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uct, offering guidance to enable a better understanding
of the EHR incentive program and empowering users
to meet meaningful use requirements. 4, 5 But to fully
attain the goal of leveraging clinical data at the point of
care, surgeons must push for optimal use of the digital
information in EHRs and registries by appropriating
more information into the surgical team’s workflow.
Federal efforts to expand HIT
Early federal efforts at using data to reduce costs and
drive improvements in outcomes focused largely on
administrative claims data, as these were the data readily available to the government through the Centers
for Medicare & Medicaid Services (CMS). Administrative claims data are routinely collected for payment
purposes and are relatively easy to analyze. However,
claims data do not capture the nuances of comorbidities, severity, conditions present on admission, complications, patient experience, or other socioeconomic
factors critical to understanding health outcomes.
Unlike administrative data, which aggregate experience for system management requirements, clinical data are patient-specific and can be more precisely
stratified to define best practices. 6 In fact, administrative claims-based performance measures quickly
proved inadequate to fully achieve the dual goals of
improving health care outcomes and slowing growth
in health care spending. In 2009, Congress passed the
Health Information Technology for Economic and
Clinical Health (HITECH) Act as part of the American
Recovery and Reinvestment Act (commonly referred to
as the stimulus package). 7 The HITECH Act contained
incentives for providers to adopt EHRs and laid out
meaningful use requirements with the goal of ensuring
that the federal funds were being spent wisely and in a
way that would improve the provision of health care.
Although the meaningful use requirements are far
from perfect, the EHR incentive program has helped
to expand the use of EHRs, increasing the amount of
clinical data potentially available for analysis.
Many obstacles must be overcome on the path to
meaningful use of digital information in health care
records before patients and surgeons will feel the ben-
eficial effects of digital clinical information. At first,
federal lawmakers seemed to anticipate that simply
digitizing the paper record would provide a return
that would satisfy surgeons and other health care pro-
viders. However, many surgeons saw the rollout of
EHRs largely as an additional administrative burden.
Due to a limited information exchange, a lack of data
standards and interoperability, and virtually no real-
time clinical analytics, time spent entering data into
EHRs may seem like a poor use of resources. For many
clinicians, the EHR is simply an expensive means of
recording data previously stored in a paper record,
and extracting information from these digital files has
proved to be an inefficient tool for meeting the needs
of patients or surgeons.
Federal programs have since taken incremental
steps to encourage the use of clinical data registries.
This effort has been aimed at increasing the clinical
value of data collected and reducing administrative
burdens, but it has also put further pressure on EHR
users to feed information back into registries. One such
federal action was attached to the so-called “fiscal cliff
bill” that prevented a government shutdown in January 2013 and delayed sustainable growth rate-related
cuts in Medicare physician payments. 8 This provision
provides an opportunity for Medicare eligible professionals (EP) to simultaneously use existing high-quality clinical registries for quality improvement and for
meeting Physician Quality Reporting System (PQRS)
requirements. Beginning in 2014, EPs were also able to
report to PQRS with the qualified clinical data registry (QCDR) reporting option. QCDRs offer more flexibility than other PQRS reporting options, allowing
EPs to report on a variety of measure types. In addition, QCDRs must have the capacity to track outcomes,
provide timely feedback reports, and risk-adjust when
appropriate. All of these capabilities are intended to
result in the reporting of measures that are more relevant, clinically appropriate, and actionable for surgeons
than the measures currently available as reporting
options through PQRS.In April of 2014, CMS approved
the Metabolic and Bariatric Surgery Accreditation and
