At Meaningful Use anniversary, clarity and usability issues still prevalent

Believe it or not, it's the one-year anniversary of defining criteria for Meaningful Use of electronic medical records (EMRs). On July 13, 2010, the Department of Health and Human Services and the Office of the National Coordinator for Health Information Technology released two long-awaited Meaningful Use final regulations specifying what physicians and hospitals had to do to receive up to $27 billion in bonus incentives for adoption of EMRs.

So how should we classify this first year--with the focus on Stage 1? Good, mediocre, promising, puzzling? Let's see what the numbers say:

Registration and attestation: In the first round of payments that began in May, the Centers for Medicare and Medicaid Services (CMS) got off to a slow start by issuing $75 million in Medicare EMR incentive payments to just 320 eligible provider organizations. These were entities that signed up in the first two weeks of the program (starting April 18) and were able to attest their compliance with the Meaningful Use requirements.

Just over 42,600 eligible professionals and hospitals have registered for the Medicare and Medicaid incentive programs between the beginning of the year through April 30. About 485,000 are potentially eligible to participate.

Are the low numbers surprising? Not really. A survey in April, for instance, from the College of Health Information Management Executives showed that many CIOs had yet to register: just under 20 percent of CIOs at standalone hospitals, and under 30 percent of CIOs at multi-hospital systems say their organizations have registered their hospitals.

In recent weeks, those who have yet to register received some good news about the likely delay of the start time of Stage 2. So time may be on the side of those providers taking who are not first out of the gate.

Certified Products: One rapidly evolving area is the certified (under Meaningful Use) health IT products list, which can be found at the ONC website. Last December, EHRWatch found that the number of certifications listed on the ONC Certified Health IT Product List totaled 187, and in February, it was 329.

This month, it reported a jump to 570 certified products in the ambulatory category and 294 in the inpatient category. The lists include both modular and complete EMR products. Digging down even further, for instance, there were 464 products certified for electronic prescribing, 523 products certified for record demographics; 446 products certified for patient reminders, 444 products certified for clinical decision support; and 423 products certified for electronic copy of health information.

Missing from the lists, though, are costs--either upfront costs of installing and maintaining the health IT tools and software, or the replacement costs providers incurred when they found their current EMR setups didn't meet various Meaningful Use criteria.

Paper proliferation: While it may seem we're in the midst of a digital revolution, paper files and records remain very much a part of the record-keeping scene among providers. Iron Mountain, which is in the paper storage and shredding business, released a survey on Wednesday that found while 70 percent of hospitals expect to claim federal subsidies for meeting stage one MU requirements, 78 percent expect to continue to treat patients using paper records for up to five more years.

Only half (49 percent) of hospitals said they had scanned what they needed and are within their budget, while 23 percent reported that they're within budget, but still have a backlog of records to scan. Paper is not going away any time soon.

So what can be anticipated for year two? Maybe clearer expectations. The rules set out by CMS and ONC "are overly complex and confusing--leaving many hospitals concerned about their ability to meet the programs' demands," the American Hospital Association recently told HHS.

And how about issues such as EMR usability--both of the individual product and as a part of a whole system. How will individuals respond and work with EMRs? There's lots to think about what is in store.

And, before I forget, happy MU year! - Janice