Will They Lower the Bar?

April 11, 2013
Mark July 16 on your calendar. It could be a very interesting day. That's when the Meaningful Use workgroup of the HIT Policy Committee makes public the next draft of its advice to the Office of the National Coordinator on the definition of meaningful use. A lot is at stake.

Mark July 16 on your calendar. It could be a very interesting day. That's when the Meaningful Use workgroup of the HIT Policy Committee makes public the next draft of its advice to the Office of the National Coordinator on the definition of meaningful use. A lot is at stake.

ONCHIT's proposed rule will be published by the end of the year and will be implemented by the Centers for Medicare and Medicaid Services.

Yesterday I attended two virtual meetings featuring members of the HIT Policy Committee. The first, a regular meeting of the National eHealth Collaborative, featured Paul Tang, M.D., chief medical information officer at the Palo Alto Medical Foundation. The second, a webinar put on by the eHealth Initiative (eHI), included Christine Bechtel, vice president of the National Partnership for Women and Families.

Both made strong cases for why the committee proposed an aggressive timeline for reporting clinical data from EHRs and for including patient access to health data in the definition. When pressed during Q&A sessions, neither felt it was appropriate to comment yet on how the workgroup's second draft might be influenced by the public comments from healthcare organizations and feedback from federal agencies, although Tang and Bechtel noted that ONCHIT has received more than 900 comments.

Although not all of those comments are public, it is clear that there is widespread concern that very few physicians and hospitals will be able to meet the criteria the first draft established for 2011.

For instance, the American Hospital Association said its members, including those with significant previous HIT investments and CPOE, consider a 2011 CPOE requirement to be unrealistic.

Many comments also have stressed that the timeline for giving patients access to electronic health data is too aggressive and needs to be scaled back. They basically see patient access as the last step in a successful implementation process.

The AHA also noted that "the expected release of a final definition will be past the 2010 budget cycle for most hospitals — making the definition proposed for 2011 unmanageable. A rush to implement the draft definition, combined with the lack of capital and personnel, could result in many hospitals choosing not to, or being unable to, participate in the incentive program."

In fact, during the eHI webinar, Michael Shabot, M.D., chief medical officer of the Memorial Hermann Healthcare System in Houston, said that even a huge organization like his, which has spent almost 10 years and more than $100 million on EHR implementations, would have trouble reporting all the quality information the first draft proposed in its Meaningful Use Matrix. "In our current state, we could not meet the 2011 objectives as outlined," he said.

Part of the problem, he continued, is that the meaningful use measures are ill-defined, and he went through a few examples from the matrix, asking how his hospitals would determine what the denominator population is in equations about percentages of patients getting certain types of treatment.

Shabot also noted that the physician practices his organization is helping implement EHRs are very patient-focused and not set up to do this type of statistical reporting. But even in his hospital setting, which is incredibly computerized, a larger issue is that the quality reporting Memorial Hermann does now often involves manual data abstraction because the systems in place do not have the hooks built in to report on those quality measures.

Joseph Heyman, M.D., Chair of the Board of Trustees of the American Medical Association, also spoke at the eHI webinar. He said physicians have to be confident that if they make the investment in health IT, they will be able to meet the criteria. He stressed that any physician who had no idea how to start on automation would look at the first draft's criteria and feel that finding products to make that possible by 2011 is an insurmountable challenge.

Heyman said AMA suggests starting at a much more rudimentary place in 2011 to get greater acceptance going in.

The eHI webinar's moderator, Lou Diamond, M.D., vice president and medical director for Thomson Reuters Healthcare, began the session with two questions that loom large:

1. How much will the public comments affect the committee's decision-making process?

2. What will happen if very few providers are able to meet the definition of meaningful use once it is established?

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