The Meaningful Use Train is Simply Moving Too Fast

The Meaningful Use Train is Simply Moving Too FastAs 2014 draws closer and the realities of meaningful use Stage 2 set in, many stakeholders are experiencing an increasing and justifiable level of anxiety about the consequences of a program that is advancing too rapidly. Following on the heels of the letter from a group of senators to the secretary of HHS that suggested a “pause” in the meaningful use program, there has been a recent avalanche of pleadings for a delay of Stage 2. These have come from such venerable groups as the AMA and AHA, MGMA, AAFP, HIMSS (the Healthcare IT industry organization), and CHIME (College of Healthcare Information Management Executives), all of which represent sizeable and varied constituencies.

The proposals offer a range of suggestions, and their solutions vary in scope and complexity, but the message is clear, consistent, and undeniable: the meaningful use train is simply moving too fast, and the future success of the program depends on an application of the brakes.

Recommendations include variations on the following:

  • Delay the start of Stage 2.
  • Expand the period for Stage 2 compliance (attestation) by up to a year.
  • Suspend the penalties, at least for those physicians who have successfully attested to Stage 1.
  • Add some needed flexibility by relaxing the “all or nothing” requirements for demonstrating meaningful use.
  • Extend the schedule so that physicians have 3 years at each stage before moving to the next.

Some lay the blame on the EHR vendors, citing lack of preparedness. To some extent they are correct—the certification website reveals that only 15 complete ambulatory EHRs from 12 different vendors have been certified for 2014 and Stage 2 so far—that’s just 3% of the 472 EHRs that were available to physicians in Stage 1. While some physicians will be left without a certified EHR in 2014, it is likely that the remaining major vendors will manage to get their EHRs certified by the end of the year. The fact remains, however, that more time before deployment can only improve the (sorely lacking) usability of the final products. One only has to look at the low average KLAS scores—now in the mid-70s—to appreciate the effects of rushed software development and implementation. Without a relaxing of the timeline, many physicians will be left with EHRs that are certified, but unusable.

The EHR Incentive Program is suffering, and its long-term success is at stake. A full 17% of the physicians who attested for the first year of Stage 1 failed to attest for the second incentive payment. (See “Alarming Fact” EMR Straight Talk post.) They simply could not sustain the use of their certified EHR—with which they were already familiar—for a full year of compliance with the complex rules of meaningful use—with which they were also already familiar. Unless we stop and evaluate why this is happening and make the necessary adjustments, the dropout rate is guaranteed to rise with Stage 2.

We have to stop and assess where we are trying to go in light of where we are now. Stage 3 is hurtling toward the final proposal without the benefit of any experience in Stage 2. The measure of the program’s success cannot continue to be the number of dollars paid in incentives, but should rather be providers’ satisfaction with the EHRs that they have been encouraged to adopt.


3 thoughts on “The Meaningful Use Train is Simply Moving Too Fast

  1. It will be wonderful if all of your posts have a standard permanent link for readers to go to a certified CMS website where they can further your post’s cause by filing further requests on delays.

    Your article is right on target. The program’s success cannot continue to be the number of dollars paid as incentives. Rather the providers’ satisfaction with the avail and cert. ehrs. Building a solid foundation is the key to success. Hurtling towards stage 2 and 3 on a weak foundation is not only a bad judgment call but highly unethical and places beyond undue burden on providers/users with no say in what is being done by interested parties.

    My sincere advice to the parties that hold the on and off key is to run parallel clinics in hospitals part A, surgery centers, family practice, ALL specialities, peds, obgyn, cardio, neuro, gastro, derm, internal medicine, onco etc with the current technology using medium priced softwares to see how their adm. decisions affect actual communities of providers and their patient bases…Then they will see the trauma that end users go through and may even, after going through the whole patient care workflow through these clinics understand and come up with SOLID, PRACTICAL solutions to find REAL and COMPREHENSION ANSWERS that are here to stay.

  2. Agreed. The timeline for stage 2 and 3 is too aggressive. EHR vendors are having to rush the programming of their products to meet the stages and the physicians and office staff are rushed to be trained on the system. Seems to be some patient safety issues to me.

  3. EHR vendors are still struggling to implement the necessary components for meeting Stage 2 requirements, which results in system upgrades and additional costs to healthcare facilities, and ultimately to patients. If CMS distributes the required objectives over the extended Stage 2 timeline, allowing providers the opportunity to collect all incentive funds during this stage, EHR vendors will have an opportunity to refine the current software to incorporate fully the requirements for improving clinical processes in a more reasonable timeframe before moving to the next level of meaningful use. CMS can easily monitor and enforce compliance for Stage 3 objectives by assessing penalties for non-compliance, rather than withholding payments until meeting the Stage 3 objectives. This modification will allow healthcare providers to receive the total amount of incentive payments during the extended Stage 2 timeline, which will help to alleviate the financial burden of EHR implementation and upgrades. In addition, providers and patients will have additional time to adjust to these changes and benefit more fully from the improvements of an electronic system.

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