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Advocacy groups register comments on definition of meaningful use

In their comments on the definition of meaningful use and on the electronic health-record incentives set by the Centers for Medicare & Medicaid Services, advocacy groups affirm their support but propose stipulations.

Vendors, physicians and health care IT leaders got their say about the trials and tribulations of addressing meaningful use criteria, implementing electronic health record (EHR) systems, and promoting interoperability among proprietary data systems at the HIMSS10 annual conference earlier this month. Consumer advocates got their turn earlier this week -- the last day to register public comments with the Centers for Medicare & Medicaid Services (CMS) about the proposed rule for meaningful use.

Some 20 consumer advocates, including the AARP, Consumers Union and the National Partnership for Women & Families, signed a set of comments on the meaningful use criteria that affirmed their support for the definition of meaningful use. They also proposed that more stipulations be added to the definition, including:

• Recording the presence or absence of an advance directive for all Medicare beneficiaries.

• Surveying patients about their experience with hospital care before and after EHR adoption.

• Cutting the amount of time hospitals and physicians have to grant electronic access to a patient’s information (including diagnostic test results, problem list, medication lists and allergies) from 96 to 48 hours after an office visit or hospital admission.

• Offering an electronic version of the instructions a patient being discharged from a hospital receives.

Christine Bechtel, vice president of the National Partnership for Women & Families, who also serves as representative for patients and families on the federal Health IT Policy Committee, said in an audio conference that she hopes CMS will not weaken the criteria for meaningful use despite the many reservations registered in comments from workers in the field of health care.

“The purpose of incentive payments in the meaningful use rules is not to reward and reinforce the status quo or the simple digitization of paper records,” Bechtel said. “Congress clearly intended the [EHR] incentives to support advancements in quality, safety [and] efficiency, and reduce disparities in both health and care.”

The consumer advocates also made specific recommendations to tighten security and privacy rules for meaningful use, calling for hospitals and physicians to conduct a Health Insurance Portability and Accountability Act risk analysis on their handling of patient data before they receive certification. Furthermore, they were careful to spell out that they meant a baseline analysis, and that hospitals and physicians not just produce a review of their past performance with HIPAA compliance. Reviews, the comments said, “should only be for those entities that have recently conducted a security risk analysis and have not added new [health IT] capabilities.”

The purpose of incentive payments in the meaningful use rules is not to reward and reinforce the status quo or the simple digitization of paper records.

Christine Bechtel, vice president, National Partnership for Women & Families

The consumer advocates recommended that CMS require providers that have completed a risk analysis to document how they filled the security holes they uncovered. The advocates also asked CMS to spell out in its final meaningful use criteria what it intends when it requires health care providers to “implement security updates as necessary” -- not leave updates to the provider’s discretion. Finally, they recommended that CMS revoke a provider’s meaningful use certification when it is found guilty of HIPAA violations.

Paul Cotton, AARP senior legislative representative, said he felt the draft meaningful use criteria were pretty much “on track.” He said that physicians who view EHR incentive payments as entitlements are way off base.

“It’s not something they should just expect; they need to improve the way they deliver care in order to receive them,” Cotton said. “[The incentives] are funded through one of the largest outlays of taxpayer dollars in health care in recent years. The people who are funding the incentives -- the public -- need to see clear benefit if this is to be a successful program and we get the return on our investment from these taxpayer and Medicare trust fund dollars.”

Regina Holliday, whose husband’s death from cancer last year inspired her to become a patient-focused advocate for EHRs, likened the transition to electronic record systems to the retail industry’s implementation of bar code scanners.

“During that first year, yes, it’s challenging when you get a computer system that helps you with your business -- yet I don’t know of any business who would go back to the way it was before,” Holliday said. “The ability to aggregate data -- and make decisions based on that -- changes everything.”

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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