The Office of the National Coordinator for Health IT held a high profile at the AMIA Symposium in Washington, D.C., last week. The ONC held several listening sessions to gauge what types of issues providers are running into as they prepare for Stage 2 of meaningful use.
The session I attended featured Chris Muir, program manager for the state HIE cooperative agreement program; Steve Posnack, director of the federal policy division; and Doug Fridsma, chief science officer.
The people asking questions did not identify themselves before speaking, which makes it difficult for me to describe their affiliations, but some were clearly EHR vendor employees seeking clarification about timing of meaningful use reporting periods for their customers, while others were providers describing problems they have experienced.
Here is a brief description of a few of the pain points mentioned:
One participant mentioned that primary care providers are running into problems with their EHR vendors and exchanging lab results. The EHR solutions have the capability, but the vendors charge an additional fee for activating the functionality, he said. These providers have a very low volume of lab exchanges, and can’t afford to pay the vendor for the custom work. Many also don’t have a local HIE to turn to as an option for this service. He asked what ONC’s plan is to reduce those barriers. The ONC execs said they have heard that this is a problem and ONC is looking at broader policy levers and different avenues to approach it. They said one thing that should help is that in their 2014 EHR certifications, vendors are required to offer more transparency on pricing.
Several people mentioned the challenge of writing interfaces to exchange with public health agencies when there is no one transport standard across the country. Fridsma said Direct messaging, which is part of meaningful use, is one approach. There also is standards work under way on a web services approach. But the reality is that currently there is a lot of heterogeneity in transport. The thing about public health agencies, Muir said, is that they don’t have a bunch of money. They are often looking for a quick and simple way to get records flowing to them. He said ONC is working with the Centers for Disease Control on pilots for different interoperability options.
Even if ONC were to adopt one or two standards, Posnack said, the public health agencies don’t have same incentives to obey ONC that the providers and EHR vendors do. Dealing with parties not in that core incentive structure requires negotiations.
There was also confusion from the audience about how small practices are supposed to find other providers to send Direct messages to. The ONC respondents said that the health information service providers (HISPs) and DirectTrust are working on standards and tools to make provider directories available.
One person mentioned the challenge of measuring specific outputs from the EHR to meet certain MU measures. For instance, a requirement about patient education materials states that the EHR must identify resources to give to a patient. But if that content is in a separate e-prescribing module that is not part of the EHR, then it may not count toward the measure and certainly the EHR system isn’t tracking them.
Posnack admitted that getting the software to track utilization, even for rudimentary things, has proven more difficult than anyone initially thought.
The session wrapped up with a remarkable set of comments from one exec who said his organization was “contorting itself” in ways that made no sense just to meet the MU measures. He said, for instance, that clinicians are measuring height and weight in ophthalmology and dermatology because the only way to meet the educational requirements is through talking about body mass index. “We are investing money we don't have to implement this in areas where it doesn’t make sense. The conversations we are having are just bizarre. Do you know whether, in the trenches, we are we creating unanticipated problems? Do you have a way of systematically tracking where those are and can we mitigate them in Stage 3?”
The ONC execs said they would try to do a better job of collecting and sharing such examples. Fridsma said that from a standards perspective, they needed to get early feedback on implementation guides and created a ticketing system for Stage 1 problem reports. “We are gradually trying to expand the number of topics, so people working on implementations can tell us what’s working and what’s not.”
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