Should We Pause Meaningful Use?

pauseThere has been some discussion about whether it might be a good idea to delay stage 2 meaningful use for some providers. Sen. John Thune (R-S.D.) and some Republican colleagues in April 2013 published a whitepaper “Reboot: Re-examining the Strategies Needed to Adopt Health IT” where they outlined their concerns with current health IT policy, including the costs, interoperability, the potential for waste and abuse, patient privacy and sustainability and suggested there might need to be a delay in the meaningful use incentive program.

The white paper accompanied a letter that the lawmakers sent to HHS Secretary Kathleen Sebelius. The letter requested information about the agency’s progress in promoting EHR adoption through the meaningful use program.

In May 2013, the College of Healthcare Information Management Executives (CHIME) chimed in and also advocated for a one year delay in stage 2 meaningful use. In a letter to the six senators who authored the REBOOT strategy, CHIME wrote, “While we share some of your concerns with the current state of interoperability, we strongly believe that EHR incentive payments under the policy of meaningful use have been essential in moving the nation’s health care system into the 21st century.”

The Senate Finance Committee has now taken up the debate starting with a hearing where they listened to government officials and then another hearing where they heard from the private sector.

During the Senate Finance Committee hearing Health Information Technology: A Building Block to Quality Health Care” on July 17, CMS and ONC officials discussed this idea of delaying the meaningful use program. National Coordinator for Health IT Farzad Mostashari and Patrick Conway, the director of CMS’ Center for Clinical Standards and Quality and Acting Director at the Center for Medicare and Medicaid Innovation, testified during the hearing. Dr. Mostashari’s submitted written testimony is available HERE and and he summarized his testimony below.

In questioning from Sen. Thune on the need for greater interoperabilty, both Dr. Conway and Dr. Mostashari indicated that this is a high priority. Mostashari acknowledged that we need to make accommodations to account for the diversity of capabilities, particularly in rural communities, while still not holding back those who want to drive forward and be trailblazers. Sen. Thune then went on to ask about what stage 3 might look like and are there any plans for future stages beyond stage 3. Dr. Conway did state that rules for stage 3 would be out in 2014; however, the issue of future stages was not addressed.

Dr. Mostashari then went on to describe his visit to Virginia Commonwealth University School of Medicine and their journey towards meaningful use. Interestingly, Colin Banas, M.D., chief medical information officer at VCU testified one week later and urged the Senators to consider a delay.

There was a particularly interesting question from Sen. Max Baucus (D-MT): “How do you develop trust?” In his answer, Dr. Mostashari mentioned the governance work being undertaken through the Exemplar HIE Governance Entities Program.

One week later on July 24, the Senate Finance Committee held another hearing “Health Information Technology: Using it to Improve Care” where they heard from vendors, healthcare providers, and others in the private market.

Janet Marchibroda, Director, Health Innovation Initiative, Bipartisan Policy Center; John Glaser, Chief Executive Officer, Health Services, Siemens Healthcare; Marty Fattig, Administrator and CEO at Nemaha County Hospital in Auburn, Neb.; and Dr. Banas from VCU testified. Ms. Marchibroda started out, and she stood out as the strongest advocate for the meaningful use program on the panel.

“I’d hate to see us not benefit from those important patient engagement and information sharing requirements in stage 2 as soon as we can,” she said at one point. “Don’t delay the start of stage 2. Align expectations for information sharing with payment both inside and outside meaningful use.”

Dr. Glaser followed with his testimony where he laid out his support for the strategy proposed by the REBOOT strategy. He recommended extending the Stage 2 deadline until October 1, 2015, and adding a third year for any given stage to give organizations time to implement upgrades and adjust to changes.

When asked by Sen. Orrin Hatch (R-UT) if the vendor community is prepared to meet the needs for every provider to upgrade to the certified 2014 Edition, and particularly for rural providers, Dr. Glaser reiterated his recommendation that stage 2 be delayed by a year. He warned of a potential digital divide, saying that for small rural hospitals “it may be on the edge of impossible” to find the resources to properly implement an EHR. “So we run the risk of a haves and have nots.”

Dr. Banas gave his testimony without using any paper and read from a small tablet. Banas told the senators that VCU is struggling with the pace of change ahead. “We are drowning in a sea of competing priorities and clinical needs to ensure that the EMR remains usable and meaningful,” he said. “The combined tsunami of the ICD-10 mandate collides precisely with the medical center’s need to attest for the first year of meaningful use, Stage 2.”

Agreeing with Dr. Glaser and Mr. Fattig, he supported the idea of a pause in the program. “Slowing down is prudent because the literature and experience has shown that these things take time,” he said.

Should we give an extra year for stage 2 meaningful use? I’d be very interested in your thoughts…

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Brian Ahier

Brian Ahier is a national expert on health information technology with a focus on health data exchange. He is President of Advanced Health Information Exchange Resources, LLC, which has provided consulting services to a variety of industry clients as well as the Office of the National Coordinator at HHS. Brian sits on the Consumer Technology Workgroup of the HIT Standards Committee which makes recommendations to the National Coordinator on standards, implementation specifications, and certification criteria for the electronic exchange and use of health information consistent with the implementation of the Federal Health IT Strategic Plan. Brian is a founding Board member of DirectTrust, and also serves on the Board of HIMSS Oregon and Q-Life., an intergovernmental agency providing broadband capacity to the region. Brian helped found Gorge Health Connect, Inc. (GHC) a health information exchange organization in the Columbia River Gorge where they implemented one of the first Direct Project pilots. Brian worked at Mid-Columbia Medical Center for eleven years, most recently as Health IT Evangelist. He served four years as a City Councilor in The Dalles, Ore., and on the Board for Mid-Columbia Council of Governments. Brian helped develop the Oregon strategic and operational plans for implementing State-Level HIE under the State Health Information Exchange Cooperative Agreement. After the plan was approved by the ONC he was appointed by the State of Oregon Health Information Technology Oversight Council (HITOC) as Chairperson of the Technology Workgroup responsible for developing a framework and providing input for technology goals, including deliverables and objectives, standards, and definition of central services. Brian has worked on a number of workgroups and committees within the Standards and Interoperability Framework and continues to work on the Direct Project.

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