Now that the comment period on the proposed meaningful use rule has ended, it is up to the Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health Information Technology to weigh the merits of those comments and develop a final rule, which is expected sometime in May or June. CIOs and EHR vendors are anxiously waiting to learn whether greater flexibility may be included in Stage 1 meaningful use requirements. On April 13, Healthcare Informatics Senior Contributing Editor David Raths sat down with David Blumenthal, M.D., the National Coordinator for Health Information Technology, in his Washington, D.C., office to discuss meaningful use and certification issues.
Healthcare Informatics: Paul Tang, M.D., vice-chair of the federal HIT Policy Committee, said the other day that people may be focusing too much attention on the $14 billion to $28 billion in electronic health record (EHR) incentive funding and not enough on the impact of the $2 billion your office is spending on other programs. Do you see it that way, too?
David Blumenthal, M.D.: Obviously, the incentive money is very important, and we shouldn’t overlook that and can’t underestimate it. If you’re thinking about changing the psychology of the market, then indeed the incentive money is the critical lever. But if one is talking about preparing providers to participate in that market, then the discretionary money is a dramatic change in what has been available before.
Another way to think about it is in terms of the identified obstacles to meaningful use. One obstacle is financial. Providers say they lack the capital to acquire and implement EHRs. The meaningful use incentives are directed at that. Another major set of obstacles is a lack of logistical support, a lack of confidence in physicians’ own ability to choose the right equipment and technical solutions, and uncertainty about how to maintain and support them. It’s those latter obstacles that the discretionary money addresses. It also addresses the issue of availability of a trained work force. In the long run, the market will probably manage that to some degree, but it won’t be sufficient. Finally, the discretionary money is the only investment we have in helping the field to go beyond adoption to optimal use, which requires a quality improvement perspective, a work redesign perspective, and a care improvement perspective.
HCI: There have been a large number of comments from groups like the American Hospital Association asking that the meaningful use criteria be simplified. Some have criticized what they call an “all or nothing” approach and ask that providers get credit for partial success. Is there a downside to doing what they ask? Would it slow progress toward health IT’s widespread deployment? Is there a compromise position that will answer these criticisms?
Blumenthal: We always knew that we were trying to achieve a balance between stretching providers and breaking them. And we knew that we would be receiving lots of comments on both sides of that issue — that is, we get comments saying that we didn’t go far enough, and comments saying we’ve gone too far. The hospital association and physician groups are more interested in this and more organized, and therefore the volume of comments tends to reflect their perspective. But we also have received lots of comments from consumer groups, industry, employers, and health plans who are urging us to be at least as ambitious as we’ve been. We’ll look at all of those and try to make a reasoned judgment on the right course to take. There are stakes on both sides. On the one hand, we want to get providers on the escalator. We want them to get started.
HCI: So what do you say to physician groups that are concerned that if many physicians try to achieve meaningful use and fail, they will become discouraged and implementation rates will fall?
Blumenthal: That may be true for some. I take a longer-term view. My view is that electronic collection, storage, management and use of information is an inevitability in the 21st century, and that the federal government is trying to speed up the inevitable. This is a fairly calculated investment by the Congress not in adoption, but in a level of use that brings benefit. We shouldn’t spend the taxpayers’ hard-earned dollars for results that don’t meet the Congress’ standard, and that standard is meaningful use.
HCI: Dr. Tang also has spoken frequently about the importance of getting clinical quality data directly from EHRs rather than from claims data. What do you say to CIOs who have indicated that the quality indicators in the first stage of meaningful use are beyond the capabilities of today’s EHRs?
Blumenthal: We know that the current generation of EHRs was not designed to produce quality data, and that without modification they won’t be able to do so. But we also know that they can do it. Vendors tell us they can. Vendors have told us they knew they could do this five years ago but they chose not to because there was no market for it. We are trying to alter the dynamics of the market. We’re trying to make a business case for the vendors to make this possible and for providers to demand it.