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Does meaningful use need an overhaul?

Brian Eastwood | July 1, 2014
Five years after the HITECH Act, the meaningful use incentive program for electronic health record (EHR) software may be in trouble.

Five years after the HITECH Act, the meaningful use incentive program for electronic health record (EHR) software may be in trouble.

As of May, only four hospitals had attested to stage 2 of meaningful use, along with 50 eligible providers (loosely defined as office-based physicians). By mid-June, nearly 450 eligible providers had completed stage 2 attestation, but the number of hospitals had only climbed to eight.

The release of this data coincided with a groundswell of both confusion and frustration aimed at conflicting proposed rules from the Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare and Medicaid Services (CMS) along with numerous reports suggesting that many healthcare organizations, in their rush to implement EHR systems, had violated the Hippocratic oath.

Meaningful use faced critics from the get-go, including the American Medical Association and the Medical Group Management Association. In the last few months, though, says Jim Tate, a meaningful use audit expert, there's been an "erosion of confidence" in the program among more neutral players. "Those who are really interested in the common good are starting to raise their voice."

EHR Vendors, Providers Equally Unprepared for Stage 2

Under the HITECH Act, hospitals and eligible providers who are eligible for the Medicare EHR Incentive Program but fail to begin the attestation process (for either stage 1 or 2) by the end of the 2014 fiscal year face financial penalties starting in 2015. Rules differ for the Medicaid EHR Incentive Program.

According to a May report from the Centers for Disease Control and Prevention, fewer than one in five office-based physicians will meet meaningful use with the EHR systems they have. While the report cites data from 2012, it also suggests that 18 percent may be a "maximum estimate."

One explanation: EHR vendors lag in stage 2 upgrades. Some told customers that their 2014 Certified EHR Technology (CEHRT) that is, the EHR version needed for stage 2 wouldn't be ready in time for hospitals to complete the 90-day stage 2 attestation reporting period by Sept. 30, the final day of the 2014 federal fiscal year. In other words, the product that got them to stage 1 wouldn't be able to get them to stage 2, so they would face meaningful use penalties.

In response, CMS and the ONC relaxed meaningful use certification in May. Under the proposed rule, hospitals and eligible providers, for 2014 only, can use 2011 CEHRT to attest for stage 1 even if, under the original meaningful use timeline, they are slated to attest for stage 2 this year. The rule also restated the one-year delay in the meaningful use timeline, which now starts stage 3 in 2017.


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