The government has already begun planning for meaningful use requirements under Stages 2 and 3 – to be used beginning in 2013 and 2015 – and some stakeholders would like to see the feds raise the ante on quality.

The federal Health IT Policy Committee's Quality Measures Workgroup, chaired by David Lansky, had requested comments on proposed quality measures by Dec. 31, 2010. Lansky said the workgroup's proposals are "broadly aligned" with the National Priorities Partnership Framework for health quality and the five pillars of meaningful use – improving safety, quality, efficiency and health disparities; engaging patients and families; improving care coordination; improving population health; and ensuring adequate privacy and security protections.

The workgroup's early proposal met with some approval and calls for an upgrade in quality requirements.

The American Health Information Management Association praised the workgroup's efforts to find "a sense of balance," yet AHIMA officials felt some of the objectives didn't go far enough and ultimately may impact patient safety. On objectives such as recording demographics, problem lists, active medication lists and reminders to patients, "if the meaningful user can achieve 80 (percent) to 90 percent by Stage 2, we support and encourage taking that next step" to 100 percent, AHIMA leaders said.

Sam Ho, MD, of the UnitedHealth Group, said the workgroup's proposal "showed progress," but also urged "a more robust set of quality measures to help improve the care patients receive."

"We support the approach of working down from conceptual and outcomes-based domains, as opposed to building up from percentages of specific measures based on processes," Ho said. "We do not believe the two are incompatible, however. It is important to patients that we identify and fill gaps in areas delineated by the workgroup."

The Health IT Now Coalition, a group of 62 organizations promoting HIT adoption, applauded the workgroup’s proposal as "a major step forward compared to the Stage 1 standards."

"We are especially appreciative of the efficiency measures as these sets will help foster appropriate cost containment while at the same time improving care quality," said Joel White for the coalition.

The Quality Measures workgroup will review the comments and make changes to its proposals before presenting them to the Health IT Policy Committee for approval, according to Lansky.