Necessary But Not Sufficient: The HITECH Act and Health Information Technology’s Potential to Build Medical Homes

June 2010
AHRQ Publication No: 10-0080-EF
Prepared For:
Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, 540 Gaither Road, Rockville, MD 20850, www.ahrq.gov

Contract Number: HHSA290200900019I TO2
Submitted By: Mathematica Policy Research 600 Maryland Avenue, SW Suite 550 Washington, DC 20024-2512
Authors: Lorenzo Moreno, Ph.D., Deborah Peikes, Ph.D., Amy Krilla, M.S.W.
Table 2. Goals for EHR systems in 2011, 2013, and 2015, by medical home principle and meaningful use policy priority
Period for Assessing Meaningful Use of EHRs
Medical Home PrincipleMeaningful-Use Policy Priority201120132015
Source: Mathematica‘s mapping of ONC‘s policy priorities and timeline (Health IT Policy Council Recommendations to National Coordinator for Defining Meaningful Use. Final August 2009) to AHRQ‘s medical home principles.
Key: CMS = Centers for Medicare & Medicaid Services; CPOE = computerized provider order entry; EHR = electronic health record; HIPAA = Health Insurance Portability and Accountability Act; PHR = personal health record.
Patient-centered, whole-person orientationEngage patients and families- Give patients secure electronic access to their health information and patient-specific education resources
- Provide clinical summaries at each encounter
- Record patient preferences (for example, preferred communication media and treatment options)
- Incorporate data from home monitoring devices
- Offer patients access to PHR populated in real time
- Give patients access to self-management tools and electronic reporting on experience of care
Comprehensive, team-based careNot specified- Not applicable- Not applicable- Not applicable
Coordinated careImprove care coordination- Perform medication reconciliation, especially when patient moves from one health care setting or provider to another- Retrieve and act on electronic prescription fill data
- Produce and share electronic summary of care record for every transition in care
- Access comprehensive patient data from all available sources
Period for Assessing Meaningful Use of EHRs
Continuous access to careEngage patients and families- None- Provide secure patient-provider messaging capability
- Access for all patients to a PHR populated in real time with health data
- None
Systems-based approach to quality and safetyImprove quality, safety, and efficiency, and reduce health disparities- Use CPOE for all orders
- Implement drug-drug, drug-allergy, and drug-formulary checks
- Maintain lists of allergies and diagnoses
- Record pertinent patient information
- Incorporate laboratory test results into EHR
- Report ambulatory quality measures to CMS
- Document each encounter and check insurance eligibility
- Use evidence-based order sets
- Record family medical history
- Manage chronic conditions using patient lists
- Use clinical decision support at the point of care
- Specialists report to external disease or device registries, approved by CMS
- Achieve minimal levels of performance on quality, safety, and efficiency measures
- Implement clinical-decision support for national high-priority conditions
- Maintain medical device interoperability
Adequate private and security protection for personal health information- Comply with HIPAA privacy and security rules and fair data-sharing practices- Use summarized or de-identified data when reporting for public health purposes- Provide patients with accounting of treatment, payment, and health care operations
Improve population and public health- Submit electronic data to immunization registries where required and accepted
- Submit electronic surveillance data to public health agencies according to applicable law and practice
- Receive immunization histories and recommendations from immunization registries
- Receive health alerts from public health agencies
- Provide de-identified electronic surveillance data to public health agencies
- Generate ad hoc quality reports
- Automate real-time surveillance
- Provide clinical dashboards
- Use epidemiological data derived from EHRs