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Will Meaningful Use Stage 3 Continue to Kill EHR Innovation?

Posted on July 7, 2015 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.

In my recent post on EMR and HIPAA titled “The Current EHR Reality,” L Parada, a product manager at an EHR vendor, offered this insightful and scary comment:

Looking at the 137 proposed certification requirements for MU3, I again see all innovation in 2016 slipping through the fingers of all specialty EHR companies. That stings.

I’ve occasionally mentioned that we’re finally at a more stable place with meaningful use that EHR vendors might be able to have some breathing room to innovate. Is that time frame for innovation going to be limited to 2015? Will meaningful use stage 3 ruin EHR innovation in 2016? I also don’t think that it just applies to specialty EHR companies either. That many government requirements is going to kill innovation at every EHR company of every size.

This would make me really sad. I’m tired of writing blog posts about the lack of EHR innovation. Can we just let the 300 EHR vendors get to work on listening to their customers and doing some creative solutions to really improve the efficiency of healthcare and improve doctors’ outcomes?

I think we all might feel different if we thought that the meaningful use stage 3 requirements were innovative and really pushing forward amazing initiatives that were going to transform healthcare. I don’t know anyone who really feels that way. At best they see it as a good step forward towards some noble goals. Should we kill innovation in the entire EHR industry for that?

With meaningful use stage 3 around the corner, it’s starting to feel a lot like meaningful use groundhog day. Does it feel that way to anyone else?

Meaningful Use Stage 3 Success Could Rely On Vendors

Posted on May 20, 2015 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.

Today I was reading a report on the Health IT Policy Committee’s review of pending Meaningful Use Stage 3 rules — which would ordinarily be as about as exciting as watching rocks erode — when something leapt out at me which I wanted to share with you, dear readers.

The overview, brought to us courtesy of Medical Practice Insider, noted that proposed plans for the Stage 3 rule would allow providers to attest in 2017, though attesting wouldn’t be mandatory until 2018. What this means, editor Frank Irving notes, is that it would be up to EMR vendors to be ready for providers wishing to attest a year early.

The folks overseeing this discussion, the Advanced Health Models and Meaningful Use Workgroup, seem (wisely) to have had their doubts that vendors could be relied upon to meet the 2017 deadline. At the session, workgroup members proposed a couple of alternative ways of addressing this timeline. One was to make the 2017 deadline go away, requiring instead that EMRs have full 2015 certification by 2018. Another was to allow optional attestation in 2017, but if need be, with 2014 EMR certification.

I don’t know about you, but this whole thing makes me nervous. By “whole thing,” I mean adjusting the rules to deal with the likely resistance vendors will exhibit to keeping their roadmap in synch with federal requirements.

After all, consider the history of EMR vendors’ relationship with providers. As we’ve noted, HHS has paid out about $30B in Meaningful Use incentives under HITECH without insisting that vendors provide interoperability. And what have EMR vendors done?  They’ve avoided developing shared standards for interoperability with an alacrity which amazes the eye.

In fact, some EMR vendors — including top contender Epic Systems — have been slapping providers with fees for data sharing (even if they’ve kind of dropped them for now), at prices which could leave them millions in the hole. If that isn’t dead opposite to what those in public policy hope to see happen, I don’t know what is.

Bottom line, if the good people overseeing Meaningful Use want to see Stage 3 accomplish good things, they’ll need to see to it that the new rules give regulators some leverage when it comes to controlling vendors.

As the whole sad interoperability saga has demonstrated, vendors will not take actions that advance health IT on their own. Unlike in other IT markets, where interoperability and meeting regulatory deadlines have been the signs of a winner, EMR vendors actually have strong incentives to ignore providers’ business imperatives.

With any luck, however, between tougher rules on Stage 3 and public pressure to achieve interoperability, EMR vendors will do the right thing.  They’ve certainly had long enough.

Meaningful Use Stage 3 to Come Out Before HIMSS15?

Posted on March 11, 2015 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.

Madelyn Kearns from Medical Practice Insider is reporting that we might see meaningful use stage 3 regulations before HIMSS. Here’s the exact quote from Robert Anthony, deputy director of CMS’ quality measurement and health assessment group:

“We will have two regulations that will come out in time to discuss meaningful use”

It’s hard to imagine that one of these 2 regulations will not be meaningful use stage 3. No doubt CMS and ONC will want to get some feedback from the HIMSS community on meaningful use stage 3. What better place than at the conference?

Madelyn aptly points out that Robert Anthony already has one session scheduled at HIMSS to discuss the meaningful use stage 3 requirements. I have a feeling that is going to be one of the really well attended sessions. Especially if the MU stage 3 rule does come out before HIMSS.

I realize that CMS is bound by laws on when they can announce the various rules and regulations, but I hope they’ve planned out the timeline better than they’ve done in the past. My colleague Neil Versel at Meaningful Health IT News has regularly pointed out how the rules always seem to go public on a Friday. He’s hypothesized that it was the case that they were trying to hide something. I think that’s true for many Washington news stories, but I think it was coincidence in meaningful use’s case.

Even worse than a Friday is the Friday before HIMSS. Talk about ruining the weekend before HIMSS. Although, if I remember right one time they announced the rule in the middle of HIMSS. I remember meeting with a number of EHR vendor’s government relations people who were grumbling about the late night reading of the meaningful use rule that they’d be consuming all night in the middle of the craziness of HIMSS.

Hopefully CMS has learned from past experience and has planned properly to be able to announce the meaningful use stage 3 rule well before HIMSS. Doing so will give people time to look over the rule so they can have a meaningful discussion of the rule at HIMSS as opposed to some frenetic review of what’s been proposed.

Either way, I’m very interested to see what meaningful use stage 3 will look like. My prediction is that it won’t be dramatically different from stage 2. It will be more of the same with maybe 1-2 additions. It’s too bad, because I’d still love to see them blow up meaningful use. Every doctor I know would love to see that as well. Instead I think we’ll be saying “more of the same.”

Meaningful Use Stage 3 Should Address Care Disparities

Posted on September 13, 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.

A consumer coalition of more than 50 consumer, patient and labor organizations has published a plan designed to thrust care disparities into center stage as part of Stage 3 of Meaningful Use, according to Healthcare IT News.

According to data from the Joint Center for Political and Economic Studies, the combined costs of premature death and health disparities in the U.S. were $1.24 trillion between 2003 and 2006. The group, the Consumer Partnership for eHealth, argues that these disparities will only increase as the country grows more diverse.

CPeH developed the plan after a year-long review of scientific literature, along with collaboration with experts on disparities in care and health IT. The plan focuses on data collection and use to identify disparities; language; literacy and communication and care coordination and planning, HIN reports.

The plan is designed to integrate disparities reduction with the other Stage 3 criteria to improve the identification and understanding of health disparities. The CPeH has submitted the plan to the Health IT Policy Committee, and has asked the committee to act on its recommendations.

Right now, the Meaningful Use program only requires basic identification of race, ethnicity and gender data collection. But the action plan would like to see Stage 3 include more stringent data collection standards designed by HHS, which would include disability status, sexual orientation and gender identity.

The group’s action plan includes recommendations that:

* EMRs have the ability to stratify patients’ specific conditions by demographic variables such as race, ethnicity, language, gender identity, sexual orientation and socio-economic status

* Providers make greater use of patient data collected and shared through mobile health applications

* Clinicians effectively communicate EMR information to patients, so patients can better make use of its benefits

While the goals outlined here are laudable, my sense is that even for doctors ready for Stage 3 Meaningful Use, requiring this level of data collection and analysis would be a difficult burden. I guess this one is a “wait and see” proposition.

Why One Doctor Switched EMRs

Posted on August 29, 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.

Over the last several months, we’ve been flooded with statistics spelling out the reasons why doctors are choosing to dump their current EMR and invest in a new one and we’ve been writing about switching EMR for a while.  To bring some perspective to this discussion, I’ve reached out to physicians who have made the Big Switch and attempted to learn a bit about why they chose to move from one EMR to another.

Today, I bring you Dr. Christy Valentine, a New Orleans-based physician practicing internal medicine and pediatrics. Dr. Valentine operates a small practice consisting of herself and a nurse practitioner.

Back in 2007, as part of opening her own practice, Dr. Valentine decided to invest in an EMR from a company better known for hospital systems. (She’s asked me not to name the vendor — let’s call them Vendor X.) Having seen generations of paper medical records wiped out by Hurricane Katrina, she was eager to go digital and enjoy the peace of mind that backup storage offers.

Dr. Valentine looked at several EMRs but was most interested in Vendor X’s product, which was in use at the local academic medical center and under consideration by couple of major health systems in her area. “I felt I’d have a better chance of hiring people who were familiar with the technology,” Dr. Valentine recalls. “Being a small practice we really wanted to save time training individuals on the computer system.”

Dr. Valentine had purchased not only Vendor X’s EMR but also the billing system that went with it. She soon came to regret that choice, however. For one thing,, she said, Vendor X was slow to respond to customer service requests; she and her staff had to leave a message and wait for a response which sometimes never came.

Perhaps even worse, despite investing years in trying to make things right, the practice management system was a wash-out. “I had to scrap it completely and move to an outside billing service because it wouldn’t work for our practice,” Dr. Valentine said. And to top things off, the system never got easier to use despite Dr. Valentine’s sincere efforts to make things work.

In retrospect, she feels that her practice should have gone with a vendor that focuses on practices her size, she says. “I learned that you if you go for a vendors whose big fish is the hospital, you won’t be important to the vendor,” she said.

About a year ago, Dr. Valentine decided once and for all to dump Vendor X, largely because she was opening her second office and didn’t want to bring Vendor X over. Instead, her practice  brought up athenahealth’s EMR and practice management system a few months ago

Dr. Valentine has been happy ever since. She’s very pleased with the athenahealth customer service and finds the product easy to use. She feels that her system, unlike the old one, is easy to use and to customize with specialized templates. Even better, she feels ready to steam into Meaningful Use Stage 3 with athena as a partner.  “As soon as they tell us what they need we’ll be ready to jump right into it,” Dr. Valentine says.

EMR Vendors Want Meaningful Use Stage 3 Delay

Posted on January 29, 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.

A group of EMR vendors have joined the chorus of industry organizations asking that Meaningful Use Stage 3 deadlines be moved up to a later date.  The vendors also want to see the nature of Stage 3 requirements changed to put a greater emphasis on interoperabilityInformation Week reports.

The group, the HIMSS EHR Association (EHRA), represents 40 vendors pulled together by HIMSS.  Members include both enterprise and physician-oriented vendors, including athenahealth, Cerner, Epic, eClinicalWorks, Emdeon, Meditech, McKesson, Siemens GE Healthcare IT and Practice Fusion.

In comments submitted to HHS, the vendors argue that MU Stage 3 requirements should not kick in until three years after a provider reaches Stage 2, and start no earlier than 2017. But their larger request, and more significant one, is that they’d like to see Meaningful Use Stage 3’s focus changed:

“The EHRA strongly recommends that Stage 3 focus primarily on encouraging and assisting providers to take advantage of the substantial capabilities established in Stage 1 and especially Stage 2, rather than adding new meaningful use requirements and product certification criteria. In particular, we believe that any meaningful use and functionality changes should focus primarily on interoperability and building on accelerated momentum and more extensive use of Stage 2 capabilities and clinical quality measurement.”

So, we’ve finally got vendors like walled-garden-player Epic finding a reason to fight for interoperability. It took being clubbed by the development requirements of Stage 3, which seems to have EHRA members worried, but it happened nonetheless.

While there’s obviously self-interest in vendors asking not to strain their resources on new development, they still have a point which deserves considering.  Does it really make sense to push the development curve as far as Stage 3 requires before providers have gotten the chance to leverage what they’ve got?  Maybe not.

Now, the question is whether the vendors will put their code where their mouth is. Will the highly proprietary approach taken by Epic and some of its peers become passe?

Meaningful Use Solidifies EHR as the Database of Healthcare

Posted on March 20, 2012 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.

Earlier this month I wrote a post describing EHR as the Database of Healthcare. I believe this is a powerful and important thing to understand. It also led to some good conversation in the comments. As an entrepreneur I’m always interested to see the trends in the industry to hopefully better understand what is going to happen in the future. I think that this is one of those trends.

Just to make the case clearer, consider the effects of meaningful use on EHR software. Meaningful use stage 1 and EHR certification has already hijacked at least one EHR development cycle and you can be sure that meaningful use stage 2 and stage 3 will be hijacking another couple EHR development cycles. You heard me right. In order to meet the EHR certification and meaningful use requirements, most EHR vendors have to put a whole development team focused just on meeting those government requirements.

Meaningful use has codified EHRs into a box.

Instead of allowing EHR software to create innovative solutions it requires standards be met for storing and accessing info. Sure it also adds in security and tries to work towards interoperability, but those aren’t innovations that doctors want to see.

I expect many of the best healthcare innovators will build on top of the EHR base, not try and build the base again.

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.


ONC Tiger Teams Working on Meaningful Use Stage 1 and 2

Posted on December 23, 2010 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 saw this a little late (which to me says something about the legislative process), but today’s the last day to provide feedback to the HIT Policy Committee’s Quality Measure Workgroup for Stage 2 and Stage 3 meaningful use. Here’s some information about it from this Health Care IT News article.

The tiger teams have already proposed measure concepts for each of the domain areas, Lansky said. After reviewing the teams’ recommendations, the workgroup revised and consolidated the measure concepts and now requests public comment on the proposed concepts.

Lansky said the workgroup is requesting general comments and specific examples of measures for each measure concept that fit the following criteria:

  • HIT-sensitive – Capable of being built into electronic health record (EHR) systems with implementation of relevant health IT functions (e.g., clinical decision support) that result in improved outcomes and/or clinical performance
  • Parsimonious – Applies across multiple types of providers, care settings and conditions
  • Demonstrates preventable burden – Supports potential improvements in population health and reduces burden of illness
  • Assesses health risk status and outcomes – Supports assessment of patient health risks that can be used for risk adjusting other measures, and assessing changes in outcomes, including general cross-cutting measures of risk status and functional status and condition-specific measures
  • Longitudinal – Enables assessment of longitudinal, condition-specific, patient-focused episodes of care

Comments to the workgroup can be submitted online here.