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As Healthcare Leaders Bring Forward their MU Stage 2 Concerns, What Might the Feds Do?

July 25, 2013
by Mark Hagland
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In late July, healthcare leaders brought forward concerns over the Stage 2 requirements under meaningful use

On July 23, HCI Senior Contributing Editor David Raths wrote an excellent report about the hearing sponsored that day by the federal advisory committees of the Office of the National Coordinator for Health IT (ONC).

As David’s story noted, Pamela McNutt, senior vice president and CIO of Methodist Health System in Dallas, and a leader within the College of Healthcare Information Management Executives (CHIME), shared with ONC officials and committee volunteers about CIOs’ concerns over the requirements in Stage 2 of the meaningful use process under the HITECH (Health Information Technology for Economic and Clinical Health) Act. Among the Stage 2 objectives that McNutt shared with the committee members as being the most difficult to meet: that patients would actually access their records via patient portals; the requirement for data exchange at transitions of care; fully automated medication reconciliation for 100 percent of patients; summary of care electronically exchanged 10 percent of the time; and the creation of completely accurate quality data derived directly from the electronic health record (EHR).

And as Randy McCleese, CIO of St. Claire Regional Medical Center in Morehead, Kentucky, noted, these challenges are even tougher to address from the standpoint of the very limited resources available to smaller and rural hospitals.

What we at Healthcare Informatics are hearing from CIOs, CMIOs, and other healthcare IT leaders nationwide, is that the transition from Stage 1 to Stage 2 of meaningful use is that this entire process is turning out to be more difficult even than the leaders of the more IT-advanced organizations had anticipated.

In that regard, Bill Spooner, senior vice president and CIO of Sharp HealthCare in San Diego, was inspired by David's reporting to comment in this week’s CHIME SmartBrief, the broad newsletter published weekly by CHIME, that “My two particular issues are with metrics and competing priorities. The National Quality Foundation,” Spooner noted, “has worked for several years to establish quality metrics that can be readily captured electronically. Those specified for Stage 1 were often not implemented to be readily recorded in the typical patient care workflow of the various EHRs. The rapid transition to Stage 2 is only a marginal improvement, allow insufficient time for effective software development and implementation.”

Ultimately, Spooner advocates for a delay in Stage 2, while stating that “Any decision to delay Stage 2 should establish clear expectations on standards harmonization.” What’s more, his views, as expressed in the July 25 CHIME SmartBrief, fully reflect the association’s position, as expressed in a May 6 letter to several U.S. senators who had questioned the broader meaningful use process and HITECH program overall.

Furthermore, as HCI Associate Editor Gabriel Perna noted in his report July 25, leaders of the American Hospital Associate and the American Medical Association are calling for delays as well.

As the hospital association declared in a statement on its website, “The AHA believes that HHS [the Department of Health and Human Services] can and should take steps to expand the meaningful use timelines and introduce more flexibility into the program. Our recommendations would still allow Stage 2 to start in 2014, but the transition would be more safe and orderly.”

What seems clear here is that we’re headed into the very most difficult phase of the entire meaningful use process under the HITECH Act, a phase in which large numbers of hospitals and medical groups (on behalf of their physician members) could well fail to meet the requirements of meaningful use, and thus not only fail to receive the funding provided by the program, but could ultimately risk the reimbursement penalties called for under the Act.

ONC officials will therefore have to very, very carefully balance the need to listen sensitively to healthcare IT leaders’ concerns, with the need to keep the program moving forward. I don’t see any “magic bullets” here. But I do believe that solutions can be found that provide for a bit more flexibility in return for ensuring that more providers be successful under the program. And I also believe that there are risks and rewards in equal measure for federal officials at ONC, CMS (the Centers for Medicare & Medicaid Services), and HHS. The choices they make right now will most certainly influence the ultimate success-or failure—of the meaningful use program.