How health IT, MU policy could 'hinder' payment reform

Meaningful Use helped accelerate the adoption of electronic health records, but now it should be changed to align IT with other payment reforms and policies and support higher value care, according to a new health policy brief from the Brookings Institution's Engelberg Center for Health Reform.

The brief, written by visiting scholar Peter Basch and Senior Fellow Mark McClellan, flags a number of problems with current health IT policy. In addition to gaps in interoperability, the EHR certification program has simplified the requirements and process measures so much that they don't support the needs of clinicians. Certification also doesn't include access to timely, accurate and actionable information on the cost and health plan coverage of tests and treatment, and plans or employers often won't accept data in standardized formats, requiring duplicate documentation.

The authors recommend several changes to health IT policy, including:

  • Remove the current requirement connecting EHR functionality to MU process measures
  • Tie MU penalty avoidance and bonuses to reporting on relevant, outcome-oriented performance measures
  • Support the development of value-based payment models and meaningful performance measures in each area of clinical care
  • Highlight opportunities for health IT vendors to insert principles of user-centered design
  • Focus on identifying and disseminating interoperability standards that enable high value care
  • Implement the Office of the National Coordinator for Health IT's Interoperability Roadmap in a manner that emphasizes interoperability driven by actual business cases, including cost and coverage data interoperability
  • Develop more flexible and adaptive business cases for how health IT and EHRs could further evolve based on specialty-specific and scope of practice needs
  • Increase efforts to support standards and methods to enable reporting of outcome and value measures directly from EHRs
  • Support more progress toward the timely availability of accurate and actionable information regarding cost and coverage of health IT across the care continuum

"[T]here is concern within the healthcare community that existing health IT policy may fail to incent and even hinder health IT innovations and evolution necessary to enable a value-based payment system," Basch and McClellan say. "Our policy recommendations should enable more progress in achieving an adaptable health IT infrastructure by helping existing policy transition from one that is too narrow and prescriptive to one that can give MU more practical meaning that resonates with providers and patients by more directly supporting improved outcomes, administrative efficiency, and value."

Many stakeholders have expressed concern and frustration regarding the direction of Meaningful Use and health IT. The Centers for Medicare & Medicaid Services and ONC have made efforts to tweak the program to make it more palatable but has not indicated that it plans on changing its direction or focus. The rule implementing Stage 3 of the program is under review at the Office and Management and Budget and should be released shortly.

To learn more:
- access the health policy brief

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