Could some Meaningful Use objectives be too aggressive?

As we examined in last week's commentary, many provider and healthcare industry groups had a lot to say about what they would like to see in Stages 2 and 3 of achieving Meaningful Use for electronic health records (EHRs).

This week, a new perspective is offered by the Certification Commission for Health Information Technology (CCHIT) on what maybe should be held back for the current time. CCHIT, a federally authorized health IT testing and certification body, conducted a survey, which sought to find out current opinions on Meaningful Use objectives and measures--incorporating both clinical workflow perspectives and perceived technological challenges.

According to a post by CCHIT Chair Karen Bell, MD, they received an earful from the survey's 468 responders that included providers (36 percent), electronic health record (EHR) vendors (29 percent), and others (29 percent).

Of the nine proposed Stage 2 Meaningful Use core measures that are enhancements of Stage 1 objectives and measures for successful EHR use, all nine were considered "too aggressive" by at least one-third of the survey participants. Several measures were even considered too aggressive by most of the survey respondents.

Here's part of the breakdown:

More than 50 percent of providers and 40 percent of EHR vendors and others thought that the proposed Stage 2 requirement of electronic reporting to public health agencies for syndromic surveillance was not ready to be a core measure for Stage 2.

Many respondents pointed to the fact that many public health agencies--facing budget cuts--do not have infrastructures to accept and analyze data. In addition, many said that no infrastructure is available to support information exchange from technical and policy perspectives, according to the CCHIT analysis.

The provision for drug formulary checks requires that a large percentage of patients seen by providers have formularies available in the system. Many survey respondents thought this would be difficult for certain providers who see patients with a large variety of insurance plans and separate formularies--or who see patients whose formularies are not readily available.

With clinical decision support (CDS), survey respondents thought it was premature to go beyond Stage 1 because a supporting infrastructure has not yet been built beyond a few simple decision support rules. While this may be possible by Stage 3, many said providers should not be held accountable to any CDS beyond what is now available--until this infrastructure can be built.

With medication reconciliation, many responded that few settings are actually doing this as part of Meaningful Use Stage 1. However, a number of responders did recommend making it core in Stage 2--but not increasing the percent of patients to which it applied (from 50 percent to 80 percent) until Stage 3.

Several other points are raised as well by CCHIT's Bell, but the message comes down to it's important not just to discuss what should be included in Stages 2 and 3, but what should be held back--at least for now. - Jan

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