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One-on-One with David Blumenthal, M.D., National Coordinator for Health IT (Part 2)

April 19, 2010
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In the final part of our interview, Blumenthal addresses concerns providers have regarding the interim final rule.

Now that the comment period on the proposed meaningful use rule has ended, it is up to the Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health Information Technology to weigh the merits of those comments and develop a final rule, which is expected sometime in May or June. CIOs and EHR vendors are anxiously waiting to learn whether greater flexibility may be included in Stage 1 meaningful use requirements. Recently, Healthcare Informatics Senior Contributing Editor David Raths sat down with David Blumenthal, M.D., the National Coordinator for Health Information Technology, in his Washington office to discuss meaningful use and certification issues.

In part 1 of the interview, Raths spoke with Dr. Blumenthal about broad issues around meaningful use criteria and about provider (hospital and physician) perspectives on meaningful use. Below is the concluding portion of the April 13 interview, which focuses on concerns providers have expressed regarding the interim final rule.

Healthcare Informatics: Some commenting groups have questioned the decision to include administrative transactions, claims submission, and eligibility as part of certified electronic health record (EHR) technology. They note that HIPAA explicitly enables an entity to use a clearinghouse to perform these transactions rather than performing them directly from its practice management systems or EHR. They note that the ONC proposal would require providers to change business processes that have no impact on improving quality and safety. Why is it important that electronic claims submission and eligibility become part of the certification criteria for EHR technology?

David Blumenthal, M.D.: Two reasons. First, for providers who don’t provide administrative data electronically, there are substantial administrative costs that insurers bear. And those costs are spread across the entire insurance system. If you ask insurance companies where they spend a lot of their administrative costs, it will be on a very small fraction of providers who don’t have sophisticated billing systems. The new health reform law invests a considerable amount of time and energy on something called administrative simplification, which involves simplifying the billing and eligibility processes. That depends on a minimum level of electronic sophistication on the part of providers, and meaningful use is the only leverage we have over the providers, so there is a compelling fiscal rationale for this. I also think there is another reason for doing this. In a private and secure environment, being able to provide electronic information on cost and on quality of care is absolutely essential to improving and modernizing our health care system. So the folks whose doctors don’t have their administrative data in electronic form will never know how efficient their doctors and hospitals are. And that’s a big hole in accountability.

HCI: Some groups, such as the HIMSS EHR Association, have said the interim final rule (IFR) did not go far enough in establishing specific technical specifications — for instance, a consistent set of transport services for document exchange or specific security and privacy standards. Was there a balance that had to be struck between flexibility and specificity? Was there concern that some implementation specifications were not mature enough?

Blumenthal: We are trying to balance flexibility and specificity. In the area of security and privacy, we were advised that this is a very dynamic sector, and that the cyber-security initiative of the president was developing new security solutions at a rapid rate and that if we put in rules or specifications that were likely to be outdated very quickly, we could be doing a disservice to vendors and to the field. In the area of communications or interoperability, there are two solutions, CCR [Continuity of Care Record] and CCD [Continuity of Care Document], both of which have very strong advocates, and we thought the market needed to sort that out further before we wrote one or the other standard into a rule. We also were told that some of the implementation specifications that people would have liked us to include in the rule were not mature, and had not been fully tested, and that they were not standard in the sense of being widely used, and that there could be considerable unintended costs to requiring their use. We needed more time to test them and assess them.