The HIT Policy Committee’s Meaningful Use Workgroup met this week to begin discussing the question that I posed at the end of my EMR Straight Talk post last week, i.e., how to reconcile the various stakeholders’ positions regarding Stage 2 meaningful use. Most of the feedback received by the workgroup in response to its request for comments relate to issues surrounding timing, with providers and vendors urging restraint, and consumer groups (representing patients and payers) pushing for more aggressive timelines.
Given the statutory constraints (i.e., changes to the law itself would require Congressional action, a path the workgroup will not pursue), the options are limited—and each carries consequences for the program’s long-term goals. The workgroup acknowledged the concerns of vendors regarding the time needed to adequately and safely develop and deploy any new required functionality. They also appreciated the impact on providers of the implementation and training demands associated with upgrading technology, particularly at a time when providers are facing other IT challenges such as ICD-10 and HIPAA 5010. The workgroup considered the following options:
- Option 1: Slow down the program’s pace by not adding any new measures and functionalities to Stage 2, but merely increasing the thresholds related to Stage 1 measures.
- Option 2: Delay the start of Stage 2 by allowing each provider more time at Stage 1 or by basing the initiation of Stage 2 on the overall level of provider compliance/success in Stage 1.
- Option 3: Shorten the first year’s reporting period to 90 days when providers progress to Stage 2.
The workgroup identified the following as the problems associated with each of the above proposals:
- Option 1 (no new measures) will not get the program where it needs to be rapidly enough. It does not advance the program past data capture and towards the program’s goals: interoperability; “advancing clinical processes” (the goal of Stage 2); or improving outcomes (the goal of Stage 3).
- Option 2 (delay Stage 2) raised the concern that extending Stage 2 will set a precedent for delaying Stage 3. The dwindling financial incentives and the lack of positive incentives after 2016 could reduce interest in Stage 2 or make it difficult for the program as a whole to ever progress past Stage 2, given that there are no positive incentives available after 2016.
- Option 3 (90-day reporting period) does nothing to resolve the vendors’ concerns about the timeline for development.
Another critical issue to be addressed is how to increase the relevance of the EHR program to specialists, which will be the subject of a special hearing on May 13—similar to the hearing that solicited their input for Stage 1. Of all of the stakeholders, physicians are the most critical to the attainment of the EHR program’s goals. Physicians—primary care and specialists alike—are the cornerstone of the program, and their participation beyond Stage 1 will depend on the development of a set of reasonable and achievable requirements.