EHR certification relief on the way

CMS proposed rule would also extend MU timelines
By Tom Sullivan
05:32 AM
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Healthcare providers and IT vendors just got a dose of welcome relief from the increasingly controversial certification pieces of meaningful use in the form of a proposed rule the Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health IT jointly circulated on Tuesday.

The rule would "change the meaningful use timeline and the definition of certified electronic health record technology," the agencies wrote.It would also change the requirements for reporting clinical quality measures for 2014.

[See also: EHR certification criteria under fire.]

The relief appears to be arriving none too soon.

"Vendors aren't ready, no subject matter experts are available to implement upgrades," said Mandi Bishop, president of FloriDATA Foundation, and a self-described hardcore data geek and patient engagement advocate. "Products aren't fully-baked. Providers are frustrated."

Just last week at an HIT Policy Committee workgroup certifying bodies, healthcare providers, and vendors alike — expressed fears and frustration over the complexity of Stage 2 and complained about the lack of guidance from ONC.

[See also: Fear and loathing in meaningful use.]

The proposed rule would "provide eligible professionals, eligible hospitals and critical access hospitals more flexibility in how they use certified electronic health record technology to meet meaningful use," the agencies explained, by letting “providers use the 2011 Edition CEHRT or a combination of 2011 and 2014 Edition CEHRT for the EHR reporting period in 2014."

Reacting to industry group and vendor comments, public forums and listening sessions, the agencies acknowledged that the time between the final Stage 2 rule and the certification deadline was impracticably short.

"We understand, based on information gained from EHR technology developers and ONC-Authorized Certification Bodies on timing, backlogs, and the certification case load, many EHR products were certified later than anticipated, which has impacted the corresponding time available to providers – especially hospitals – to effectively deploy 2014 Edition CEHRT and to make the necessary patient safety, staff training, and workflow investments in order to demonstrate meaningful use in 2014," CMS and ONC wrote. 

CMS and ONC also incorporated a provision into the proposed rule to formally extend Stage 2 through 2016 and start Stage 3 in 2017. 

"The agencies have proposed a new model for the remainder of 2014 that should go a long way toward relieving some of the time crunch eligible professionals and hospitals are experiencing, and help them continue the march toward meaningful use of EHRs and healthcare transformation," said Tom Leary, HIMSS vice president of goverment relations, he said in a statement, adding that questions remain about how the meaningful use timeline changes would affect participating providers, especially eligible hospitals.

The College of Healthcare Information Management Executives, which represents 1,400 CIOs,  is also onboard with the proposed rule.

"If the government acts quickly to finalize the proposed rule, it will provide the flexibility needed for our members and their organizations to adequately optimize newly deployed technology and ensure success of the program," said CHIME President and CEO Russell P. Branzell, in a news release. He added that CHIME members are concerned that the timing of these changes may not afford hospitals a chance to take advantage of the proposed flexibility.

Pundits and industry associations have been calling for changes to the meaningful use timelines and requirements for months now and dire predictions have arisen recently suggesting many providers would opt out of Stage 2.

"An analysis of CMS' own data, which does not include the entire year of 2013, shows a 20 percent drop-out rate in the MU program," American Medical Association CEO James Madara, MD, wrote in a letter to ONC chief Karen DeSalvo, MD and CMS Administrator Marilyn Tavenner last week. "We expect this to grow substantially unless the all-or-nothing approach is removed."

The changes in this proposed rule won’t last forever. Rather, CMS explained that beginning in 2015, eligible hospitals and professionals must report using a 2014-certified EHR – but did include a phrase suggesting even that could change in the future.

"We are proposing this change for 2014 only," they wrote in the rule. "We will maintain the existing policy that all providers must use 2014 Edition CEHRT for the EHR reporting periods in 2015, and in subsequent years or until new certification requirements are adopted in subsequent rulemaking.”