Will Stage 2 of Meaningful Use leave some hospitals behind?

Perhaps prophetically, the day before the government issued the final rules implementing Stage 2 of Meaningful Use, we reported on a study published in the Journal of the American Informatics Association on the substantial changes occurring in the electronic health record market due to the incentive program.

"Meaningful Use and certification represent the single largest government intervention in a multi-billion dollar market, a source of significant ongoing costs for public and private institutions, and a policy that will ultimately change the daily operations of healthcare and public health organizations across the country," the study's authors said.

The researchers analyzed the EHR vendor market to show if, and how, the industry had changed, and if so, if that change occurred in the ways that the architects of this federal policy wanted it to change. They found that indeed, the market was changing "substantially" with upward trends to EHRs, more EHR vendors in the market and more competition.

The study itself is a real eye-opener, outlining in detail the variation in EHR adoption rates among hospitals. It revealed significant disparities, creating gaps in EHR use and coverage. Many hospitals in several of the most rural areas of the country still rely on paper records.

The researchers also expressed serious concern about the ability of smaller hospitals to implement EHRs, which need more help than larger hospitals but for the most part don't qualify for additional assistance. 

The clear implication is that as the industry marches on to Stage 2 of Meaningful Use, those hospitals that already are ahead and have the resources to forge on will do so, while those hospitals that continue to struggle will fall further behind in the implementation process.

That does not bode well for a nationwide health information network and related health IT innovation, which is the ultimate goal of the federal government.

The researchers noted that the federal policies intervened in the market, but that they didn't know if that intervention created the outcomes for which the government had been aiming. I would venture to guess that the government is aiming for a blanket of uniform adoption, not a crazy patchwork quilt with holes in it. And that can have big repercussions on patient care.

For the tremendous effort and resources being poured into this initiative, it would be a shame for it to fall short this way. This study may be one of the first to quantify that the Meaningful Use program needs to be assessed and perhaps fine-tuned.

Let's heed its message. Let's keep a close eye on how providers are faring, and if some of them need additional help to adopt health IT.

The Office of the National Coordinator for Health IT and the Centers for Medicare & Medicaid Services seem to be willing to do so, compromising on deadlines, tweaking measures, and the like. But the agencies can only do so much. As CMS' Rob Anthony acknowledged at the agency's recent webinar explaining the new rules, much of the most substantial provisions of the program, such as eligibility and funding, are governed by the HITECH Act, the statute that created the program. That means that Congress may need to weigh in.

And that means we may have to remind Congress to do so. - Marla

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