Washington Debrief: Fed Mid-Year Update: Few Providers Attest to MU Stage 2

May 28, 2014
Only four Eligible Hospitals and 50 Eligible Professionals have attested to Stage 2 Meaningful Use as of May 1, 2014. An additional 26 Eligible Hospitals and 175 Eligible Professionals attested to Stage 1 in 2014.

Mid-Year Update Reveals Few MU Stage 2 Attestations 

Key Takeaway: Only four Eligible Hospitals and 50 Eligible Professionals have attested to Stage 2 Meaningful Use as of May 1, 2014. An additional 26 Eligible Hospitals and 175 Eligible Professionals attested to Stage 1 in 2014. 

Why it Matters: This snapshot gives CIOs a sense of where their peers are in the journey towards achieving Meaningful Use in 2014. A November 2013 CHIME survey indicated that roughly 15 percent of CIOs expected to attest to MU Stage 2 by the end of Q2; in reality, fewer than 1 percent of hospitals have attested in 2014. Policymakers will now shift their attention to July, when the results of Q3 attestation are released. 

During the May meeting of the Health IT Policy Committee, officials from the Office of the National Coordinator (ONC) and the Centers for Medicare & Medicaid Services (CMS) provided their usual “data review” on the EHR Incentives Program and related metrics. Based on questions from the April meeting, CMS provided breakdown information on the number of hospitals and physicians who had attested to Stage 2 Meaningful Use. As of May 1, only four hospitals and 50 physicians had attested to Stage 2. Stage 1 attestations using 2014 Edition EHRs included 26 hospitals and 175 physicians, CMS data indicated. These numbers reflect how hospitals are faring, nearly eight months into the fiscal year, leaving them less than 60 days to be Meaningful Use-ready. Hospitals must implement and be positioned to meet Meaningful Use thresholds by July 1 to collect 90 days of data to attest in October. Physicians, meanwhile, have until October 1 to gather 90 days of data. 

According to historic data, some 3,800 hospitals should be expected to attest in 2014. With a total of only 30 hospitals having successfully attested to MU Stages 1 and 2 in fiscal 2014, this represents less than 1 percent of the total number of U.S. hospitals. For physicians, the picture is worse: 0.1 percent of physicians have cleared the hurdle in 2014. 

It remains to be seen if CMS will heed industry calls for more time and flexibility, or if they are willing to gamble on a strong Q4 finish, aided by hardship exceptions.

EHR Certification Process Gets Stakeholder Spotlight 

Key Takeaway: The Health IT Policy Committee will consider two proposals meant to address concerns about ONC’s EHR certification program. 

Why It Matters: ONC is considering ways to leverage certification beyond what’s required for Meaningful Use. However, industry stakeholders believe the process is overbearing and assures little about EHR product performance. 

EHR certification is meant to provide “assurance to purchasers and other users that an EHR system offers the necessary technological capability, functionality and security to help them meet MU objectives and measures. Certification also gives providers and patients confidence that the electronic HIT products and systems they use are secure and can work with other systems to share information.” This ONC description of their certification program was called into question last week, as the Certification and Adoption Workgroup heard testimony from providers, vendors, accrediting organizations and testing bodies. The first panel consisted of six providers, including Cletis Earle, CIO at St. Luke’s Cornwall Hospital in New York. Mr. Earle described the complexity of updating inpatient EHRs on the timelines dictated by Meaningful Use. “Because our EHR ties in with dozens of other systems,” he said, “a relatively small patch can translate into hundreds of work-hours. Since receiving certified code, we’ve had updates as large as 60 thousand lines of code, and this has happened more than once.” Virginia Commonwealth University Medical Center CMIO Colin Banas echoed similar concerns. “The biggest challenge with the current certification program includes that there is virtually no guarantee that a certified EHR product will result in a clinician’s ability to meet MU requirements, especially veteran users of this technology with years of pre-existing customization and concrete workflows,” Banas said in his testimony. 

As a way to address these and other concerns, advisors to ONC suggested that a kaizen-style gathering to focus on the process and implementation of EHR certification is needed. They also suggested certification focus only on quality measurement, interoperability and privacy/security as a way to simplify the outcomes sought. The recommendations now will advance to the full Health IT Policy Committee for feedback and approval. 

FTC Conducts Hearing on Patient-Generated Data

Key Takeaway: The Federal Trade Commission (FTC) conducted a hearing called “Spring Privacy Series: Consumer Generated and Controlled Health Data” to better understand both consumer protections and competition in the health IT marketplace. 

Why It Matters: As patient engagement increases and remote monitoring technologies become more prevalent, companies and agencies need to be prepared to deal with privacy and security concerns from multiple agencies, including the FTC. 

According to a Roll Call article, de-identifying patient information was one of the main privacy concerns discussed by the panel. To de-identify data, medical facilities must take out all information that could identify one person. De-identified data can be used for research for purposes such as population health or genetics. Panelists also discussed fitness and health apps that share information with third parties, Consumers often record their personal habits and share personal information in apps, which potentially put protected health information at risk.

CHIME Questions Value of Voluntary 2015 Edition Certification 

Key Takeaway: CHIME joined several industry voices in recommending ONC reconsider its proposed rulemaking schedule and scope. The pace of regulation in health IT policy has outstripped the industry’s capacity to absorb changes, the nation’s CIOs said. 

Why It Matters: ONC is looking to develop an extensible pattern of rulemaking for EHR certification that addresses needed bug fixes, incorporates emerging standards and identifies areas for future software development work. If ONC chooses to forego or limit the 2015 Edition proposed rule, industry will need to prove it can accomplish these goals without regulation. 

Earlier this year, ONC proposed a voluntary 2015 Edition EHR certification update, describing the agency’s vision of an extensible certification policy approach that addresses technological deficiencies in currently certified products; incorporates findings and emerging standards; and identifies areas for future software development work. 

In comments submitted to ONC last week, CHIME noted its support of these goals as part of federal certification, but questioned the breadth and timing of this NPRM. “The pace of regulation in health IT policy has drastically increased in the last five years,” CHIME noted. “This trend is resultant from the nearly $30 billion Medicare and Medicaid EHR Incentive Program, and its associated timelines – not necessarily in response to market failures or deficiencies in healthcare technology.” 

CHIME recommended that ONC move forward with plans to investigate 2017 Edition criteria further and reconsider the more incremental, periodic updates to CEHRT Editions envisioned in this NPRM after the 2017 Edition is deployed for Stage 3. Further, CHIME encouraged ONC to develop a process to identify “bug fixes” in the future through an open, transparent process, such as hearings conducted by the Health IT Standards Committee, which can be regularly convened to provide periodic updates less frequently than the NPRM proposes.

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