At a Senate committee hearing Wednesday, Lamar Alexander (R-Tenn.) said that Meaningful Use Stage 3 should be delayed until 2017 and phased in based on the program's success thereafter.
Alexander, who has talked at previous Senate Committee on Health, Education, Labor & Pensions meetings about the possibility of "slowing down" implementation of Stage 3, called for the outright delay while also saying the Centers for Medicare & Medicaid Services rule modifying Stage 2 should be implemented immediately. Both rules are in the hands of the Office of Management and Budget for review.
"Our goal is to help patients," said Alexander, the chairman of the committee. "It does not help them to do this fast and wrong. It does help them to do it deliberately, carefully and right."
Witnesses at the hearing, the focus of which was improving consumer access to electronic health records, testified about the need to involve patients in their own care and the challenges surrounding that task.
For instance, Eric Dishman, an Intel fellow and general manager for the company's health and life sciences divisions, said that current standards are not specific enough.
"I believe the software vendors realize where the puck is going and [we] are moving toward interoperability," said Dishman, a cancer survivor. "But some of the standards are not specific enough and they leave too much leeway."
To that end, Dishman said, there needs to be "implementation specs" in addition to rigorous standards.
"This is like getting a car, but it's not yet ready to drive until you get somebody to put all of the pieces together to actually use it," Dishman said. "An implementation spec that's very specific and that's common across all of these would help to drive the standards that are becoming real into actual practice."
He added that Meaningful Use is not just a technical challenge, but also the "redefinition of the social covenant" between providers and patients.
"We're undoing 150 years of 'the doctor has the information as a lone practitioner,'" Dishman said. "Moving to the paradigm of coordinated care teams where patients are part of it--this is hard. I had to actually fight to be a bona fide member of my care team. ... That requires re-education of the patient to have more responsibility and re-education of the clinicians."
Raj Ratwani, scientific director for MedStar Health's National Center for Human Factors in Healthcare, said that EHRs should be designed more with doctors and patients in mind.
"We need to design these systems so they're intuitive for clinicians to use, intuitive for patients to be able to adjust their information, and importantly, it's not just about the interaction pieces," he said. "It's also about how the information is represented."
Both the College of Healthcare Information Management Executives and the American Medical Association praised Alexander's call for a delay to Stage 3. CHIME Vice President of Congressional Affairs Leslie Krigstein, in a statement released shortly after the hearing, said that the organization values the senator's "recognition that hospitals and health systems are still working to meet requirements under Stages 1 and 2."
AMA President Steven Stack, meanwhile, called a delay necessary given the need to improve EHR usability and interoperability. "There is growing bipartisan recognition that the Meaningful Use program needs adjustments to achieve its goals," Stack said in a statement. "Proper reassessment of the program before implementing the final stage of regulations will help avoid problematic software that physicians and patients will be burdened with for years to come."