Federal panel wrangles over timing for MU Stage 2

April 15, 2011 | Mary Mosquera, Contributing Editor

WASHINGTON – The Health IT Policy Committee, a federal advisory panel, is wrestling with competing visions of how bold to make measures for the next stage of meaningful use of electronic health records. Time limitations underlie many of the tensions in deciding the path.

Vendors need time to develop new software and healthcare providers to install it and then report on quality measures to qualify for Stage 2 incentives.

Further roiling the mix, the release last the proposed rule for establishing accountable care organizations (ACOs) month of adds another tension because it will also rely on reporting quality measures, according to members of the Health IT Policy Committee.

To accommodate time constraints for software development, committee members explored a phased-in approach that separates existing and new functionalities, said Paul Tang, MD, committee vice chair at the April 13 meeting. He is also chief medical information officer at the Palo Alto Medical Foundation.

[Related Q&A: The good, bad, and otherwise of ACO regs.]

In 2013, providers would fulfill core meaningful use objectives, increased performance thresholds and new quality measures. In 2014, requirements for new EHR functionalities would take effect. For example, the committee's meaningful use work group has proposed new objectives for electronic prescribing for discharge prescriptions, electronic clinical progress notes and patient-provider secure messaging.

Paul Egerman, a committee member and software entrepreneur, said the meaningful use process is already complicated without changing it again.

"It's disruptive to solo practitioners' practices to change things every year. We have to be aware of other things that are going on in the industry," he said, citing the approaching deadline for adopting ICD-10.

[Related: Should ICD-10 be delayed until 2016?]

ACO concerns

If the committee only increases thresholds for the next stage of meaningful use, however, EHRs won't have the capabilities called for in ACOs and transitions of care, Tang said. "Stage 1 of meaningful use was getting data in a structured way; stage 2 is spreading it around," he said.

Deven McGraw, a committee member and director of the health privacy project at the Center for Democracy and Technology, offered that there should be alignment of meaningful use measures and those programs in the health reform law, such as accountable care organizations.

The proposed ACO rule from the Centers for Medicare and Medicaid Services incorporates quality measures, including some from the meaningful use program. The rule also has detailed some new measures related to sharing savings through coordinating patient care.

"Let's have everyone marching in the same direction rather than lighting 10 separate fires. Let's move those that are aligned and look at those others that aren't so well aligned to make some timing adjustments and based on experience," she said.

Reader Comments (2)Login to Post a Comment

EMR Diva says: Thank You

April 26, 2011 | 1:14AM GMT

Dr. Duncan thanks on behalf of most every physician I know who feel the exact same thing you are Overwhelmed!

Dr Duncan says: Timing for MU stage II

April 25, 2011 | 4:22PM GMT

""we're in the situation of having to act before we have the data that we'd like to have," he said."

That sort of says it all.

As I've commented several times before, too much, too soon, is counterproductive to the MU goals. It is souring providers to the merits of an EMR.

Surveys and polls to date are biased and inaccurate. Listen to the masses (of providers), especially to those in private practices who are the ones affected the most. They can't all be wrong. They are intelligent people.

There is a lot of preaching to the choir going on amongst those of you in charge. You've been assigned a job and you are carrying it out as prescribed. You need to stop occasionally and look at the big picture. It may raise some awareness and bring to mind some valuable questions that should be considered regarding the MU process. You need to stand up to those who have assigned you your tasks when a change in course is needed.

All of you, and I, know that the EMR is a extremely valuable tool with a huge potential but you are pushing MU down the throats of providers who don't have the same appreciation. The timing is bad. Providers are hard workers and working harder than ever trying to deal with rising costs of running a practice and decreasing reimbursements, and at the same time are challenged with increasing demands of the public, insurance agencies, quality grading by the government and private businesses, government regulations, policies, and reporting not to mention the ever looming medical legal climate. Adding the burden of MU has to be done very carefully and the course of the process has to be monitored while keeping in mind that changes may be necessary to prevent failure as a result of pushing the provider too far.

Visit some CIOs, CMIOs and physician champions in private practices whose reimbursement is based on a production model. They are incentivized to practice efficiently and productively. They have some very legitimate insights as to problems associated with the MU agenda. Over time these challenges can be overcome with a process of incorporation and evolution and with addition of younger physicians graduating from training institutions where the use of the EMR is part of the curriculum. But with the current demands in the proposed timeline you are playing with fire. What's the big rush anyway? Sure it would be nice "to have it all" tomorrow or yesterday. But don't create your own hazards and bumps in the road to success by being overzealous or blindly following orders.

Doug Duncan MD