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Meaningful Use is On the Ropes

Posted on May 9, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

We’re entering a really interesting and challenging time when it comes to meaningful use. We’ve often wrote about the inverse relationship between incentive and requirements that exists with meaningful use. As meaningful use stage 2 is now becoming a reality for many organizations and EHR vendors, the backlash against it is really starting to heat up.

If you don’t think this is the case, this slide from the HIT Policy Committee presentation says it a lot when it comes to organizations’ view of meaningful use stage 2.

Meaningful Use Stage 2 Attesatation - May 2014

For those that can’t believe what they’re reading, you’re reading it right. 4 hospitals have attested to meaningful use stage 2 and 50 providers as of May 1st. Certainly it’s still relatively early for meaningful use stage 2, but these numbers provide a stark contrast when you think about the early rush to get EHR incentive money during meaningful use stage 1.

This article by Healthcare IT News goes into many of the strains that were seen in the HIT Policy Committee. Sounded like the healthcare IT version of Real Housewives. However, the point they’re discussing are really important and people on both sides have some really strong opinions.

My favorite quote is this one in reply to the idea that we don’t need EHR certification at this point: “Deputy national coordinator Jacob Reider, MD, disagreed. Ongoing certification is required to give physicians and hospitals the security they need when purchasing products.”

Looks like he stole that line from CCHIT (see also this one). What security and assurance does EHR Certification provide the end user? The idea is just so terribly flawed. The only assurance and security someone feels buying a certified EHR is that they can get the EHR ID number off the ONC-CHPL when they apply for the EHR incentive money. The EHR certification can’t even certify EHR to a standard so that they can share health data. EHR Certification should go away.

I’m also a huge fan of the movement in that committee to simplify and strip out the complexity of meaningful use. I wish they’d strip it down to just interoperability. Then, the numbers above would change dramatically. Although, I’ve learned that the legislation won’t let them go that simple. For example, the legislation requires that they include quality measures.

No matter which way they go, I think meaningful use is in a tenuous situation. It’s indeed on the ropes. It hasn’t quite fallen to the mat yet, but it might soon if something dramatic doesn’t happen to simplify it.

Meaningful Use Dropout Rate At 17 Percent

Posted on July 2, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

In theory, once a provider achieves Meaningful Use and picks up their first check, one might think that they’re on board and ready to power through the program. Well, think again.

According to a piece published in HIT Consultant, 17 percent of providers who got an $18,000 EMR check in 2011 didn’t get the second $12,000 incentive payout in 2012.  The stats come from a recently published analysis of the federal April EMR attestation data crunched by Wells Fargo.

What that means, in real terms, is that 17 percent of providers were able to demonstrate MU for the 90 days required in 2011 but couldn’t keep things up for the full year required for to get the second check, notes Evan Steele, CEO of EMR firm SRSsoft, who authored the article.

You’d think that providers could have demonstrated a year’s compliance, given that after 90 days they already had the needed workflows in place to support those requirements, but for nearly 20 percent of providers, it seems that simply wasn’t the case, Steele says. And this is very bad news, he suggests:

A 17% loss rate in any business is wholly unacceptable, and this failure does not portend well for the future of the EHR Incentive Program. If $12,000 proved to be insufficient motivation for physicians with meaningful use experience to meet the relatively low requirements of Stage 1 on an ongoing basis, it would be foolish to expect physicians to muster the wherewithal to meet the increasingly demanding requirements of Stage 2. The incentive for a year’s performance at that point will be a mere $4,000.

Thinking that perhaps the 17 percent dropoff trend will correct itself as time passes?  Probably not. As Steele points out, another survey recently found that 14 percent of physicians who attested to Stage 1 already say that they don’t intent to attest to Stage 2.

As Steele sees it, this is evidence that we need to simplify Meaningful Use rather than making it increasingly complex, while focusing on interoperability across the entire healthcare system.  In his view, if we don’t “the entire program will go down the drain.”

I don’t know if these numbers are evidence that Meaningful Use is on the skids, but a 17 percent dropoff is certainly troubling. Clearly something must be done to reach out to providers who’ve climbed off the train.

Intermediaries for Meaningful Use Stage 1 – Prime Opportunity?

Posted on September 6, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

John’s recent post about ONC trained participants finding it difficult to find jobs struck a chord. A different post over at HIMSS had me thinking in overdrive.

Dr. Noam Arzt has a post on Meaningful Use and public health reporting. In it he discusses the problems faced by providers in submitting health information to public health bodies in ways that are also Meaningful Use Stage 1 compliant.

Health records in provider offices are sometimes stored in disparate silos that are cannot/do not communicate with one another. As Dr. Arzt explains with an immunization records example, there is no demonstrable Meaningful Use if an uncertified system makes the data submissions to public health.

Of course, adding additional functionality to the EHR system with a simultaneous revamping of uncertified system to provide Meaningful Use share data with one another is one (costly) solution. Getting the secondary data system certified is another one. A third approach, which Dr. Arzt touches on, is for Health Information Exchanges to act as/provide for certified intermediaries that bridge the data flow between an uncertified system and one that is Meaningful Use certified.

Here’s what HHS had to say about the subject a month ago:

If an intermediary performs a capability specified in an adopted certification criterion and a provider intends to use the capability the intermediary provides to satisfy a correlated meaningful use requirement (submission to public health according to adopted standards), the capability provided by the intermediary would need to be certified as an EHR Module

This intermediary need can be filled, especially by innovative software vendors or those looking to break into the EHR IT industry. From plain data conversions to web services, IT companies have plenty of tricks up their sleeve to assist HIEs. The technology is there, all we need are savvy techies (companies, people) to see the opportunity this presents and act on it.

Stage 2 Meaningful Use Delay Raises Questions

Posted on June 10, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

This week, federal policymakers gave providers and hospitals a welcome break in complying with Stage 2 Meaningful Use requirements. The Health IT Policy Committee has voted to delay the implementation of Stage 2 for one year, from 2013 to 2014.

The delay, which is relevant for eligible providers and hospitals that already qualified for MU incentives this year, is a welcome reprieve. Since final rules for Stage 2 aren’t likely to emerge until June 2012, many would have missed their deadlines, something that even the Policy Committee admitted.

Now, the matter of getting Stage 2 rules finalized moves to CMS, which will review the draft recommendations and issue final rules. Nobody’s sure what will happen if the agency doesn’t meet the expected deadline in mid-June, but I guess we’ll just have to wait and see.

In the meantime, as blogger Jim Tate correctly notes, the move raises many questions.

For example, will this decision slow down the implementation of Stage 3 MU rules?  Will eligible providers/hospitals actually take advantage of the delay, or get bogged down and burn through the extra time?  If the eligible providers that qualified in Stage 1 stay there for three years will they only get two years of incentives based on meeting those rules?

I would add a few other questions as well:

* Will those providers who qualified for Stage 1 incentives find adopting Stage 2 to be a reasonable, incremental change or a big leap? Is even an extra year enough to make the needed HIT and process changes necessary to meet this goal?

* Over the next two years, will some providers find that it will cost more to meet the added requirements than they’re getting from the government?

* Will the Policy Committee and other federal officials be able to sell Meaningful Use to newly-arriving providers for 2012, or will there be a revolt of some kind?

I suppose you can see from my questions that a) I suspect hospitals and providers would be unlikely to adopt MU-type features on their own and b) that I don’t know if the government’s existing carrot-and-stick approach can keep  them interested.

Honestly, I’ve always been skeptical that a template-like approach like the MU regs is likely to produce the kind of rich data and improvements in care quality that backers hope. I believe there are better ways to foster smart use of the EHRs the government has demanded.

After all, if requiring certain process changes worked seamlessly, they’d work even without digital medicine, and the whole MU issue would be moot. (The EHR system would support those super-cool care processes rather than being replete with specific features set up as proxies for quality care.)

But maybe I’m being a Luddite or a troglodyte or whomever you are when you’re skeptical that something new works. What do you think?

 

5 Ways Meaningful Use Will Change Your Practice

Posted on March 29, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I love the title of this post since it uses the word change. People when they see change start to get really concerned. For some reason we don’t generally like change. We often like it after the fact, but rarely want to engage in change. I’ll be the first to tell you that implementing an EMR requires change. Anyone who tells you otherwise probably has something to sell you. Certainly some EMR require more change than others, but they all require a change.

The American Medical News put out an interesting article discussing what they said would be 5 ways meaningful use will change your practice. Here’s their 5 ways and my commentary on each of the items:

Patients will be more involved in their care – Certainly meaningful use has some requirements that encourage the sharing of clinical information with the patient. I expect in future meaningful use stages we’ll see even more sharing of the clinical information with the patient. However, I don’t really see this sharing as translating to a more involved patient. Tons of people miss incorrect charges on their bank account and credit card statements and they have all that information. I’m sure the same will happen as patients get access to this information. Many won’t care to look and many of those that do look won’t have much of an idea what they’re looking at.

With this said, there is a general movement to the active and involved patient. Combine the easy access to health information (good and bad information I might add), the easy social interactions amongst patients (ie. asking your friends on Facebook), and other changes we see in society and the patients will be more involved going forward. I just don’t see meaningful use being a huge driver for this.

Doctors will find it easier to see how they’re doing – Ummm…this seems way off base to me. First, because it’s pretty hard to define “how they’re doing.” So, it makes it hard to talk about. Let’s just focus on the meaningful use measures. Does anyone really think that tracking the meaningful use measures is going to make a doctor better at what they’re doing? Can they really be used to measure how well a doctor is doing? I guess I just don’t think meaningful use is the right “report card” for doctors.

Physicians will collaborate more with other doctors – Stage 1 definitely does little to help this happen more efficiently. We’ll see if stage 2 or 3 takes it much farther. Although, if stage 3 takes it too far, I imagine many will opt out of showing meaningful use for stage 3 since the payouts are so small at the end of the EHR incentive money.

Long term, having an EMR will facilitate collaboration and information sharing amongst doctors. However, we don’t have the highways for that information built yet.

Physicians will pinpoint practice inefficiencies – This feels a little like the second one to me. However, it’s worth also pointing out that I think it would be a very difficult argument to make that meaningful use somehow makes a practice more efficient. I could certainly make an argument (which I’m sure many would love to argue against) that an EMR can make a clinic more efficient, but not meaningful use.

Physicians will need a firmer grip on data security – MU stage 1 has little HIPAA requirements and I don’t expect MU stage 2 and 3 to change that. There are some privacy and security requirements in the EHR certification that try and take data security and privacy in an EMR to the next level. Also, the HITECH act has provided some “teeth” to the enforcement of HIPAA which it never had before. I still think we need a few more clinics to get “bitten” by it to really understand what the requirements are going to be and how they’re going to enforce it.

Screwed Up Meaningful Use (at least for specialists)

Posted on January 24, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I regularly get passionate emails from readers of EMR and EHR (and of course my other site EMR and HIPAA. I don’t always agree with the emails, but I almost always find them interesting. The following is one such email. It wasn’t intended to be published, so excuse the format. However, I find much of the comments about ONC’s approach to specialists spot on. The hard part is that I think ONC realizes this as well. The question is whether ONC in meaningful use stage 2 is going to do anything to address the specialist problem. I think this is a topic we need to voice to ONC.

The EMR’s basically started with certification requirements from CCHIT…ONC took that starting point…and moved to MU from it…without regard to specialty. Properly done, they should have started with MU by specialty…then figured out what the product certification requirements should be from there—for that specialty: Orthopedic guys see lots of patients (50-70 per day, and lose two days/week to surgery), mostly NEW patients with specific problems (broken bones or joint replacements)…no big longitudinal charts…and need to dictate complex notes; Dermatologists have lots of lab/biopsy tests, need to draw pictures and annotate them, not dictate; Pediatricians need growth charts and long medical histories and trends; Oncologists need detailed treatment histories, dosages, outcomes; Ophthalmologists need lots of technical data, measurements and interfaces to optic devices. Yet ONC made a set of rules that really only apply to Primary Care…which is where much of the CHRONIC conditions (and a large portion of the medical cost issues) are quarterbacked…and have the best chance of prevention.

Besides…all the data from specialists should flow back to the PriCare docs anyway…why try to keep it coordinated in both places? I think we have a long way to go to get all healthcare “communitized”…and powers that be need to recognize how different things are for various specialties…and define MU from each specialty’s point of view…and find out that the current certification standards are WAY overkill for most of them…unnecessary complexity and, thereby, cost….to do the irrelevant things to qualify for incentives. After five years, they will stop doing those things anyway, when incentives run out. Having a data pathway between in-patient and out-patient (ambulatory) is a great goal…that should come first..the ability to share data…even if via documents. That could be done today. Trying to devise interoperability standards for 400 EHR’s, a dozen or so major Hospital-based vendors…and registries, labs and other participants….that is a LONG way from being reality

Will be interesting to see how the “success stories” pan out this year starting in May for EP’s. Thank goodness ONC has made it almost impossibly easy for specialists in Stage I….they can opt out of almost everything required and get incentives the first 2 years($30k)…is that a good use of taxpayer money?

Great Chart Comparing Meaningful Use Stage 1 with Stage 2 and 3

Posted on January 21, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today I came across this really great chart that compares the meaningful use stage 1 requirements with the proposed requirements for meaningful use stage 2 and 3. The comment period is still open for meaningful use stage 2 and 3 so make your voice heard.

Here’s the roadmap as described by John Halamka:
Jan, 12, 2011: release draft Meaningful Use criteria and request for comment
Feb-March, 2011: analyze comment submissions and revise Meaningful Use draft criteria
March, 2011: present revised draft Meaningful Use criteria to the HIT Policy Committee
2Q11: CMS report on initial Stage 1 Meaningful Use submissions
3Q11: Final HIT Policy Committee recommendations on Stage 2 Meaningful Use
4Q11: CMS Meaningful Use NPRM

See the comparison chart embedded below.