Meaningful use requirements could be too much
WASHINGTON – As members of the HIT Policy Committee debated the proposed Stage 2 meaningful use regulations on April 4, many expressed concerns that the rules would require eligible providers to collect data for too many measures.
That burden poses problems from the start, said some committee members, noting that the cost of $10,000 per measure for physician practices to have their certified electronic health record systems updated makes the 120 proposed new measures unreasonable.
There was also concern that the measures are being collected, but won’t be used by the federal government for some time, if at all, to improve public health.
National Coordinator for Health Information Technology and Committee Chair Farzad Mostashari, MD, agreed. Collecting data that’s not going to be used seems pointless, he said. The federal government needs to connect data collection with the elimination of disparities to show providers “why we’re doing it,” he said.
Paul Tang, chair of the Meaningful Use Workgroup, said Wednesday’s discussion of the proposal was only a start. The workgroup would consider feedback from the entire committee and return with updated recommendations for the group’s approval at the HIT Policy meeting on May 2. The group’s approved recommendations were due to Mostashari by May 7, Tang said.
The proposed meaningful use Stage 2 rule was released Feb. 23, with the comment period closing in May. The government is expected to release a final rule this summer. The meaningful use rules are used to qualify eligible Medicare and Medicaid providers for federal incentives for electronic health record adoption.
David Lansky, chair of the committee’s quality measures workgroup, said his group was somewhat satisfied with the proposal. A number of the measures recommended by the workgroup made it into the proposed rule.
“We feel good about the framework,” he said of the Stage 2 proposal. “We want to continue to advocate the right framework, but of course, the question now is how to accelerate the ability to use this framework in common care settings.”
On the down side, Lansky said the workgroup did not think care coordination is adequately addressed by the proposal. Members also thought “the availability of some of the measures is pretty thin.”
Very few providers would have cases that would allow them to collect the specified data. “It doesn’t apply to very many physicians,” Lansky said. “We’re not going to be able to see a lot of measured improvement around care coordination if this is the best we’re able to do over the next three years.”
In addition, Lansky’s workgroup frowned on the proposed use of check boxes for physicians to acknowledge they’ve captured data.
Tang agreed. The strength of electronic health records is that they allow data collection to be automated, he said. Using the checkbox method runs counter to that. “If it’s not automated, you’ve just added more work to every doctor’s life.”
“Adding what is possible to what is feasible is an important part of this conversation,” Tang said at the end of the meeting. He anticipated discussion around the measures to be even more intense at the May meeting.
He also stressed urgency. “If we can’t get a move on, we won’t make this happen," he said. "We’re not going to have these measures until four or five years from now. It just takes that long.”