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Washington Debrief: CIOs, CMIOs, Vendors Testify on Stage 2

July 30, 2013
by Jeff Smith, Director of Public Policy at CHIME
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Jeff Smith, Director of Public Policy at CHIME

CHIME Members Testify During Federal Hearing on Implementation and Usability

Four members of the College of Healthcare Information Management Executives (CHIME) testified to federal officials last week, calling for a safe, orderly transition to Meaningful Use Stage 2 that leaves no one behind.

During a joint hearing of two Federal Advisory Committees in Washington, D.C., CIOs representing facilities in Kentucky, Pennsylvania, Texas and Virginia spoke to officials on Meaningful Use Stage 1 implementation, Stage 2 readiness, and Stage 3 proposed policies. Believing Stage 1 had accomplished great strides in electronic health record (EHR) adoption, the panel of CIOs highlighted common challenges surrounding Stage 2.  Specifically, they identified objectives related to transitions of care, patient portals, and clinical quality measures (CQMs) as posing the greatest challenges for their organizations.

“All of the objectives listed as challenges require significant work to implement after upgrading to 2014 certified software,” said Pamela McNutt, Sr. Vice President and CIO at Dallas-based Methodist Health System. “For example, after delivery of the patient portal we will have to map data elements from the patient record and clinical staff will need to ensure that the data is representing accurately.”

Current adoption trends for EHRs are promising, with nearly 79 percent of all eligible hospitals (EHs) and over 55 percent of eligible professionals (EPs) having received an EHR incentive payment under Medicare or Medicaid since 2011. However, the structure of the incentives program has created a timing crunch in 2014 when over 500,000 hospitals and physicians are required to upgrade their existing technology to demonstrate meaningful use.

“The difficultly in achieving meaningful use, beyond the new, more complex objectives, is compounded by the short timeframes allowed for hospitals to implement 2014 certified EHRs.” said Randy McCleese, Vice President of Information Systems and CIO at Morehead, Kentucky-based St. Claire Regional Medical Center. 

To alleviate this short timeframe, CHIME recently called for an extension of Stage 2 to ensure momentum towards widespread adoption of EHRs was maintained; flexibility was granted to hospitals and physicians striving towards meeting program requirements of their respective stage; and policymakers had time to assess and evaluate programmatic trends needed to craft thoughtful Stage 3 rules.

Healthcare Stakeholders Urge Flexibility in 2014 during Congressional Hearing

CHIME was not the only group in Washington this week, urging federal officials to consider policy changes in Meaningful Use.  Congress convened another hearing on health IT Wednesday, which was the second such hearing in as many weeks.  Last week, testimony was given to the Senate Finance Committee by vendors, providers and a Washington-based think tank, assessing progress and the path forward for Meaningful Use.  Previously, the Committee heard from officials at CMS and ONC discussing the same topics.  In opening comments, Ranking Member Senator Orrin Hatch (R-Utah) said he was interested in the timing of Meaningful Use Stages and the related requirements involved.  “We need to make sure incentives are well placed and effective,” he said.  “The right timelines are a necessity.”  In response to this, Siemens Healthcare CEO Dr. John Glaser recommended CMS “Extend Stage 2 deadlines to October 1, 2015… giving ample time for organizations to prepare, implement, and gain tangible outcomes.”  Dr. Glaser also suggested that future Stages be less prescriptive on form / function of EHR technology and focus instead on outcomes.  Meanwhile, he also advocated for a more focused effort to develop and solidify standards to achieve greater interoperability in healthcare.  Nebraska-based Nemaha County Hospital CEO Marty Fattig echoed these recommendations, calling on CMS to adopt an AHA and AMA-endorsed policy that would give all providers three years at each stage, “to ensure a safe, orderly transition to Stage 2.”  In his testimony, Virginia Commonwealth University Health System CMIO Colin Banas said that Meaningful Use had been a tremendous tool and incentive for his organization.  However, he was concerned with the growing amount of complexity facing providers and suggested the industry had a creative opportunity to maintain momentum and provide flexibility before hospitals and doctors become completely overwhelmed.

Lawmakers Weigh-In on Stark, Anti-Kickback Exemptions

Reps. Diane Black (R-Tenn.) and Mike Honda (D-Calif.) recently sent a letter to CMS Administrator Marilyn Tavenner, R.N. and National Coordinator for Health IT Farzad Mostashari, M.D. urging them to expand protections that allow hospitals to donate electronic health record technology to physicians in an effort to boost health IT interoperability.  Specifically the pair wants HHS to extend the Stark and anti-kickback to the end of 2016 with provisions that prohibit donors from restricting data exchange between EHRs.  The letter also urges HHS to clarify “neither the donor nor donee can take any actions to limit the interoperability of donated" health IT by establishing a new condition in the exceptions that “clarifies the prohibition against data ‘lock-in.’”  The Representatives believe the Stark law should require that any written contract subject to the exceptions incorporate such new conditions.  CMS has a proposed rule pending and a final rule should be forthcoming soon.

Now open! CHIME State Public Policy Award for CIO Leadership
The State Public Policy Award will be presented during National Health IT Week on September 18 in Washington, DC. (Winner need not be present, but it’s encouraged!) This award recognizes the contribution of a CHIME member engaged in educating policy makers at the state-level on the value of health IT and its role in patient care. You may nominate yourself or a colleague. Submission deadline: Aug 2, 2013

Edited by Gabriel Perna

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