Saying requirements are moving too fast, vendors and providers gave policymakers looking for feedback an earful about the electronic health record (EHR) implementation process and the aggressive timeline for meeting Stage 1 meaningful use criteria.
During hearings held Jan. 10 and Jan. 11 by the Implementation Workgroup of the Health IT Standards Committee, hospital and physician representatives mostly praised the efforts of regulators for devising steps that will lead to greater use of health IT. Nevertheless, many also expressed frustration with what they see as inadequate communication and foggy instructions from officials as the five-year EHR Incentive Program begins.
It is clear that practices are still struggling with the acquisition stage and are light years away from meaningful use of any kind.
Tricia Marriott, director of reimbursement advocacy, American Academy of Physician Assistants
"When adopted in the right spirit, [meaningful use] can produce some of the clinical benefits of EHRs that providers lose sight of in the course of the painful transition away from paper," said Robert Murry, medical director of informatics at Hunterdon Medical Center in Flemington, N.J., in his testimony before the committee, which is part of the Office of the National Coordinator for Health Information Technology (ONC).
"The committee needs to understand and keep in mind the time scale of health care IT projects," Murry said. "This is not like upgrading a Web browser. … It is more like upgrading the engines on an airplane while it is flying."
The Centers for Medicare & Medicaid Services is planning to roll out even more tools to help providers through the process, including Web-based videos, technical sheets and an interactive application that can show whether a provider will meet eligibility before it submits criteria, said Robert Anthony, health insurance specialist at CMS. That agency and ONC share oversight of the EHR Incentive Program, and officials from the two organizations were on hand during the hearing to listen to the experiences of early EHR adopters.
The feedback will help ensure that policymakers are on the right track for stages 2 and 3 of the meaningful use rollout, Anthony said. "Where do we go beyond just collecting information?" he asked. Officials are currently seeking comments on proposed Stage 2 meaningful use criteria.
Eligible hospitals and providers can begin demonstrating they are meeting Stage 1 criteria this year to receive incentive payments. The CMS has already produced a 2011 timeline for registering and attesting to meaningful use criteria.
UPDATE: Time not healing wounds from meeting meaningful use criteria
While providers say communication with policymakers has improved, their sentiments about the meaningful use timeline are widely unchanged.
Speaking in early May, four months after his original testimony to the standards committee, Murry said IT initiatives and the efforts to boost adoption of electronic health records are unaligned.
"When people were dissatisfied with how Stage 1 is phrased from CMS and ONC, it’s because there was not enough information," he said. "Now, since the CMS website is becoming easier and more user friendly, it’s not a question of communication but a question of implementation between the vendor and enterprise."
Murry added ONC has made strides to ease the process. That said, he wasn't too quick to dish out compliments, nor did he place burden on the organization. A balance among provider accountability, provider initiative and the importance of the provider and vendor relationships is needed, he said.
Still, achieving meaningful use and making the appropriate adjustments in workflow will be difficult, according to Tricia Marriott, a physician assistant and director of reimbursement advocacy for the American Academy of Physician Assistants (AAPA).
In an email to SearchHealthIT.com, Marriott said adoption goes beyond just purchasing EHR systems. "It is clear that practices are still struggling with the acquisition stage and are light years away from meaningful use of any kind," she said. "Additionally, meaningful use is a behavior, not just the purchase of certified technology. So, once the acquisition stage has been completed, the hard part begins; adaptation to a change in process and workflow is tough on human beings."
Marriott said there's so much information that it can be difficult to digest, and scaling down the initiatives would be helpful.
"With all of the different incentive/penalty (payment adjustment) programs going on, consolidating the reporting would certainly be welcomed," she said. "Every program has a somewhat different structure, attestation vs. claims vs. registry. Timelines are all over the place. Practices need a whole team of staff just to keep up."
A similar reaction was expressed by Dr. Kevin Lanphear, president of the Newburyport (Mass.) Family Practice. He contends a number of providers will be scrambling.
"It is what it is," he said about the reality of the deadline. "What Stage 1 has done is distracted practices and halted health information exchange. Everyone has to focus more on the criteria of meaningful use, and that slows down the progress of larger projects."
On the other hand, Lanphear feels that the Stage 1 deadline will not accomplish CMS' mission statement, which is to increase the use of EHR systems for the majority of physicians nationwide. He took aim at ONC and CMS for whom they targeted in terms of stressing EHR implementation, saying that timing played a key role.
"Most of the physicians reaching meaningful use appear to be the folks who previously implemented EHRs prior to the parameters being announced," he said. "The providers they are trying to reach now are those offices that have not previously implemented EHRs. Those are the doctors who are not aligned with major medical centers and are in more rural settings."
In particular, Murry showed concern for the 41% of physicians surveyed who think they’ll get the meaningful use incentive in 2011. He believes a large fraction will find that they're unable to adopt and will have to wait until 2012 because of the sizeable infrastructure changes that accompany EHR implementation. While there are clinical benefits in achieving the criteria in the program, there's still ambiguity on the number of providers able to achieve meaningful use.