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Republican Congress could spur meaningful use slowdown

CIOs think needed changes to meaningful use may happen with a Republican Congress, but health IT advocates fear trouble with ONC in disarray.

The midterm election near sweep that gave Republicans control of both houses of Congress could help move a CIO-inspired meaningful use reform bill, as it elevates a leader of the Senate GOP "Reboot" group critical of meaningful use.

Meaningful use was already under the gun before the elections, and the election results will likely intensify that trend, according to health IT legislative specialists.

The Democratic administration's program was facing a growing backlash among CIOs and leaders in most sectors of health IT, who had coalesced in fall 2014 to demand that CMS and ONC back off from what many doctors and hospital executives saw as too demanding a pace.

CHIME sees positive impact

"The near-term impact is, just by virtue of a balance of power shift, that it created new opportunities for old ideas," said Jeff Smith, director of public policy for CHIME (College of Health Information Management Executives). "Now we might have an audience in the Senate that just might be willing to address problems in the administration of the meaningful use system and how the regulations have been written."

Meanwhile, turnover and instability at ONC, as well as diminishing funding in the past two years of the Obama administration, have further weakened the agency, according to health IT advocates.

"The cost of the interregnum at ONC is that they have been unable to decide where to focus their energies and that's unfortunate," said David Harlow, a Boston lawyer and health IT blogger who served on ONC's Health IT Standards Committee.

In late 2014, ONC has appeared to shift its main focus -- under pressure from industry groups that are backing a bill to slow down meaningful use -- to interoperability. Meanwhile, despite low stage 2 attestation numbers, ONC officials have maintained that meaningful use is still moving toward stage 3.

The "Flex-IT" bill being promoted by CHIME and others would return the stage 2 attestation period to 90 days from the 365-day period currently in the regulations.

CHIME hopes Flex-IT bill will pass

Smith said the two best hopes for the bill are either to pass it quickly in the lame-duck Congress before next year's lawmakers are seated, or to attach it to a bigger vehicle such as the sustainable growth rate policy bill, the so-called SGR Medicare payment "patch." That measure, which usually comes before Congress in March, includes language that in effect would mandate interoperability between EHRs by 2018, and is an example of the older ideas that Smith referred to.

Or, Smith said, CMS officials could back off the meaningful use pace on their own.

It's about maintaining the momentum, about what stage 3 will look like.
David HarlowHealth IT attorney and Healthblawg author

"I'm still optimistic that CMS and leaders at HHS will make the same calculations," Smith said.

As for the Reboot crew, one of the group of six Republican senators, Lamar Alexander of Tennessee, is expected to become chairman of the Senate's influential Health, Education, Labor and Pension Committee, POLITICO reported. Four others are returning to the Senate, and only one is retiring.

Health IT advocates worry about ONC

Harlow also maintained that former ONC coordinator Karen DeSalvo, M.D., who is technically not running day-to-day operations of the agency but still overseeing it as she works on the U.S. Ebola response as acting assistant secretary for the Department of Health and Human Services (HHS), "consolidated out of existence" some valuable functions when she streamlined ONC in June.

"The patient piece was lost," Harlow said. "So what happens down the line? It's about maintaining the momentum, about what stage 3 will look like. For me, what's more interesting is what is after stage 3."

Janice McCallum, a health IT social media consultant who helped run the 2014 HealthCamp conference in Cambridge, Mass. with Harlow, credited ONC with prodding the healthcare industry to adopt electronic health records, but a weakened ONC won't kill progress in health IT.

"ONC is not the only part of HHS interested in care coordination," McCallum told SearchHealth IT during the recent HealthCamp session. "If it weren't for ONC, we wouldn't have EHRs, but I think the core of that will probably die down."

Let us know what you think about the story; email Shaun Sutner, news and features writer, or contact @SSutner on Twitter.

Next Steps

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