Thrill is gone as meaningful use strains

'I’m telling you, it’s really, really hard out here.'
By Diana Manos
09:27 AM
Stressed man placing head and hands on table

It seems just about everybody has a gripe or two concerning the meaningful use program: software vendors that make electronic health records systems, hospital CIOs, the very people charting the related committees and, of course, physicians.

Whether that means it’s time to trim the EHR program’s sails, turn the boat around, or abandon ship entirely is becoming a matter of increasingly winded debate.

And product certification is perhaps fanning those arguments more than any other aspect of meaningful use now.

Nitty gritty: ONC workgroups

Workgroup members from the EHR development sector, providers, certifying bodies, federal officials and others gathered for an all-day hearing Wednesday, followed by a workgroup brainstorming session Thursday. The intent was to draw up recommendations for the larger HIT Policy Committee and ultimately the Office of the National Coordinator for Health Information Technology.

Wednesday’s hearing quickly broke down into a gripe fest and finger-pointing about the difficulty of managing the achievement of meaningful use Stage 2, from every facet of the process.

[See also: Stage 2 off to a slow start.]

Policymakers drew heat from everyone for driving the program too quickly and with too much prescriptive action to be realistic. In return, policymakers argued they are only making the regulations in accordance with the HITECH Act.

Certification bodies, meanwhile, complained they have been left without a compass to discern the gray areas of EHR product features. And vendors took heat for “not listening” to their clients and for “taking too long” to develop certified software. EHR makers, in return, bemoaned the constant changes and limited time the government has given them to fully develop, test and train providers to use their products.

And healthcare CIOs’ emotions ranged from frustration to anxiety.

"I’m telling you, it’s really, really hard out here," said Virginia Lorenzi, associate manager of information services at NewYork- Presbyterian Hospital.

Physicians, for their part, argued that they are the ones trying to practice medicine under the burden of all the overwhelming requirements and difficult-to-use products designed piece-meal as standards and requirements are handed down.

Others contend that all the various factions involved have never been together in the same room to help explain the difficulties to one another. The idea of using the Kaizen process to bring stakeholders together to consider the “entire certification supply chain” all the way through auditing was evoked.

[See also: The man against meaningful use.]


“Do we even need certification at this point?”

That question came up several times. Since the original intent of certification was to encourage adoption and some workgroup members said that has already reached something of a natural tipping point.

Deputy national coordinator Jacob Reider, MD, disagreed. Ongoing certification is required to give physicians and hospitals the security they need when purchasing products.

Another category of stakeholders, those organizations that develop proprietary EHRs — some of the most innovative participants in the entire meaningful use process — expressed utter frustration and pointlessness in the certification they are required to attain even though the in-house EHR will never to be taken outside their four walls.

A majority of those testifying and workgroup members agreed that policymakers should scale down the meaningful use program and reduce some of the unneeded complexity, focusing instead on getting interoperability off the ground.

“Meaningful use is not the ultimate goal; it’s not the end,” said John Berneike, a family physician and clinical director at St. Mark’s Family Medicine, in Salt Lake City, pleading for increased simplicity and calling for a broader view. “It’s the means to an end.”

Indeed, ONC’s workgroup on Thursday ultimately approved two major recommendations they plan to present for consideration at ONC’s next meeting.

The first is to take a holistic look at the certification lifecycle, from testing through audits, to determine how best to make the process a more streamlined, coordinated, timely, and feedback-oriented one, wherein all stakeholders can contribute to continuous improvement.

And secondly, “we want to address the overwhelmed feeling by everybody in the process, and [find] ways to look at the scope,” said Paul Tang, MD, who presides over the workgroup. Limiting the program could help with jammed timelines and tight resources. The group is recommending the scope be honed to interoperability, clinical quality measures and privacy and security.

“These,” Tang added, “are two very potent recommendations.”