The Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the 2009 stimulus legislation, authorizes the Department of Health and Human Services (HHS) "to establish programs to improve health care quality, safety, and efficiency through the promotion of health information technology (HIT), including electronic health records and private and secure electronic health information exchange."
Judging by that description, the Meaningful Use EHR incentive program was always about more than just ensuring that the federal government spent its money wisely on HIT. Congress' real objective was to reshape the healthcare delivery system. To be sure, provisions of the Patient Protection and Affordable Care Act (PPACA) are also directed to the same end. These include sections that authorize HHS to promote accountable care organizations (ACOs), bundled payments, medical homes and value-based purchasing. Nevertheless, none of these PPACA provisions has yet affected as many providers as the Meaningful Use program has. Moreover, the success of these care delivery innovations will depend in large part on how well the EHR incentive program works.
In Meaningful Use Stage 1, providers are mainly supposed to show they're using the basic functionality of their certified EHRs. But even in this phase, they must apply that functionality to meet goals that are designed to improve quality and efficiency. For example, hospitals and eligible professionals must use computerized physician order entry (CPOE) to order medications for at least 30 percent of patients; must use drug-drug and drug-allergy checks; must implement a clinical decision support rule; and must report quality data to states or the Centers for Medicare and Medicaid Services (CMS). They must also demonstrate the capability to exchange data with other providers.
The Meaningful Use Stage 2 proposals take these steps much further and add new criteria. For example, the CPOE requirement remains, but the percentage of orders is doubled from 30 percent to 60 percent. Most Stage 1 optional menu items are core criteria in Stage 2, including medication reconciliation at transitions of care and an electronic medication administration record (eMAR) in hospitals. Among the new requirements are CPOE for lab and radiology orders, giving patients the ability to view, download, and transmit their own medical information, and exchanging data at transitions of care with non-related providers.
This description only hints at the far-reaching effects these proposed criteria--most of which will probably make it into the final rule--will have on the healthcare industry. Here are just a few:
- Raising the CPOE percentage to 60 percent will require hospitals to go beyond the early adopter physicians and convince the more traditional doctors that CPOE will be good for patient care and won't slow them down too much.
- eMAR requires the bar coding of all doses of medicine administered in hospitals. That's a tall order, considering that many suppliers don't bar code medications or just bar code the larger packages in which those drugs arrive.
- Eligible professionals are supposed to send reminders for preventive and followup care to at least 10 percent of patients seen in the previous 24 months. In many practices, that will require an entirely new workflow, as well as automated systems to make patient outreach economically feasible.
- Exchanging data with non-related providers at transitions of care will probably be limited initially to Continuity of Care Documents (CCDs). Still, the mechanisms for data transport, such as those that that enable data exchange using the Direct secure messaging protocol, are still being built, and health information exchanges are either lacking or in early stages in many areas.
The good news is that the proposed Stage 2 criteria will move the industry further down the road toward creating an efficient, safe, high-quality healthcare system. The bad news is that getting there will create a lot of pain points in healthcare organizations. It's like driving down a dirt road to get to a paved highway: there are a lot of bumps along the way, but you have to keep on driving. - Ken