CHIME voices concerns about meaningful use, standards regulations

By Diana Manos
10:54 AM

The College of Healthcare Information Management Executives says questions on reporting, product certification and implementation deadlines could hinder efforts to implement electronic health records under recently proposed federal regulations.

CHIME is reviewing the recently released regulations to implement healthcare information technology provisions of the American Recovery and Reinvestment Act of 2009 (ARRA). Officials said several provisions in the regulations merit closer scrutiny and could pose significant challenges for providers hoping to implement electronic health records.

"The nation's providers definitely need federal stimulus funding to offset the cost of implementing these systems, but it's important for the regulations to help hospitals in their efforts to succeed, rather than serve as impediments to success," said Tim Stettheimer, chairman of CHIME's board of trustees, a regional CIO for Ascension Health and a senior vice president and CIO at St. Vincent's Health System in Jacksonville, Fla.

The regulations face a 60-day comment period; after review, changes may be made before they become final. They will provide guidance for hospitals and their IT departments in the coming months and represent an important step toward digitizing healthcare records.

CHIME's leaders said the provisions favor a three-phase approach to measure the meaningful use of electronic health records. Through the phased approach, first-year meaningful use criteria will apply to hospitals whenever they are eligible. However, CHIME said, the current schedule places pressure on hospitals that delay in implementing EHRs because by 2015, all hospitals and eligible providers would need to meet Stage 3 criteria to avoid payment penalties.

"Adequate time to understand the impact of these new systems and to implement them are some of my secondary concerns," said David Muntz, senior vice president and CIO of the Baylor Health Care System. "My primary concern is the time and effort required to achieve successful organizational change management."

To qualify for the incentive payments in either Medicare or Medicaid, eligible providers and hospitals must use certified EHRs to meet specific objectives and report specific HIT functionality measures to the Centers for Medicare and Medicaid Services. According to CHIME, additional quality measures also will need to be submitted, and as a whole, reporting requirements will be burdensome. Many of the measures will require organizations to gather information that spans both electronic and paper-based systems, such as the percentage of orders entered through CPOE systems.

Initial reporting will be done through attestation to CMS, but that will still require hospitals to provide data on each of the HIT functionality measures. Quality reporting provisions of the regulation also will require hospitals to develop reporting capabilities, since only nine of the 35 quality measures being proposed in the regulations are used in the Medicare pay-for-reporting program.

CHIME officials said physicians will face a major challenge in using Physician Quality Reporting Initiative indicators for reporting quality data. The proposed regulations indicate that medical groups that qualify for stimulus funding no longer will be eligible for the two percent bonus for reporting PQRI data.

The regulations also stipulate that hospital-based physicians are not eligible to receive stimulus payments. CHIME officials said this could prompt healthcare systems and teaching programs to stop investing in ambulatory records systems for these physician groups.

CHIME also is concerned about the regulations' burden on providers to demonstrate that they are using certified EHR technology. To receive Medicare and Medicaid incentive payments, providers must attest to CMS that the EHR system they use meets the statutory definition of a qualified EHR and has been "tested and certified in accordance with the certification program established by the National Coordinator."

CHIME is concerned that the certification process won't be known until it is described in a forthcoming proposed rule from ONC, and that neither of the just-released CMS and ONC regulations provide for acceptance of previous CCHIT certification or allows for a transition time between when certification criteria are announced and when providers will be expected to use products certified to those criteria.

CHIME is conducting an analysis of the regulations primarily through its Policy Steering Committee, which is composed of member CIOs who will examine the proposed regulations for their potential impact on widespread implementation of EHRs.

CHIME said it plans to survey its members and seek their input on the regulations. CHIME also plans to submit public comments, and the organization encourages all concerned parties to comment on the proposed regulations as well.