To delay or not to delay?

Stage 2 deadlines trigger anxiety
By Diana Manos
12:00 AM
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The Health IT Policy Committee, an advisory panel to the federal government, was divided over the start date for Stage 2 meaningful use requirements, voting 12-5 June 8 to delay Stage 2 by one year – from 2013 to 2014.

Since its inception in 2009 under the American Recovery and Reinvestment Act, the EHR Incentive Program has been fraught with controversy over timing, which some claim has been too difficult a hurdle for most healthcare providers to achieve, despite one extension already granted.

The American Hospital Association, CHIME and several other professional associations called on the committee to delay Stage 2 until results of Stage 1 have been adequately assessed.

In May, HIMSS called for shorter reporting periods in Stage 2, but not for a delay.

Carla Smith, HIMSS executive vice president, noted that since the inception of the HITECH Act in 2009, HIMSS has "supported the concept of graduated complexity of meaningful use that recognizes the varying degrees of maturity of adoption and implementation of health IT that serve as the foundation for healthcare transformation.”

As summer waned, and fall took hold. The vendors who found Stage 2 EHR certification much more challenging than Stage 1, had gone through the hurdles and received the stamp of approval from the certification bodies. Not only that, but ONC chief Farzad Mostashari, told all not to hold their breath for a delay.

"I think folks should assume that the timelines stick," Mostashari said Oct. 9 in a keynote address to CIOs at CHIME’s fall forum.

Health IT Policy Committee member Marc Probst, CIO of Salt Lake City-based Intermountain Healthcare, was one who had voted for more time. "Much more time," he said. Probst would like to see Stage 2 delayed later than the proposed recommendation of 2014.

"Essentially, we have people in a ski race who were three-quarters of the way down the hill," Probst said. "We have to help people at the top of the hill. It's going to be difficult to get people (to EHR adoption)," he said. "It just is."

Intermountain Healthcare is one of the front-runners in the nation to use EHRs to successfully improve population health. At the end of September, Intermountain’s senior executives, including Probst announced the health system would roll out a Cerner system to replace the institutions home-built EHR.

Judith Faulkner, founder and CEO of Epic had reservations over the proposed 2014 start date. "If we don't know how long it will take vendors to do the work, we don't know how long it will take for providers to get up and running," she said.

For Stage 1, federal advisors relied on "giving signals" to vendors throughout the planning process. This was intended to help vendors get underway with what would be needed in EHR products, so they could be ready for providers when the time came.

But some of the signals didn't end up in the final regulations. Faulkner said signals that ended up being false cost vendors thousands of dollars to correct later. "We might be feeling good about giving signals, but those receiving aren't so good with that," she cautioned.

Faulkner also had concerns over the amount of time it would take doctors to meet the proposed requirements in the course of their day. Doctors are already challenged to find enough time to spend with patients, she said.

Neil Calman, MD, president and CEO of the Institute for Family Health was adamant about moving forward as planned. "This program is not a subsidy program. It doesn't subsidize HIT adoption," he said. "We have a responsibility to use these funds as incentive dollars. If we're not accelerating the process, then we don't need to put all these dollars on the table."

Calman said the market is, of its own accord, moving rapidly toward EHR adoption, fueled by patient expectations. Time is of the essence, he warned. Too many medical errors are taking patients' lives for lack of EHRs.

Paul Tang, MD, chair of the committee's Meaningful Use Workgroup, and vice president and CIO at the Palo Alto Medical Foundation, said the group's recommendations are merely advice. The federal government will ultimately decide on the timing and criteria of Stage 2.

Tang said he would like to see the group get started as soon as possible on Stage 3 recommendations, expected to begin in 2015, but with no specified start date. In addition, the federal government could create a Stage 4 for meaningful use incentives, should it choose to do so, Tang said.

ONC released a draft proposal for Stage 2 criteria in mid-January of this year and accepted public comments through Feb. 25. The advisory committee is making changes based on those comments and expects to issue final recommendations this summer. CMS will issue a final rule on Stage 2 meaningful use by June 2012.