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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.

It shouldn't be surprising that meaningful use hasn't done enough to improve healthcare IT, according to the government advisory group known as JASON. The headlong plunge into EHR adoption overemphasizes meaningful use at the expense of innovation and the "creation of a truly interoperable health data infrastructure," the group says in a recent report funded by the Agency for Healthcare Research and Quality (AHRQ).

According to RAND, that's because meaningful use encourages the use of existing EHR technologies that "are not designed to talk to each other." (The consultancy comes down particularly hard on market leader Epic Systems, which sells client-based EHR systems so customizable that facilities in the same system often cannot share data.)

It shouldn't be surprising that "those with an interest in the common good," as Tate calls them, have called for a meaningful use reboot that emphasizes standards and outcomes and puts the brakes on new requirements so providers can focus on infrastructure, quality reporting and interoperability.

Meaningful Use May Get Worse Before It Gets Better

These circumstances alone suggest that things could get worse before they get better. Additional factors tip the scale even further.

First, there's the 2015 EHR certification program. As stated, meaningful use stage 1 requires the use of 2011 EHR certified technology, stage 2 requires 2014 EHR and stage 3 is expected to require 2017 EHR.

In February, ONC released a proposed rule for a 2015 voluntary EHR certification program. "A two- to three-year regulatory is sub-optimal," the agency writes in its proposed rule, having "created cycles of significant peaks and valleys from a health IT development standpoint." What's more, the program would act as a bridge of sorts to the 2017 EHR certification requirements.

In theory, 2015 voluntary EHR certification represents ONC's attempt at a flexible EHR strategy, especially given the changes to the meaningful use timeline announced at the end of 2013. To that end, it introduces the possibility for "gap certification" to cover anything that remains unchanged from the 2014 to 2015 requirements. (At a glance, these criteria consist largely of those with the lowest software development cost.)

In practice, Tate says, it's just more confusion:

  • Why would a vendor rush to pursue voluntary 2015 EHR certification if, under the proposed meaningful use recertification rule, 2011 EHR certification will be OK for 2014?
  • Will those 40 percent of providers in the market for a new EHR system look less favorably on an EHR vendor that hasn't completed a voluntary certification program?
  • Without knowing what will change between the 2015 and 2017 certification criteria, what's the point of the voluntary certification?

Another thorny issue, reporting of clinical quality measures (CQMs), receives much attention from the GAO report.


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