RWJF's report on MU gives validity to pausing Stage 3

It's not often that you see one report hedge its bets so often regarding whether something is working.

But that's exactly what the Robert Wood Johnson Foundation's (RWJF) annual health IT report does regarding the Meaningful Use program. 

The 112-page report addresses myriad issues pertaining to the HITECH Act's design, goals and impact. 

And we get the truth. But it's also a dodge.   

For instance, the report says:

  • The HITECH Act has helped initiate "significant" progress in the use of health IT, but fell short of its overall goals.
  • While the law spurred the adoption of electronic health records, physicians and hospitals that attested to Stage 1 are barely making it to Stage 2. Only 1,826 hospitals had successfully attested to Stage 2 of the program, far fewer than the 4,379 that attested previously. What's more, only 20 percent of physicians who had attested to Stage 1 in the past attested to Stage 2. According to the report, these numbers indicate that providers were facing substantial challenges in meeting the more stringent requirements.
  • Health information exchanges (HIEs) were operating in most states and were helping providers meet the Meaningful Use data sharing requirements, but faced several major challenges, including financial sustainability and their inability to recruit and retain staff. Without comprehensive policy changes implemented quickly, HIEs will "continue to struggle."
  • The regional extension centers helped more than 90 percent of providers who asked for help in adopting an EHR, but had less success in helping them demonstrate Meaningful Use.
  • EHRs have moved patient records into digital form, but that created "corporate islands" that could exchange information mainly among themselves, not with others. While future interoperability was looking up because of upcoming changes to software and payment structures, overall data exchange was "barely better than it was close to a decade ago." 
  • The early signs on the lasting impact of the HITECH Act were "promising" but its legacy "remains to be seen."

It's almost as if HITECH's goals were too ambitious, which the report alludes to. Perhaps had it been more modest, the law would have racked up more successes.

The report then says that the program's greatest contribution may have been to delineate the lessons learned and challenges that still need to be addressed in advancing health IT. Not the best ringing enforcement of the program itself.

The authors don't opine on the direction the Meaningful Use program should take going forward, which is unfortunate, since that could have been illuminating.

But they do make the calls to delay Stage 3 even more compelling.   

I have no problem with a program or initiative serving as a litmus test. That's done all the time. Look at all of CMS' pilot payment and audit programs.

But the Meaningful Use program is not a pilot program. It's a multi-year, national project. It's expensive. There's a lot at stake. 

While the industry needs direction regarding Stage 3, it still doesn't have the final rule softening the requirements for 2015-2017, and 2015 is almost over.

And if Stage 2 is still struggling, then it may not be the best foundation upon which to build Stage 3.

It's certainly powerful for lawmakers and provider groups to call for Stage 3 to be paused while the program is reevaluated. But it's even more persuasive when one looks at the evidence laid bare in the RWJF report. - Marla (@MarlaHirsch and @FierceHealthIT)

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