and effort and work with ONC helping to meet their objectives.
On another note, while reducing the expenses is the goal, its more about the reduction of wastefull expenses which is being targeted to get the healthcare costs under control.

ONC maintains an extensive directory and blog of what they do at WIKI and any company interested can join. In order to realize value, the companies interested should be able to dedicate one or two senior resources towards this; there are many pilots that go on related to MU Phase II; the EMR companies can participate in the Pilots, provide their inputs and the ONC group is more than willing to listen. Actually, this is a great group of people to work with and they take the input and integrate that within the initiatives framework. We do not participate in all the Pilots – we are participating in two of them currently.
I believe its better to participate and shape the outcome as opposed to sitting on the sidelines and later on finding fault in such initiatives…………..

Here’s a link to the Wiki that Anthony mentions.

The other comment that prompted this post was a comment made by Julie Lundberg about the meaningful use smoking status requirement:

In an attempt to improve ‘Usability” we are trying to build a smoking status that will satisfy both the Core Measure (which requires CDC smoking status categories) and CQMs (which require SnoMed codes). There is no 1-1 relationship between the 2 lists. In fact, the CDC list makes no distinction between a “Light” cigarette smoker (1-9 cigs/day) and a “Very Heavy” cigarette smoker (40+ cigs/day). Both would be considered a “Current every day smoker”. We can obviously gain this granularity with SnoMed codes but this makes the task more onerous for the provider to capture (selecting from 2 lists of “descriptions”). Let’s give the Providers 1 smoking status to fit all requirements.

It’s an interesting question for which I don’t have the answer to which feels odd since I feel that I’m reasonably well versed with meaningful use and the creation of the meaningful use creation process. The only way to know the answer to this is to have been intimately involved in the creation process in Washington. Something no doctor that sees patients daily can really do.

I love that Julie was willing to offer her suggestion on my EMR blog. Plus, I know that a number of people from ONC read this site, so I’m hopeful that now that I’ve posted Julie’s comment it will get more traction from the people in Washington. However, I still feel there needs to be an easier way for those who can’t spend their days following the latest meaningful use happenings in Washington DC to have their voice heard in the process. Then, they wouldn’t have to resort to blogs like mine to provide comments.

I’m open to other suggestions on how regular people can get involved in the process. Maybe my personal fear of involvement is that I want to actually effect change on something I’m involved in. It seems like casual involvement in the process isn’t enough to be heard. I guess that’s the problem when you want what you said to be meaningful (ie. actually heard and used).

Clearing the Air on the Smoking Measures – Meaningful Use Monday

Posted on June 20, 2011 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

Smoking is a major and costly health problem. Because it is such a high priority for CMS, smoking is addressed in the Stage 1 meaningful use requirements by three distinct measures, which has caused a fair amount of confusion. I will try to clarify.

The first is a core meaningful use measure. Therefore, every eligible professional (EP) must satisfy this requirement, unless they can attest to meeting the exclusion.

Core Meaningful Use Measure: Record Smoking Status

More than 50% of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data.

Exclusion: Any EP who sees no patients 13 years or older.


  • Smoking status must be recorded as one of the following 6 categories: current every day smoker; current some day smoker; former smoker; never smoker; smoker, current status unknown; unknown if ever smoked.
  • The information does not have to be updated at every visit—it simply has to be in the patient’s record, (i.e., no need to ask a non-smoker whether he has taken up the habit yet!)

The other two smoking-related measures are clinical quality measures. There is a different minimum age for the patient population—18, as opposed to 13—and these measures encompass tobacco use in addition to smoking. EPs must report on 6 CQMs—3 Core CQMs and 3 Additional CQMs. Like all CQMs (for Stage 1 meaningful use), neither of these measures have required thresholds that must be met.

The Core CQM (NQF 0028 – Preventive Care and Screening Measure Pair, defined below) must be reported by all providers—there are no exclusions, even if the EP’s EHR generates zero denominators for this measure. In that case, the EP reports zero and must also select and report on an alternate core CQM. This is a 2-part measure that assesses the intervention/treatment provided related to smoking cessation, e.g., counseling and/or medication, and it is based on a 2-year timeframe.

The Additional CQM: (NQF 0027 – Smoking and Tobacco Use Cessation, Medical Assistance, defined below) is one of the 38 Additional CQMs, from which EPs must select and report on three, so this measure is an option, not a requirement. It sounds a lot like NQF 0028 above, unless you read the extremely detailed measure specifications. (We’ll leave that responsibility to the EHR vendors, since the CQM data EPs report must be generated by the EHR!) The major difference is that this measure only involves advice and counseling—it does not ask about intervention—and it has a shorter measurement period than NQF 0028.


NQF 0028: Core Clinical Quality Measure: Preventive Care and Screening Measure Pair: a. Tobacco Use Assessment, b. Tobacco Cessation Intervention

a) Percentage of patients aged 18 years and older who have been seen for at least 2 office visits who were queried about tobacco use one or more times with 24 months

b) Percentage of patients aged 18 years and older identified as tobacco users within the past 24 months and have been seen for at least 2 office visits who received cessation intervention.

NQF 0027: Additional Clinical Quality measure: Smoking and Tobacco Use Cessation, Medical Assistance: a. Advising Smokers and Tobacco Users to Quit, b. Discussing Smoking and Tobacco Use Cessation Medications, c. Discussing Smoking and Tobacco Use Cessation Strategies

Percentage of patients 18 years of age or older who were current smokers or tobacco users, who were seen by a practitioner during the measurement year and who received advice to quit smoking or tobacco use, or whose practitioner recommended or discussed smoking or tobacco use cessation medications, methods or strategies.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.