The advisory panel that is developing proposals for the next set of EHR quality measures is weighing whether to follow the same structure for Stage 2 of meaningful use as for Stage 1, with core and specialty items, and whether to carry forward the 2011 measures.

Panel members told the Health IT Policy Committee at a meeting March 2 they must balance how advanced the measures can be, while making sure they are still achievable for providers who are at varying levels of capability with EHR technology.

The quality measure workgroup is considering measures that have been retooled for electronic reporting and the new measures that ONC will put forward, which must be balanced by the availability of standards and methods, said David Lansky, co-chair of the committee's quality measures workgroup. Lansky is also CEO of the Pacific Business Group on Health.

Over the next several months, ONC will start to contract with organizations for measurement development based on the work done so far by the panel, and identify which measures can be established for Stage 2 of meaningful use. The standards committee will also identify the standards and vocabulary that supports the retooled electronic measures, Lansky said.

[See also: NQF posts specs for electronic measures .]

The panel is also narrowing down to the most promising measures contained in public comments that were filed by Dec. 31.

The quality measures will fall into four categories:  clinical appropriateness and efficiency, population and public health, patient and family engagement, care coordination and patient safety.

An example of the complexities the panel is wrestling with is the collection of data from multiple sources. Those can be an electronic health record (EHR), claims data, another EHR or a hospital system. And then it has to consider integrating data from multiple settings of care, and from multiple points in time.

That means there must be health information exchange and interoperability in place, Lansky said.

"The methodological challenges are important from the point of view of care coordination, integration and patient management," he said.

Pushing the envelope

With this process, the federal government has the chance to consider a broader range of measures than in Stage 1, and to be more representative of the practice of health and medicine and include more specialties in the measures, said David Blumenthal, MD, the national health IT coordinator.

He pressed the panel to keep pushing the envelope in quality measures, "even though there are issues of timing, issues of electronic exchange that may or may not be there, and all kinds of practical questions, because the system will catch up with us eventually and the work done here will be valuable when the system catches us."

The meaningful use framework will become the "raw material" for the work of private and public providers and payers whose goal is to improve quality through systemic change.

"It's not going to necessarily happen through the measures that we collect but, as we collect them, it will make it possible for other levers and other influences to produce change," Blumenthal said.

[See also: AHIMA presses ONC to deal with vocabularies in Stage 2 MU.]

The quality measures for meaningful use must also support new models of healthcare delivery, including accountable care organizations, value-based purchasing and medical homes, for which the Centers for Medicare and Medicaid Services is providing direction, he said.

By doing that, "the federal government sends as consistent a message as we can about what their priority measures are, so we are setting the stage electronically for a new system of data collection that will extend into the future and hopefully makes it easier for providers to collect measures electronically that meet multiple program purposes," Blumenthal said.

Tony Trenkle, CMS acting CIO, said the agency is beginning to align the measures of multiple programs, but "it's an evolution instead of getting everything synched up at once."

"We are actively working to make sure that over time (but) as soon as possible, we can harmonize what's being done with meaningful use, accountable care organizations and other areas where we're going to be collecting quality measures," he said.