The more that healthcare providers use electronic health record (EHR) systems, the more questions they have about interoperability, optimization, patient portals and the future of the meaningful use incentive program.
The Office of the National Coordinator for Health IT (ONC) has, for that reason, spent recent weeks outlining its vision for the EHR market and, accordingly, alleviating the fears of providers wrestling the pressures of EHR implementation, the ICD-10 conversion, clinical quality measures and evolving care models.
The ONC's statements at the recent Health Information and Management Systems Society's HIMSS 2014 conference suggest both progress and pitfalls in an effort to meet what's increasingly becoming a moving target.
Government Granting Meaningful Use Amnesty to Stressed Providers
The action, as it were, began in December, when the ONC and the Centers for Medicare and Medicaid Services (CMS) announced a one-year delay in the meaningful use timeline. Stage 2, which emphasizes more advanced clinical processes, now ends one year later, in 2016, with stage 3 and its emphasis on improved outcomes beginning in 2017.
With the delay, ONC and CMS essentially admit that they understand how hard healthcare has it. After all, meaningful use represents but one of many deadlines looming over healthcare the industry:
- Providers have until Oct. 1 to make the switch to the ICD-10 code set — and the process has proven more complicated, costly and controversial than anticipated.
- Organizations participating in the Pioneer ACO Model have two years (ending in 2014) to demonstrate shared savings. The process carries so much risk that nine of the original 32 participants dropped out. (Those in the less-arduous Medicare Shared Savings Program must continue to demonstrate lower costs as well.)
- Medicare requires hospitals to reduce readmissions within a 30-day period. Those who do not face reimbursement reductions that increase each year.
- Likewise, through the Physician Quality Reporting System, eligible healthcare professionals who don't report on quality measures face a "payment adjustment" beginning in 2015.
Amid such tumult, the ONC told HIMSS attendees to expect flexibility with meaningful use stage 2 hardship exemptions. Since meaningful use and the ICD-10 conversion have already been delayed once, their deadlines won't be moved again, but CMS says it will extend an olive branch to providers who can't meet stage 2 criteria — they won't receive incentives money, but they won't be penalized, either.
'Pockets of Progress' For Healthcare IT Interoperability Rare
On the sole basis of stimulating EHR adoption, meaningful use has succeeded. The incentive program has awarded more than $20 billion to hospitals and eligible providers, or roughly all of what was allocated in the HITECH Act of 2009. According to CMS, 80 percent of eligible hospitals and 50 percent of eligible providers are participating in meaningful use. (There is no payment cap, so participants will receive what they are due.)
That said, many organizations continue to struggle with EHR usability, health information exchange, interoperability and other issues related to EHR use. Russell Branzell, the CEO of one such organization (the College of Health Information Management Executives), says the going is so tough that some organizations "are just giving up" on meaningful use because they (and their vendors) lack the resources to meet the criteria.
At a town hall meeting with ONC officials at HIMSS, providers weren't shy about airing their concerns. Most problems relate to interoperability. Far from simply linking disparate EHR systems within hospital walls, providers want to connect to pharmacies (especially for one-click prescribing), to patient portals (and not just the ones their EHR vendors offer), to affiliated institutions and to immunization registries, among other things.
It's been suggested that providers focus on interoperability "pockets of progress" — the proverbial low-hanging fruit with low costs and high ROI.
That's easier said than done. Want to connect your practice's EHR systems to an HIE entity? Expect each EHR vendor to ask for several thousand dollars to establish that connection. Want to exchange data with an immunization registry? Read up on standards — as Dr. Doug Fridsma, the ONC's chief science officer, puts it, "The good thing about health IT standards is that there are so many of them to choose from."
ONC Understands Healthcare Providers Pain
Amid the frustration, there's hope.
Dr. Karen DeSalvo, the national coordinator for health IT, says Congress is taking interest in breaking down data silos — though she admits that, when it comes to coordinating with Congress on that matter, and others, "I don't have rabbits like that to pull out of my hat."
In addition, DeSalvo says meaningful use stage 3 won't be an endpoint but, rather, the "next chapter" in a process that aims to "power forward on care transformation."
Combine that with the proposed voluntary 2015 EHR certification criteria — part guidance for vendors making EHR systems for providers ineligible for meaningful use, part request for comment on what meaningful use stage 3 should look like — and it's clear that ONC understands the frustrations that healthcare providers face.
Whether the relief will be enough, and whether the right time for it has already passed, remains to be seen.
Brian Eastwood is a senior editor for CIO.com. He primarily covers healthcare IT. You can reach him on Twitter @Brian_Eastwood or via email. Follow everything from CIO.com on Twitter @CIOonline, Facebook, Google + and LinkedIn.