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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.

Confused? You're not alone. So is Dr. John Halamka, CIO of Beth Israel Deaconess Medical Center in Boston and co-chair of ONC's Health IT Standards Committee. He arguably knows meaningful use better than anyone. While Halamka says the proposed rule "wisely" and "elegantly" adds flexibility to meaningful use, he adds that layering fixes on meaningful use "creates too much complexity" and further suggests that the program needs consolidation and simplification.

Frustrated? You're not alone, either. So it Tate, who goes so far as to say that the proposed rule open to public comment until July 21 and subsequently revised strikes at the credibility of the whole meaningful use program. "Out of the blue, they said, 'Even though you've been planning for stage 2, you may not have to meet it, but we won't tell you for three months,'" Tate says. "Nobody knows, and we won't know until August or September."

Meaningful Use Too Much Time, Money and Effort?

Not everyone will be waiting patiently. Some providers plan to take the meaningful use money and run, accepting that the noncompliance penalty is less than it will cost to attest for stage 2.

This is the case because meaningful use frontloaded its incentives. Under the Medicare program, for example, eligible providers attesting for stage 1 in 2011, 2012 and 2013 have received $38,000 of the $44,000 for which they are eligible. Hospitals likewise attesting all three years have received close to 90 percent of what they're due.

For such small incentives, it's a lot of effort. As it is, meaningful use stage 1 changed the way hospitals implement EHR, with functionality previously saved for the end of the process moved forward if it happens to be a meaningful use requirement. (Examples include computerized physician order entry, or CPOE, and clinical care guidelines.)

Stage 2 brings additional challenges. As a Government Accountability Office (GAO) report detailed earlier this year, several optional (or "menu") requirements in stage 1 become mandatory (or "core") in stage 2 transition of care documentation, public health data submission (syndromic and reportable lab results), medication reconciliation and providing patients with electronic copies of their health information. Many of these issues point to an unmet need for better infrastructure, Tate says.

It shouldn't be surprising, then that many providers feel buyers' remorse, with 40 percent indifferent toward or dissatisfied with their EHR systems. Meaningful use isn't wholly to blame here poor usability, a lack of interoperability and inadequate health information exchange capabilities all leave providers frustrated with EHR systems but it has led some organizations to consider replacing an EHR system in order to attest for stage 2. (Word to the wise: It's harder than you think.)


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