The Centers for Medicare & Medicaid Services' proposed rules implementing Stage 3 of the Meaningful Use program and adding flexibility to the current stages are steps in the right direction but still challenging to providers, according to several hospital CIOs.
The CIOs, participating in an online "member reaction panel" on Wednesday to a presentation by Elizabeth Holland of CMS' policy and outreach division of health IT on the proposed rules, expressed concern about the rules, particularly the requirements not controllable by the providers themselves.
"The measures that involve actions by someone else are difficult, especially with the bar up [in Stage 3] after being put down in the flexibility rule," pointed out Pamela McNutt, senior vice president and CIO of Methodist Health Systems in Dallas.
Other panelists agreed. Howard Landa (pictured), chief medical information officer of Oakland, California-based Alameda Health System, pointed out that while it's a value added to increase patient engagement, trying to get people to do things just to reach a number is "artificial" to providers. Also, he said, if patients don't reach out to the providers, then the onus is on the providers to reach out to the patients, which could create a backlash to communicate just to show that the providers did so.
"We can take the horse to water but can't make them drink," Albert Oriol, CIO at Rady Children's Hospital in San Diego, said.
Even if the providers can succeed in engaging patients to meet the Meaningful Use Stage 3 thresholds, new problems will arise, according to the CIOs. For instance, while the patient generated health data objective proposed for Stage 3 is conceptually "wonderful," Landa said, there are problems not only in getting patients to provide such data, but how to deliver it, how to review and validate it and how to incorporate it into the record.
"Patients tell different stories to different people. What do I do with that discrepancy?" Landa said. "A lot of these pieces no one has looked at."
The problem is not limited to patient engagement; other aspects to Meaningful Use remain out of the providers' control, as well, they said. For instance, it's difficult to meet the electronic prescribing thresholds because many pharmacies are still in the 20th or even 19th century and don't have the capability to receive them, Oriol said.
Another issue the CIOs said they would like addressed is the creation of a unique patient identifier, to allow providers to adopt technology in a way that is "smart" rather than "forced."
"I wish the [regulatory] genie would make it all go away," McNutt said.
Comments on the proposed Stage 3 are due May 29; comments on the flexibility rule are due in mid-June.