Federal officials this week recommended easing the burden health providers will bear as they adopt health IT and follow meaningful use criteria, but the deadline for implementing changes remains aggressive.
At its Feb. 17 meeting, the federal Health IT Policy Committee accepted suggestions from its meaningful use workgroup that will allow providers some flexibility as they comply with the criteria that define how health IT should be used. In the last month, the health care industry has been submitting comments on the proposed rule outlining those criteria that was released in December by the Centers for Medicare & Medicaid Services. The meaningful use workgroup’s recommendations to the policy committee will be included in comments that the committee will submit on the proposed rule.
There are 28 criteria in the first stage of the meaningful use proposed rule. Providers must begin next year to implement health IT and demonstrate they are using it according to those criteria if they want to qualify for incentive payments under the American Recovery and Reinvestment Act of 2009 Hospitals and doctors have expressed concern that the number of criteria they are expected to meet -- and the timeline for implementation -- make compliance challenging.
Under the policy committee recommendations, providers will be able to defer compliance on some meaningful use criteria until the rule’s second stage, but only within specific categories. There will be no flexibility regarding the privacy and security criteria, nor regarding the criteria related to patient and family engagement.
In addition, providers will be able to defer compliance on three of the proposed rule’s quality measures. Under the committee’s recommendations, providers will not be able to defer the use of computer physician-order entry (CPOE) systems, electronic prescribing and the maintenance of demographic information. In addition, providers may defer one care coordination measure, as well as one population health criterion.
While most committee members agreed that some flexibility would help providers concerned with the pace and level of health IT adoption required to meet the meaningful use criteria, they still believed some-- such as keeping personal health data private and secure, and ensuring patients are involved with their care decisions -- were too important to be deferred.
In addition, if providers don’t hit 100% compliance but manage to reach a high level of adoption in some criteria, they should be recognized for that effort and not be penalized financially, some said. “We set such a high bar,” said Gayle Harrell, a former Florida state legislator who sits on the policy committee. Without some flexibility on meeting measures, “we still stand in the way of the goal we want to accomplish.”
Those recommendations were part of a broader presentation by the meaningful use workgroup, which also tried to clarify that entering clinical orders through a CPOE system must be done by “authorizing providers,” a phrase that caused concern among committee members.
We set such a high bar … we still stand in the way of the goal we want to accomplish.
Gayle Harrell, Health IT Policy Committee member and former Florida state legislator
Marc Probst, CIO of Salt Lake City-based Intermountain Healthcare, and another member of the policy committee, said there could be some confusion about the term “authorizing providers.” It might refer only to a patient’s doctor, who is not always the professional making decisions about care. “There are workflows embedded now that allow for ordering outside the physician,” he said during the committee’s Feb. 17 meeting.
That term also could be confusing in academic settings, Harrell said. There are medical students, residents and attending physicians caring for patients; and the issue becomes a clinical decision support question -- for example, determining who needs to see alerts and make decisions about orders entered in the CPOE system.
Paul Tang, a physician who is vice president and CIO of the Palo Alto Medical Foundation and co-chair of the meaningful use workgroup, said the term isn’t meant to circumvent workflow processes. The point is to ensure that providers in authority positions have the opportunity to see any alerts or other decision support tools that involve their patients.
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