CMS: Listen to the trench warriors

One of the biggest themes emerging this week--as the Centers for Medicare & Medicaid Services stands poised to unveil its proposed rule outlining its vision for Stage 2 of Meaningful Use--is that the incentive program isn't as useful as it could be for providers.

That's not to say that adoption of electronic health records is impractical or bad for the industry. Quite the opposite. We know that EHRs provide many benefits. But Meaningful Use doesn't provide optimum real world applicability, and the people who deal with this on a granular level are more willing than ever to point that out.

This comes at a crucial time. HHS' fiscal year (FY) 2013 budget, released this week, allocates $66 million for its Office of the National Coordinator for Health IT (ONC) to accelerate the adoption of health IT and promote EHRs as tools to improve the health of both individuals and the healthcare system as a whole. That's $5 million more than last year.

According to the budget, HHS aims to increase the number of providers attesting to Meaningful Use from an estimated 80,000 in FY 2012 to 140,000 by the end of 2013. The budget includes $7.8 million, an increase of $2 million, to allow ONC to work with community and healthcare organizations to share best practices and encourage the adoption of Meaningful Use of health IT.

The budget specifically states that "by encouraging providers to modernize their systems, this investment will improve the quality of care and protect patient safety."

But if the program contains flaws, then HHS's ambitious plans may not be met.

Let's take a look at some real world, practical examples just from this week. Meaningful Use requires providers to electronically report immunizations and other information to public health departments. But without more funding to the public health departments, they'll be unable to process the overwhelming influx of information. 

Stage 2 of Meaningful Use will also require providers to demonstrate that their EHRs can exchange information. But without a standard EHR interface, providers are creating private networks rather than pushing for the broader, more useful national health information network, Dawna Paton, managing partner of Gantry Group tells FierceEMR. And the program only requires one-way public health reporting, so the provider neither can use its required reporting to public health entities to demonstrate interoperability nor reap any benefit from information the public health entity may have and could send to the EHR, such as whether a patient has already been immunized.

Or look at certification itself. To successfully attest to Meaningful Use, a provider needs to use an ONC-certified EHR and attest to various clinical quality measures. All well and good. But the EHR isn't required to work well, warns Karen Bell, head of the Certification Commission for Health Information Technology (CCHIT). "The current situation will continue for Stage 2. There will be no required testing for integration and workflows are not driving [Meaningful Use]," she tells FierceEMR.

HHS officials are working very hard to meet their goals, and they should be lauded for their herculean efforts. They want EHRs to be practical, to work effectively in the real world. Members of HIT's policy committee seemed grateful for the feedback on the practical problems practices are experiencing in attesting to Meaningful Use and eager for additional feedback. But the program can be tweaked.

So please take heed of what those in the trenches are saying. Sure, some of them just complain. But most of them do offer suggestions to resolve some of the program's deficiencies. It's a real opportunity to give more stakeholders buy-in and to make the program the best it can be. - Marla

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