When it comes to Stage 2 of Meaningful Use, the divisive, polarized views appear difficult to reconcile; it's hard to believe that in actuality the industry shares a common goal of safer, more efficient and cost effective quality healthcare.
Evan Steele, CEO of electronic health record vendor SRSSoft, noted in a blog post this week that the overly "aggressive nature" of the proposed requirements has pitted patient against provider, and that the situation has turned into a "battle," for example.
Yet, there really is common ground in the comments, even if the stakeholders disagree about many of the details. In fact, many of the suggestions seem like no-brainers, including ones pertaining to the following areas:
Patient engagement: There's a lot of flak regarding whether patient action should affect a provider's ability to meet Meaningful Use, since providers don't control their patients' use of health IT. And there's no consensus regarding how to actually get patients to interact electronically with providers. But there seems to be general agreement that it's important for patients to be more involved in their care, as noted in comments submitted by Healthwise and the Robert Wood Johnson Foundation.
Alignment of Department of Health & Human Services programs: It would be less burdensome and less confusing if the reporting, health IT, incentive and quality programs--the e-prescribing, physician quality measure reporting, Medicare Shared Savings Program, and the like--were aligned with each other, as groups like the Healthcare Information and Management Systems Society (HIMSS) and the American Medical Association point out.
Alignment with other federal laws: The proposed regulations really should be consistent with existing laws that are integral to the use of EHRs. For instance, while some may disagree with Medical Group Management Association's position that requiring a risk analysis in the incentive program is a duplicative burden--since HIPAA also ready requires one--it's hard to argue with its request that if the Stage 2 rule retains the requirement, then the Centers for Medicare & Medicaid Services will work with the Office of Civil Rights to develop guidance regarding the definition and requirements of such a risk analysis. Likewise, it's reasonable on the part of MGMA to ask CMS to work with the Drug Enforcement Administration to finalize the rule permitting e-prescribing of controlled substances so that physicians can streamline workflows without running the risk of penalties.
Reduction of health disparities: That's a laudable goal suggested by several commenters. For instance, the Leadership Conference on Civil and Human Rights recommended that one way to do so would be to require in Stage 2 that participating providers comply with the Civil Rights Act, the Americans with Disabilities Act and other laws affecting disparities, and to disqualify providers fined for willful neglect of HIPAA.
Extension of the donor safe harbor: The safe harbor that allows hospitals and others to subsidize up to 85 percent of the cost of EHR software to physicians without fear of violating the Stark and anti-kickback laws is set to "sunset" in 2013. Buried in the AMA's comment letter is a request that this safe harbor be made permanent to encourage EHR adoption. Considering that health plans and companies like Quest Diagnostics still are rolling out donor programs pursuant to the safe harbor, it certainly seems worthwhile to extend the legal protection. - Marla