A Patient-Centric Look at Meaningful Use and Value-Based Purchasing: Q&A with Kathleen Rafter

I recently had the opportunity to sit down with my colleague Kathleen Rafter to discuss Meaningful Use from the clinician/patient perspective. I thought it would be good to share a little of “how the other half lives” in this space since so much of the Meaningful Use discussion on HL7Standards focuses on healthcare standards and data exchange.

How has the focus shifted in Meaningful Use and what are you seeing in the field?

Ms. Rafter: “It was such an honor working with the first hospital in the country to attest for Meaningful Use and to be part of the attestation team for the third hospital in the country to file and attest for Meaningful Use. That provided me with a solid experience and expertise that I continue to draw upon.

Kathleen A. Rafter, MSN, RN, is vice president and clinical practice director for Healthcare Transformation Resources (HTR). Her specialties include bridging governmental regulatory requirements for ARRA/HITECH, Meaningful Use, value-based purchasing, and evolving accountable care strategies to current and future information technology. Kathy is a registered nurse with a master’s in nursing informatics and more than 15 years in the healthcare industry.

“Stage 1 focused on data capture and meeting metrics, Stage 2 focuses on leveraging that data to increase the coordination of care to increase quality of care. Stage 2 also focuses on patient engagement.

“By Stage 3 the focus will be patient outcomes (along with device integration). We cannot expect to meet these regulations and outcomes by just checking a box in an EMR. These changes mean creating real changes to workflow, process and content to gain efficiency. This means the right information and knowledge to the right provider and the right time…as in the case of Medication Administration Check (barcoding technology).

“The Philadelphia-area health system I’ve supported is progressive, with a Department of Clinical Informatics. We have directed what information is best at the bedside and directed workflow. This is an exciting time to be in healthcare and technology – especially when done well.”

There has been much in the news lately around Meaningful Use Audits – once a hospital attests, do they need to continue that process? What best practices would you suggest to avoid future penalties?

Ms. Rafter: “You mean, ‘How does one survive an audit for Meaningful Use?’ First of all, every site should retain all documentation related to their attestation whether a hard copy or an electronic file. In that file/folder there should be a copy of each report for each and every objective. The reports, security risk assessment – everything should be kept in one place. That 90-day report will always be needed and subsequent reports will be added.”

Ms. Rafter was very clear that as long as documentation is kept, reports maintained from attestation onward – hospitals would be prepared. Many facilities were not diligent about keeping records (or passing along records as positions/people move around) thus; audits become worrisome for such facilities.

You mentioned a shift from monitoring and meeting objectives to patient engagement, both with Meaningful Use and with value-based purchasing. What does this mean for hospitals and providers?

Ms. Rafter: “This is what we get most excited around – we enjoy getting creative with providers and facilities around how to incorporate the shift to patient/family involvement in care and quality. This will be the core of both Meaningful Use and value-based purchasing – moving forward.

“More information does imply more action/care coordination. If there is a test result, who will follow up with the care? This is ideal for our best wellbeing and this may not have been the case at the facility in the past. Workflow, care coordination, hand-offs all become revealed when under the magnifying glass of these next stages of Meaningful Use and value-based purchasing.”

What are your predictions for 2013?

Ms. Rafter: “2013 will be the Year of the Patient, seen mainly via: Patient Engagement. This will be a challenge for both providers and patients to become a team in their care. Not only a challenge for meeting Meaningful Use Stage 2, but, as mentioned, we will see this as value-based purchasing moves forward. Patients are also becoming more tech and information savvy.

“We suspect our clients will find the most challenge in the area of true engagement of patients and families. Clinical transformation to meet all regulations is just too much for so many. Using the system in a meaningful way, leveraging technology and care coordination, that is what we do best.

“Of course additional changes for 2013 will be an increase in the use of mobile and cloud technology, along with a defining and growth of our healthcare information exchanges.”


Author bio: Melissa Cole, BSN, MSW, is a senior consultant for Healthcare Transformation Resources. She has more than 25 years experience in the healthcare industry and continually advocates her passion for leveraging technology in ways that increase patient safety.


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Melissa Cole, BSN, MSW, is a senior consultant for Healthcare Transformation Resources. She has more than 25 years’ experience in the healthcare industry and continually advocates her passion for leveraging technology in ways that increase patient safety. Follow Melissa on Twitter @melissacolehtr.

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  • http://twitter.com/2healthguru Gregg Masters

    Well done Melissa! Keep em coming…