BackgroundWith the aim of improving health care processes through health information technology (HIT), the US government has promulgated requirements for “meaningful use” (MU) of electronic health records (EHRs) as a condition for providers receiving financial incentives for the adoption and use of these systems. Considerable uncertainty remains about the impact of these requirements on the effective application of EHR systems.ObjectiveThe Agency for Healthcare Research and Quality (AHRQ)-sponsored Centers for Education and Research in Therapeutics (CERTs) critically examined the impact of the MU policy relating to the use of medications and jointly developed recommendations to help inform future HIT policy.MethodsWe gathered perspectives from a wide range of stakeholders (N=35) who had experience with MU requirements, including academicians, practitioners, and policy makers from different health care organizations including and beyond the CERTs. Specific issues and recommendations were discussed and agreed on as a group.ResultsStakeholders’ knowledge and experiences from implementing MU requirements fell into 6 domains: (1) accuracy of medication lists and medication reconciliation, (2) problem list accuracy and the shift in HIT priorities, (3) accuracy of allergy lists and allergy-related standards development, (4) support of safer and effective prescribing for children, (5) considerations for rural communities, and (6) general issues with achieving MU. Standards are needed to better facilitate the exchange of data elements between health care settings. Several organizations felt that their preoccupation with fulfilling MU requirements stifled innovation. Greater emphasis should be placed on local HIT configurations that better address population health care needs.ConclusionsAlthough MU has stimulated adoption of EHRs, its effects on quality and safety remain uncertain. Stakeholders felt that MU requirements should be more flexible and recognize that integrated models may achieve information-sharing goals in alternate ways. Future certification rules and requirements should enhance EHR functionalities critical for safer prescribing of medications in children.
Based on that discussion, the best practices are being revised in the form of an effectiveness guidance document and will be circulated for a targeted external review before being finalized and released. Results: Specific recommendations include: set forth all analytical plans and decision criteria a priori; design for three potential statistical adjustment methods; involve patients and other stakeholders early in the study design process; seek and evaluate external and observational data to help assess methodological assumptions and/or estimate counterfactual survival times; and regard informed consent as a continuous process and explain all treatment switching options. ConClusions: Adoption of these recommendations regarding treatment switching will help assure clearer evidence from oncology drug trials for decision makers. They will be publicly released in 2016.
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