The dangers of getting “bogged down” in HITECH Regulations & Schedules

At a time when healthcare IT professionals are inundated with new regulations, new mandates and the ongoing goal of implementing the most effective and affordable technologies for their medical clients, stakeholders should guard against the dangers of getting bogged down in the details.

Rather than getting mired in regulatory compliance, healthcare IT providers should address the opportunities these new regulations create, said Dr. Harry Greenspun, chief medical officer at Dell Perot Systems, speaking at a the Nashville Health Care Council on Jan. 20, 2010. Sub-committee members at the Health IT (HIT) Policy Committee on Feb. 17 reinforced those comments. The purpose of the meeting was to review comments from sub-committees about the Dec. 30, 2009, HIT Policy Committee’s Notice of Proposed Rulemaking (NPRM) for the Electronic Health Records (EHR) Incentive Program for Medicare and Medicaid.  According to the timeline, Stage 1 implementation of the criteria for meaningful use begins 2011.

The Dec. 30 NPRM outlines standards without implementation specifications, said Paul Egerman, co-chair of the Adoption/Certification Workgroup. Detailed specifications are not included under the rulemaking, and the healthcare industry and related entities are starting to form their own conclusions creating a proverbial Tower of Babel.

Attendees also raised the ongoing question about Certification Commission for Health Information Technology (CCHIT) certification. The issue is complex due to administrative laws that ensure a competitive process and grandfathering CCHIT certification is extremely complex, noted Jodi Daniel, Director, Office of Policy and Research, Office of the National Coordinator for Health IT, HHS.

The NPRM also requires eligible professionals (EPs) to include significant amount of structure data, but lacks an exchange standard for EHR systems to receive this structure data, warned Deven McGraw, chair of the Health Information Exchange Workgroup. For example, EPs will report a percentage of EHRs with structured laboratory data. However, hospitals and local labs handle 75% of test results. The NPRM does not impose a requirement on hospitals to send structured laboratory data. Even when standards are specified, they are ambiguous and do not provide the clarity required to motivate vendor innovations, said McGraw. Another challenge: The present Health Level 7 (HL.7.2.51) exchange format used by the healthcare industry, which is not compatible with web-based Software-as-a-Service (SaaS) applications using the popular XML format. HL.7 was approved by the Healthcare Information Technology Standards Panel (HITSP) which ended it work on Jan. 27.

Gayle Harrell, committee member and former Florida State legislator, voiced a concern about the governance of state health information exchanges (HIEs). The standards for inter-operation of the nationwide HIE are in development said David Lansky, chair of the NHIN Workgroup. Provider authorization directories will be built upon existing federal standards, policies and practices. These directories will allow providers and related entities the ability to route information to the intended participants, Lansky said.

The first stage of implementation is scheduled to occur in 2011. However, release dates for additional NPRMs were not discussed at the committee meeting and will require a 60-day comment period.

Gayle Harrell asked Paul Egerman if the metrics required will be overwhelm EPs. Physicians get visiting rights to incentives money which then goes to the vendor, said Egerman. These challenges discourage early adaption, according to a discussion with two New York City EPs. Instead, the EPs will take a wait-and-see position.

It’s not the first time healthcare IT professionals have voiced concern. Healthcare has far to go in technology adoption. Small physician practices provide the majority of care, but their adoption of electronic health records hovers between 5% and 10%, Dr. Brad Perkins, executive vice president for Strategy and Innovation and Chief Transformation Officer, at Vanguard Health Systems during the Nashville meeting on Jan. 20, 2010. “We look at the healthcare industry and say, ‘It’s not working,’” noted Perkins. “Yet more than most industries, it is all about information — getting the right information to the right person at the right time.”