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Latest meaningful use delay both expected and baffling

Delay, delay and delay again.

That seems to be the implementation option of choice for the federal government’s healthcare IT policy in recent years.

It’s hard to see exactly what forces pushed the Centers for Medicare and Medicaid Services to finalize its latest proposed delay on the eve of the 2014 Labor Day weekend: putting off stage 3 of meaningful use until 2017 and allowing providers to use 2011 certified EHRs for stage 2 attestation this year instead of 2014 certified EHRs, which was the original plan.

Previous 2014 postponements have included two abrupt moves last spring, when Congress forced CMS to delay ICD-10 until Oct. 1. Prior to that, at HIMSS CMS announced it would grant meaningful “hardship exceptions” to providers that showed their EHR vendors aren’t ready, which let providers collect their EHR incentive checks without attesting to stage 2, judged on a case-by-case basis by federal authorities.

The recent move was slammed by, among others, two heavyweight groups not normally known for sharing the same side of an argument – the College of Healthcare Management Executives (CHIME), and the American Medical Association.

So who likes this deferment?

Not athenahealth Inc. of Watertown, Mass., which like many of its cloud-based EHR vendor peers, makes attesting to meaningful use central to its marketing strategy, and whose customers all are in prime position to attest to stage 2 by the end of the year, according to company executives. The company was certified in June 2013 for stage 2.

“Most people are generally kind of glad the delay went into effect, but we’re not happy about it,” said Matt Hoenigsberg, athenahealth product marketing manager. “It actually just punishes the people who were ahead of the game.”

Hoenigsberg asserted that vendors with cloud offerings – such as athenahealth, CareCloud, eClinicalWorks LLC, Practice Fusion, Inc. and CureMD Healthcare – can develop software more nimbly than their traditional software counterparts. It’s considerably easier and faster to upgrade to current certification standards. So when meaningful use is delayed or rules governing the use of certified EHRs are loosened, traditional software vendors get a break and cloud vendors lose their competitive edge.

Basically, the delay allows providers who were unable to upgrade to 2014-certified software this year to still use their 2011-certified software to do the easy stage 1 meaningful use measures, which mainly involve collecting patient medical information.

And it excuses these organizations and practitioners from the tougher patient engagement measures such as using electronic referrals to third-party providers and getting patients to view, download and transmit secure messages on patient portals.

As for the 365-day meaningful use reporting period still mandated for many providers next year if they want to avoid CMS penalties, it was one part of meaningful use where CMS stood firm and didn’t delay or defer previously established timelines.

Most players in the industry anticipated that, though it would be safe to say they were disappointed. The alternative was a 90-day reporting period like 2014’s, which offered breathing room for implementing 2014 certified EHR upgrades.

It might not be the end of the delays, as CMS and the Office of the National Coordinator (ONC) of healthcare information technology leaders head into the coming months of the Obama administration’s lame duck-dom.

Healthcare provider CIOs have to wonder, however as they plan budgets and purchasing decision for 2015 and beyond, what toll these delays are taking on the program, and if they are diluting it. After enough delays, looming above all of the procrastination could be a more serious specter: The future of meaningful use itself.

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