An advisory panel is wrestling with competing visions of how bold to make measures for the next stage of meaningful use of electronic health records (EHRs). Time limitations underlie many of the tensions in deciding their 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 month of the proposed rule for establishing accountable care organizations (ACOs) 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, according to Dr. Paul Tang, 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?]
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.
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"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.
Tony Trenkle, acting CIO at the Centers for Medicare and Medicaid Services, said that the health reform law will provide many approaches to achieve similar goals as meaningful use, including ACOs and the national quality strategy.
"These other levers, alone or combined with meaningful use, can accelerate change," he said.
[Related: CMS: Want ACO savings? Start with meaningful use.]
Dr. Neil Calman, a committee member and CEO of New York's Institute for Family Health, said that ACOs will become a dominant force even if just a portion of providers who say they will participate do so.
"The ACO movement is going to eat meaningful use for lunch," he said, saying meaningful use is limited in time and funding by comparison.
Health information exchange for care coordination, and not just for the sake of exchange, will be critical in ACOs, he said. For example, it's not enough just to share a patient's lab results, but "have we talked with each other about what our plans are for the patient," he postured.
Dr. Farzad Mosashari, the newly-appointed national coordinator for health IT, said that meaningful use offers a path to ACOs.
"To communicate with providers that meaningful use is a way to get a jumpstart on what you're going to need to do to be successful as an ACO is very compelling," he said at his first meeting as committee chair.
To further fine tune its recommendations, the policy committee will adjust its recommendations based on the experience of providers in stage 1. CMS will open its attestation system for providers April 18.
Over the next several months, CMS will capture how providers' experience is playing out and how that might affect timing, Trenkle said.
Tang doesn't believe demonstrations of experience will come from "the little guy" but from providers who were already there.
"That's why we're in the situation of having to act before we have the data that we'd like to have," he said.