CHIME airs "critical concerns" about EHR incentive program

By Molly Merrill
11:17 AM
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The <a href="/directory/college-healthcare-information-management-executives-chime" target="_blank" class="directory-item-link">College of Healthcare Information Management Executives filed its comments regarding the EHR Incentive Program with the Centers for Medicare & Medicaid Services on Friday. The comments address what the Ann Arbor, Mich.-based organization calls "critical concerns" regarding the proposed regulations that were unveiled on December 30, 2009.

The organization, which has 1,400 members representing chief information officers and other top information technology executives at many of the nation's largest hospitals, coordinated efforts with other industry organizations, such as the American Hospital Association, to thoroughly research key concerns and reach a consensus on responses that provide guidance on how to successfully roll out the incentive program, said officials.

"We wanted to make our position known on the proposed regulations," said Pamela McNutt, senior vice president and CIO at Methodist Health System, Dallas, and a chair of CHIME's policy steering committee.

CHIME comments address what it calls "critical concerns" regarding the proposed regulations governing the meaningful use of EHRs, as well as parts of the regulation document for which the industry needs clarification.

"We expect that our views will prove useful to other organizations developing comments and will foster alignment of comments to CMS," said David Muntz, FCHIME, senior vice president and CIO at Baylor Health Care System, Dallas.

One of CHIME's primary concerns is that the regulations outline an "all-or-nothing" approach to defining and achieving meaningful use that is too ambitious, doesn't take into account the need for flexibility by providers and does not reward incremental progress.

"With an approach that rewards progress or provides sufficient time, organizations with limited resources will likely have little chance of qualifying for payments, thus widening the 'digital divide' in the country," CHIME's comments say.

In its recommendations, CHIME wants CMS to give providers until 2017 to adequately achieve all components for EHR implementation; develop an expanded suite of 34 core objectives, some of which can scale over time; use an incremental approach that would deem a provider a meaningful user if it can achieve 25 percent of objectives by 2011, 50 percent by 2013, 75 percent by 2015, and substantially all by 2017.

Contending that the "HIT marketplace does not have the capacity to support the timeframe imposed by the proposed regulations," CHIME notes that the lack of a certification approach is resulting in industry uncertainty regarding product certification and heightens time pressures that both providers and vendors are facing. CHIME proposes that the final regulations extend the time frame during which Stage 1 meaningful use objectives will be used, and it asks CMS to adopt a "grandfathering provision" under which existing EHR systems that meet meaningful use objectives be accepted as certified for two years.

CHIME's comments contend that quality reporting requirements in the proposed regulation are unrealistic at the early stages of the incentive program, and it asks for a delay in implementing quality reporting until 2012.

"While automated quality reporting is critically important to the meaningful use of electronic health records, no EHR system in use today is able to automatically report the full set of (35) proposed measures," the organization says.

CHIME also comments on specific objectives and HIT functionality measures included in the proposed regulations. The organization seeks the elimination of administrative measures, such as EHRs producing metrics on automated claims submissions and insurance eligibility.

CHIME also is making recommendations regarding computerized provider order entry, medication reconciliation, data submission to public health agencies and HIT functionality data submissions.

The Ann Arbor, Mich.-based organization is seeking:

    <li>Reconsideration of the hospital-based professional provisions of the regulations that exclude some hospital based ambulatory clinics from participating in the program.
  • Clarification of certification guidelines for EHR systems, given that "the vast majority of EHR systems are not one product but instead incorporate different systems from multiple vendors."
  • Further explanation on how the EHR Incentive Program will be administered.
  • Review of provisions regarding health information exchange, and a recommendation to develop and widely use a national patient identifier.
  • Reassessment of impact analyses that "seriously underestimate the total cost of ownership for these systems, and overstate the amount of incentive payments in aggregate that will be paid if the proposed rules are implemented."

An executive summary of CHIME's comments on the regulations can be found here. To view CHIME's letter to the CMS in its entirety, see here.