Despite the federal government's best intentions to create an interoperable healthcare landscape, the Meaningful Use program has yet to truly prevent information blocking by both providers and vendors, legislators on the Senate's Health, Education, Labor & Pensions committee declared at a hearing Thursday. To that end, they led a discussion focused on potentially delaying Stage 3 of the program, proposed in late March.
Committee Chairman Lamar Alexander (R-Tenn.) said based on what providers have told him, Meaningful Use Stage 3 is a terrifying prospect that could cost systems millions, and in some cases billions, of dollars.
"My instinct is to say to Secretary [Sylvia Mathews] Burwell 'let's not go backward on electronic health records,'" Alexander (pictured) said. "But let's not impose on physicians and hospitals a system that doesn't work and which they spend most of their time dreading."
Alexander clarified he wants to slow down implementation of federal rules, not halt progress altogether, to ensure EHR implementation is done right the first time.
Three of four individuals who testified at the hearing agreed with the notion of delaying Stage 3, although two--David Kendrick, chair of the University of Oklahoma's department of medical informatics, and Michael Mirro, past chair of the medical informatics committee for the American College of Cardiology and current chief academic and research officer at Parkview Mirro Center for Research and Innovation in Fort Wayne, Indiana--said the Office of the National Coordinator for Health IT's EHR certification program should continue.
"We want to delay [Stage] 3 of Meaningful Use in its entirety," Mirro said, adding that Stage 2 has created "incredible inefficiencies" regarding workflow and usability. "We really have to digest the impact of [Stage] 2."
David Kibbe, president and CEO of DirectTrust and a senior advisor to the American Academy of Family Physicians, called for "an immediate moratorium" on Stage 3 until Stage 2 is fixed.
"There are parts of Stage 2 that need to be fixed and improved to ensure that more hospitals and eligible providers can participate in Stage 2 before we go onto anything called Stage 3," Kibbe said. In particular, he said, certification, interoperability, quality reporting and security all must be improved.
Allscripts CEO Paul Black, however, said the Department of Health and Human Services should stay the course with the rollout of Stage 3, noting that 2018 is a long way away.
Niam Yaraghi, a fellow at the Brookings Institution's Center for Technology Innovation, recently wrote that Meaningful Use Stage 3 makes provider too reliant on the actions of others, pointing out that the proposed rule requires an increased number of provider to send electronic summaries for patients they refer to other providers, as well as receive summaries for patients referred to them. No matter how technologically advanced a provider organization is, if it is working with an organization struggling to connect, Stage 3 cannot be completed, he said.
"Given the distance between the proposed rules of the Meaningful Use program and the reality of the healthcare market, the program's success should be considered a miracle," Yaraghi wrote. "Even if this miracle happens, we will not achieve much in terms of quality or efficiency in the healthcare system."
To learn more:
- watch the hearing