To forge ahead or hold back – that was the question

In March, the big question weighing on the minds of policymakers was a crucial one: Wait, or move ahead on Stage 2 of meaningful use?

Professional organizations that represent CIOs and other information technology managers and staff were weighing the pros and cons of slowing down or keeping up the pace. The answers weren’t easy to come by – indeed they seemed to be different for everyone.

The College of Healthcare Information Management Executives, with 1,400 CIO members, had called for delaying the move to Stage 2. But in a statement released in February, the Healthcare Information and Management Systems Society (HIMSS), which counts 30,000 individual members – many of whom are also members of CHIME – urged providers to act.

“We believe that every institution is on its own different schedule,” said HIMSS President and CEO H. Stephen Lieber. “Every institution needs to make their own decisions based on their strategic plan.

“We feel confident in the regulatory support and funding here and now,” he added. He suggested that implementation delays would expose providers to inherent risks of the unknown.

CHIME saw the move to Stage 2 in a slightly different light.

"CHIME believes that it would not be prudent to move to Stage 2 until about 30 percent of (eligible hospitals and providers) have been able to demonstrate EHR MU under Stage 1," CHIME leaders wrote in a Feb. 18 letter to the Office of the National Coordinator for Health Information Technology.

"Hospitals and physicians are going to continue to need flexibility as we enter Stage 2," said Pamela McNutt, senior vice president and CIO of the Dallas-based Methodist Health System and chairwoman of CHIME's Policy Steering Committee. "Measures being introduced for the first time should be part of a menu set to allow providers to focus on those that best match their operational goals."

"Although most CIOs take the lead in deploying and encouraging optimization of information systems, our primary goal is to help introduce and manage change in our organizations," said David Muntz, chairman of CHIME's Advocacy Leadership Team. "The change management implications of our current environment have never been greater, hence our interest in finding certainty and practicality whenever possible. Even well-intended efforts must recognize that the staff and physicians need a clear vision of the future and time to absorb and adjust to the changes."

“There is no rationale for delaying this, but hospitals and providers need to accomplish implementation within their timeframe,” said Lieber. “We have to remember why we’re doing this. Stay true to your mission of delivering high-quality care. In the end, you must make the decision that is right for your healthcare organization and your patients.”

“We believe the time to act is now – the nation needs better quality care and greater cost-efficiencies,” he added. “Health IT is a powerful tool to achieve this transformation. Let us not waste this opportunity – for our patients and for our future.”

Meanwhile, the American Health Information Management Association (AHIMA) was urging the ONC to emphasize the use of a standard suite of terminologies and classifications in meaningful use requirements.

“AHIMA believes it is time for ONC and the HIT committees to address the governance of standard vocabularies, including terminology and classification, that are or should be requirements for the ARRA-HITECH meaningful use program as well as other HHS regulations, including HIPAA and various uses such as quality measurement, public health, research, reimbursement and policy making,” wrote Dan Rode, AHIMA’s vice president of policy and government relations, in a Feb. 25 letter to the ONC.

The Premier healthcare alliance, whose members include more than 2,500 hospitals and health systems, has urged the ONC to evaluate the success and challenges that emerged during Stage 1 when refining the criteria for Stage 2 – something essential to ensure that hospitals have a more concrete idea of where the program is heading, said Blair Childs, Premier’s vice president of public affairs, in a Feb. 25 letter.

Premier specifically underscored 18 issues impacting its members, including e-prescribing, menu versus core requirements, clinical quality measures, use of clinical decision support, single-source reporting for eligible providers and patient access to Web-based portals.

The American Medical Group Association, a trade association representing multi-specialty medical groups, also expressed concern that the timetables may not allow enough time for vendors to respond appropriately with upgraded products, nor allow eligible professionals enough time to implement and train on these products.