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AMIA Panels Offer Mixed Messages on Stage 3 MU

November 17, 2014
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Some express eagerness for new EHR measures; others call for ONC to stop

At the AMIA 2014 Annual Symposium, talk about Stage 3 of meaningful use reveals tensions among members about what the Office of the National Coordinator for Health IT should do.

One Nov. 17 session detailed the Institute of Medicine’s new recommendations for a panel of 12 social and behavioral measures that should be required in Stage 3, and the audience comments were largely enthusiastic. (More detail below.)

Yet less than an hour earlier, AMIA’s EHR 2020 Task Force, charged with reflecting on the current status of EHRs and needed future directions, said its early recommendations are for ONC to stop where they are. Instead of adding more requirements, ONC should give providers time to stabilize and focus on how to be more innovative in meeting Stage 2 functional measures, said Michael Zaroukian, M.D., chief medical information officer of Sparrow Health System in Lansing, Mich., and one of the task force members. “We have enough EHR functionality in place now to advance quality and value,” he said. But Zaroukian also detailed some of the problems with Stage 2. He said 500 out of 1,000 eligible provider in his community would have to drop out of the MU program if Stage 2 reporting requirements for the full year in 2015 don’t change. “There is a Stage 2 dropout crisis looming,” he said. Only 17 percent of eligible hospitals have attested and 2 percent of EPs, he noted.

The task force’s early formulation of recommendations are that ONC should focus on relieving data entry burdens for clinicians, advance interoperability, ease quality reporting burdens, simplify meaningful use, and promote safety and quality.

During the Q&A discussion, some providers suggested that AMIA promote the JASON Task Force recommendations to have Stage 3 focus tightly on interoperability and public APIs. Others said that because the FHIR standard is still in draft form, it is not far enough along to include in Stage 3, and the best ONC can do is hint that open APIs and FHIR are the direction it will move in later EHR certifications.  Still others questioned whether the marketplace is really ready to innovate with the current systems in place if regulations from CMS are relaxed.

The IOM report, issued a week ago, recommends that 12 measures be included by the ONC and CMS in certification of EHRs and meaningful use objectives, and the data should be recorded for every patient. The first four are already widely collected: alcohol use, race/ethnicity, residential address, and tobacco use. The IOM calls for adding eight more to the panel:

• Education

• Depression

• Financial resource strain

• Intimate partner violence

• Physical activity

• Social connection/isolation

• Physical activity

• Stress.

“This is not a set of independent measures. They are complementary and make up a true panel,” said George Hripcsak, M.D., assistant professor in the Department of Medical Informatics at Columbia University and one of the IOM committee members. Hripcsak said the committee recognized the importance of minimizing the burden to providers. “The technology is only part of getting it implemented,” he said. There are workflow and patient engagement impacts. “We need to decide where and how to collect and review the data. HIEs may be used to share the data, even though privacy also is critical. The data can be de-identified for sharing with public health, he said.

The committee noted that having this data could lead to more effective population health management for health systems and agencies.

So the ONC will have to balance the desires of those who want to add more elements such as patient-generated data now that EHRs are more ubiquitous with the loud calls for a halt to any new regulations.