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Is the Bar Still Too High?

August 31, 2009
by David Raths
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ONCHIT appeased some by tweaking CPOE requirements, but many still say the timeline for patient access to records is too aggressive

This posting has been edited due to spacing concerns. To read all of David Raths' blogs in their entirety, please visit /contributors/david-raths.

Paul tang

Paul Tang

In several of the revisions to its recommendations announced July 16, the Meaningful Use Work Group of ONCHIT's HIT Policy Committee demonstrated flexibility and a willingness to compromise in order to gain wider acceptance. But on a few fronts, it's likely that some hospital executives and physician practices are still going to see the bar for achieving “meaningful use” as being set too high. And the work group didn't budge on its stance that patient access to their electronic health data must come sooner rather than later.

ONCHIT's proposed rule will be published by the end of the year and will be implemented by the Centers for Medicare and Medicaid Services.

Some clarifications and details offered up by co-chair Paul Tang, M.D., CMIO at the Palo Alto Medical Foundation, will no doubt ease some concerns about earlier proposals. For instance, many comments received by the work group stated that a 2011 CPOE requirement was unrealistic. Tang said the revised suggestion is that at least 10 percent of all orders processed in a hospital must be entered through CPOE to qualify the institution for CMS incentives under the HITECH Act. That figure may come as a relief to many hospitals, although ones that haven't started on a CPOE implementation may still have difficulty achieving it by 2011.

However, concerning patient access to health record information, the committee stuck to its guns in suggesting that e-copies of health information should be part of the 2011 definition. Despite the current lack of progress industry-wide on patient portals, it actually suggested moving up “real-time” patient access to that data in a personal health record from 2015 to 2013. (It's not clear what the definition of “real time” is.)

Tang said the work group believes it is important to stress that consumer access should become part of the equation right away. Many written comments had stressed that the timeline for giving patients access to electronic health data is too aggressive and should be scaled back. At the July 16 meeting, Neil Calman, M.D., of the Institute for Family Health, restated his position that asking practices to develop a patient portal in their first year of EHR implementation is impractical. And Calman expressed the concern that practices with no technology experience will see the bar as set impossibly high for them to reach. But the work group clearly disagreed.

The work group also sought to address the problem of calendar year versus adoption year. Because of what ONCHIT has set out to describe as meaningful use in 2011, 2013, and 2015, the longer an organization waits to begin an implementation, the higher the bar is set in terms of what they must achieve in the very first year. The work group proposed having the 2011 requirements be renamed Adoption Year 1 requirements and 2013 requirements renamed to Adoption Year 3, no matter when you start. But Tony Trenkle, director of CMS' Office of e-Health Standards and Services, noted that by statute, in 2015, funding disincentives start kicking in, so a three- or four-year implementation process encouraged by incentives really can't be extended out for those starting later. So it's not clear how much this proposal would help.

Organizations had also expressed concern about requirements for participating in health information exchanges when so few are actually up and running. The revision suggested the 2011 standards involve requiring the capability for exchange, and to take part in one where possible. Then the 2015 guideline would include required participation in an HIE.

What will these proposals mean to your organization? Do you find the proposals for 2011 to be realistic?

Healthcare Informatics 2009 September;26(9):38

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