The mood was hopeful as 2014 dawned. "This is the year," said Robert Tagalicod, director of the Office of E-Health Standards and Services at the Centers for Medicare & Medicaid Services, speaking in February at a HIMSS14 in Orlando as the industry prepared for the kick-off of Stage 2 meaningful use attestations.
But as the months wore on, some of that initial enthusiasm began to wane. And as paltry attestation numbers continued to disappoint, before long some industry groups were wondering whether unreasonable federal expectations were threatening the very future of meaningful use.
In this slideshow, we look back on a year of Healthcare IT News stories, tracking the twists and turns of a program that turned out to be much harder to comply with than providers and the government anticipated.
Well before any official statistics were available, Healthcare IT News contributor Neil Versel reported that anecdotal evidence was suggesting that this new phase is off to a slow start.
"Healthcare providers, EHR vendors and other health IT industry insiders have identified several pain points that seem to be hindering the migration from Stage 1 to Stage 2," he wrote. "Notably, providers have to juggle multiple healthcare reform efforts simultaneously and are struggling with Stage 2 requirements to engage and educate patients."
Moreover, vendors were grappling with tight timelines to bring their EHRs up to snuff for Stage 2, he wrote, and were unclear about new testing for usability. Any delay on the vendor side naturally makes achieving meaningful use more difficult for their customers."
Editor-at-Large Bernie Monegain spoke with former National Coordinator for Health IT David Blumenthal, MD, one of the architects of meaningful use. He said Stage 2 was the pivotal moment for the program.
Despite some early frustration, Blumenthal said he took a "long view" of MU's success. “The consequences of that digitization of information in a reasonably systematic way, guided by meaningful use, will have enormous, difficult to predict, and generally positive effect on the American health system over a generation to come,” he said. “That’s my view of it. I know that physicians find certain aspects of meaningful use problematic. Some find it too aggressive. Some find it not aggressive enough. But, I still think it was a reasonable way to proceed, and we’ll see the results over decades.”
With just 3 percent of eligible hospitals and 1 percent of eligible providers having attested to Stage 2 by the summertime, it began to sink in just how tough a slog Stage 2 would be for many providers – especially when it came to problematic measures such as view/download/transmit of patient data and electronic transmission of care summaries.
July's batch of attestation numbers were better than June's, but still far from a smashing success. Elisabeth Myers, policy and outreach lead at CMS' office of e-health standards and services, pointed to another set of numbers, spotlighting the progress CMS and has made in getting eligible providers and hospitals to register for meaningful use.
"We are hovering just under 95 percent," Myers said of eligible hospitals and "just under 92 percent" of eligible providers.
"I do want to point out this is registration and registration is required to participate, so many providers register their intent and it may take them a little longer to get to meaningful use," she added. "But it's a great indicator of the depth of knowledge about the (meaningful use) program."
As one of the first organizations to successfully attest to Stage 2, tiny, rural Cottage Hospital, located in Woodsville, N.H., had some lessons to offer other providers.
"I didn't really know what to expect when I came into it," said Rick Frederick, chief information officer of the 25-bed critical access hospital. "That said, I wasn't expecting the challenges that we did in fact encounter."
CMS put forth a new final rule for Stage 2 meaningful use Aug. 29 that it said offered hospitals and physicians more "flexibility" for attestation. For one thing it offered providers the opportunitiy to use the 2011 Edition of certified EHR technology or a combination of 2011 and 2014 Editions.
"We listened to stakeholder feedback," said CMS Administrator Marilyn Tavenner said.
"CHIME is deeply disappointed in the decision made by CMS and ONC to require 365-days of EHR reporting in 2015. This single provision has severely muted the positive impacts of this final rule. Further, it has all but ensured that industry struggles will continue well beyond 2014," said Branzell.
"Millions of dollars will be lost due to misguided government timelines," said Branzell. "Now the very future of meaningful use is in question.
In a pointed letter sent to HHS Secretary Sylvia Matthews Burwell on Sept. 15, a who's-who of industry stakeholders complained of "immediate concerns" about their members' ability to continue meaningful use participation.
Co-signed by alphabet soup of groups – CHIME, HIMSS, MGMA, AHA, AMA and more – the letter reiterated what many of them were shouting from the rooftops since CMS published its Stage 2 final rule in August: the success of meaningful use "hinges on addressing the 2015 reporting period requirements.
As long as CMS continued to insist on a 365-day reporting period, the organizations said they were "incredibly concerned" about the "forward trajectory" of the MU program.
The very next day after those industry groups implored HHS to reconsider its Stage 2 requirements, a bi-partisan bill was introduced on Capitol Hill, aiming to offer providers some relief.
Republican North Carolina Congresswoman Renee Ellmers introduced H.R. 5481, The Flexibility in Health IT Reporting (Flex-IT) Act of 2014, on Sept. 16. Co-sponsored with Democratic Utah Rep. Jim Matheson, the legislation is crafted to offer providers more flexibility in showing meaningful use compliance.
Specifically, according to Ellmers' office, it would remedy HHS' "short-sighted final rule" requiring 365 days of EHR reporting in 2015.
"(I)nstead of working with doctors and hospitals, HHS is imposing rigid mandates that will cause unbearable financial burdens on the men and women who provide care to millions of Americans," said Ellmers. "Dealing with these inflexible mandates is causing doctors, nurses and their staff to focus more on avoiding financial penalties and less on their patients."
A new batch of still-disappointing attestation numbers led several industry groups to once again implore CMS to shorten the meaningful use reporting period in 2015.
CMS numbers released Nov. 4 showed fewer than 17 percent of U.S. hospitals demonstrating Stage 2 capabilities; worse, fewer than 38 percent of eligible hospitals and critical access hospitals had met either stage of meaningful use in 2014.
Officials from the AMA, CHIME, HIMSS and MGMA issued a joint press release to reiterate their concerns: The numbers are "disappointing, yet predictable," they wrote, and called again for CMS to offer more leniency to help address providers' widespread difficulty in meeting federal electronic health record requirements.
"Meaningful use participation data released today have validated the concerns of providers and IT leaders," said CHIME President and CEO Russell P. Branzell. "These numbers continue to underscore the need for a sensible glide-path in 2015.