Healthcare leaders from across the nation are renewing calls for the Centers for Medicaid and Medicare Services (CMS) to shorten the meaningful use (MU) reporting period in 2015 and provide more program flexibility, citing concerns with lower-than-expected Medicare numbers and continued reports detailing nationwide difficulty in meeting federal guidelines for electronic health records (EHR) requirements.
According to newly released CMS numbers, less than 17 percent of the nation’s hospitals have demonstrated Stage 2 capabilities. Further, less than 38 percent of eligible hospitals (EHs) and critical access hospitals (CAHs) have met either stage of meaningful use in 2014, highlighting the difficulty of program requirements and foretelling continued struggles in 2015. And while eligible professionals (EPs) have until the end of February to report their progress, only 2 percent have demonstrated Stage 2 capabilities thus far.
Officials from the American Medical Association (AMA), College of Healthcare Information Management Executives (CHIME), Healthcare Information and Management Systems Society (HIMSS) and Medical Group Management Association (MGMA) called the results disappointing, yet predictable.
“Meaningful use participation data released today have validated the concerns of providers and IT leaders. These numbers continue to underscore the need for a sensible glide-path in 2015,” said CHIME president and CEO Russell P. Branzell, FCHIME, CHCIO. “Providers have struggled mightily in 2014, in many instances for reasons beyond their control. If nothing is done to help them get back on track in 2015, we will continue to see growing dissatisfaction with EHRs and disenchantment with meaningful use.”
CMS data required by Congress indicate that more than 3,900 hospitals must meet Stage 2 measures and objectives in 2015 and more than 260,000 eligible professionals (EPs) will need to be similarly positioned by January 1, 2015. Given the low attestation data for 2014 and the tremendous number of providers required, but likely unable to fulfill, Stage 2 for a full 365-days in 2015, healthcare leaders have pressed for a shortened reporting period in 2015, mirroring the policy of 2014.
Electronic health records uptake in the U.S. has accelerated dramatically as a result of government initiatives and the considerable resources – both capital and time – healthcare providers have invested over the past five years. Electronic health records have become the heart of health IT, and U.S. clinicians use them on a daily basis.
Frost & Sullivan’s newest health IT analysis, “EHR Usability—CIOs Weigh in On What’s Needed to Improve Information Retrieval,” finds that as the market matures and the volume of EHR data proliferates, ensuring reliable information retrieval from EHRs at the point-of-care will become a priority for healthcare providers.
In spite of significant progress in EHR adoption, the road is paved with pitfalls for many providers. Frequently highlighted customer pain points include:
Slow and inaccurate information retrieval from EHRs, as well as difficulty in finding and reviewing data, both of which result in productivity losses for clinician end-users as well as potential risks to patient safety.
Inability to create targeted queries or easily access unstructured data such as clinician notes.
Time-consuming data entry tasks.
“U.S. regulatory authorities will take notice of the growing chorus of complaints about EHR usability, resulting in a push to devote more resources to solving this issue,” saidFrost & Sullivan Connected Health Principal Analyst Nancy Fabozzi. “Further, the high levels of end-user frustration with usability present strong business opportunities for pioneering technology vendors.”
The College of Healthcare Information Management Executives released the following statement in support of embracing federal interoperability plans:
The federal government’s top health IT advisers recently made recommendations on how public and private stakeholders should progress toward interoperability in healthcare. Leaders from the College of Healthcare Information Management Executives (CHIME) and Health Level Seven International (HL7) embraced the recommendations of the JASON Task Force, calling them a significant step forward in achieving the promise of information technology in healthcare. CHIME and HL7 also highlighted the need to incorporate critical enhancements to standards currently under development for meaningful use Stage 3.
During a joint meeting of the Health IT Standards and Health IT Policy Committees, federal officials discussed new details regarding a national interoperability roadmap and outlined concrete recommendations meant to improve the appropriate access and use of health data. The JASON Task Force said that a solid foundation for interoperability should utilize public APIs, advance modern communications standards, such as HL7’s Fast Healthcare Interoperability Resources (FHIR), and use meaningful use Stage 3 as a pivot point to initiate this transition.
FHIR is a simple-to-use format that can improve interoperability for a range of technologies, including EHRs, patient-centric solutions and mobile applications. A next generation standards framework created by HL7, FHIR combines the best features of HL7’s Version 2, Version 3 and CDA product lines while leveraging the latest web standards and applying a tight focus on implementability.
“Today’s discussion and the recommendations of the JASON Task Force represent an evolution in thinking,” said CHIME president and CEO Russell P. Branzell, FCHIME, CHCIO. “The updated roadmap and the recommendations put forth by the JASON Task Force incorporate a tremendous amount of stakeholder input and articulate the challenges facing our industry much more completely than previous efforts.”
“The prioritization of standards-based interoperability and a commitment to long-term policymaking will enable healthcare to benefit from information technology in very tangible ways,” said Charles Jaffe, MD, PhD CEO of HL7.
CHIME and HL7 believe important recommendations were accepted by the full Health IT Standards and Health IT Policy Committees. HL7 and CHIME also support allowing time to make meaningful use Stage 3 more impactful with the inclusion of key standards that are still under development. “There remains a disconnect between artificial government timelines and the realities of standards and technology development,” Branzell said. “This highlights a principle concern with how health IT policy is created, adopted and implemented at the federal level.”
CHIME and HL7 are committed to collaboration in the advancement of health IT initiatives such as FHIR and support government efforts on the interoperability roadmap.
CHIME is an executive organization dedicated to serving chief information officers and other senior healthcare IT leaders. With more than 1,400 CIO members and more than 140 healthcare IT vendors and professional services firms, CHIME provides an interactive environment enabling senior professional and industry leaders to collaborate; exchange best practices; address professional development needs; and advocate the effective use of information management to improve the health and healthcare in the communities they serve.
A new survey of senior information technology executives at some of the nation’s largest health systems reveals that their top priority for IT infrastructure investment is analytics – a technology that is central to achieving the systematic quality improvements and cost reductions required by healthcare reform.
Health Catalyst surveyed members of the College of Healthcare Information Management Executives (CHIME), all chief information officers (CIOs) or other senior IT executives of US healthcare organizations. Survey respondents provided a high-level view of the many competing priorities for IT investment that hospital leaders face in the era of “value-based care” – a term describing elements of the Affordable Care Act as well as private industry incentives that reward providers for improving their patients’ health.
Most experts agree that value-based care will require hospitals to use sophisticated analytics to comb through terabytes of clinical and financial data to reveal actionable opportunities for improving quality and efficiency. The survey’s findings confirm that view, with 54 percent of respondents rating analytics as their highest IT priority, followed by investments in population health initiatives (42 percent), ICD-10 (30 percent), accountable care/shared risk initiatives (29 percent), and consolidation-related investments (11 percent).
Congresswoman Renee Ellmers (R-NC-02) released the following statement after introducing H.R. 5481 – The Flexibility in Health IT Reporting (Flex-IT) Act of 2014:
“Healthcare providers have faced enormous obstacles while working to meet numerous federal requirements over the past decade. Obamacare has caused many serious problems throughout this industry, yet there are other requirements hampering the industry’s ability to function while threatening their ability to provide excellent, focused care.
“The meaningful use program has many important provisions that seek to usher our healthcare providers into the digital age. But instead of working with doctors and hospitals, HHS is imposing rigid mandates that will cause unbearable financial burdens on the men and women who provide care to millions of Americans. Dealing with these inflexible mandates is causing doctors, nurses, and their staff to focus more on avoiding financial penalties and less on their patients.
Congressman Jim Matheson
“The Health IT Reporting Act will provide the flexibility providers need while ensuring that the goal of upgrading their technologies is still being managed. I’m excited to introduce this important bill and look forward to it quickly moving on to a vote.”
Congresswoman Renee Ellmers introduced H.R. 5481 – the Flexibility in Health IT Reporting Act of 2014. The legislation would allow healthcare providers to receive the flexibility they need to successfully comply with meaningful use program.
On August 29th, the HHS published a short-sighted final rule, maintaining a provision that requires providers to perform a full-year EHR reporting period in 2015. According to Ellmers, “The Flex-IT Act will allow providers to report their health IT upgrades in 2015 through a 90-day reporting period as opposed to a full year. This shortened reporting period would be an important first step in addressing the many challenges faced by doctors, hospitals and other medical providers due to the inflexible mandates of the meaningful use program.”
In a letter to HHS Secretary Sylvia M. Burwell, the College of Healthcare Information Management Executives (CHIME), the Association of Medical Directors of Information Systems (AMDIS) and 15 other healthcare organizations issued an immediate call to action to adjust the 2015 EHR reporting period to help hundreds of thousands of providers meet Meaningful Use Stage 2 requirements in an effective and safe manner.
Responding to the Centers for Medicaid and Medicare Services’ (CMS) final rule on meaningful use flexibility, the letter states the agency’s decision to require a full-year of reporting using 2014 Edition certified EHR technology (CEHRT) in 2015 puts many eligible hospitals and physicians at risk of not meeting Meaningful Use next year and hinders the forward trajectory of the program.
“We implore you to take immediate action by shortening the 2015 EHR reporting period to 90 days and by adding flexibility in how providers meet the Stage 2 requirements,” the letter states. “The additional time and flexibility afforded by these modifications will help hundreds of thousands of providers meet Stage 2 requirements in an effective and safe manner. This will reinforce investments made to date and it will ensure continued momentum towards the goals of Stage 3, including enhanced care coordination and interoperability.”
As the Centers for Medicaid and Medicare Services (CMS) and the Office of the National Coordinator for Health IT (ONC) finalized a regulation granting providers additional flexibility in meeting meaningful use (MU) requirements in 2014, the final rule lacked a key provision that would ensure continued EHR adoption and MU participation, according to CHIME.
CHIME issued as statement stating that the organization is “deeply disappointed in the decision made by CMS and ONC to require 365 days of EHR reporting in 2015. This single provision has severely muted the positive impacts of this final rule. Further, it has all but ensured that industry struggles will continue well beyond 2014.”
According to the statement by CHIME, roughly 50 percent of EHs and CAHs were scheduled to meet Stage 2 requirements this year and nearly 85 percent of EHs and CAHs will be required to meet Stage 2 requirements in 2015. Most hospitals who take advantage of new pathways made possible through this final rule will not be in a position to meet Stage 2 requirements beginning October 1, 2014. This means that penalties avoided in 2014 will come in 2015, and millions of dollars will be lost due to misguided government timelines.
Nearly every stakeholder group echoed recommendations made by CHIME to give providers the option of reporting any three-month quarter EHR reporting period in 2015. “This sensible recommendation, if taken, would have assuaged industry concerns over the pace and trajectory of rulemaking; it would have pushed providers to meet a higher bar, without pushing them off the cliff; and it would have ensured the long-term vitality of the program itself. Now, the very future of Meaningful Use is in question,” said CHIME.
The College of Healthcare Information Management Executives (CHIME) welcomes today’s announcement from the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC),on a proposed rule that would give healthcare organizations and professionals a greater chance to continue participation in the Meaningful Use program in 2014.
While the proposed changes are complex, CHIME believes the adjustments will ensure broad program participation and will enable providers to continue their meaningfuluUse journey.
“If the government acts quickly to finalize the proposed rule, it will provide the flexibility needed for our members and their organizations to adequately optimize newly deployed technology and ensure success of the program,” said CHIME President and CEO Russell P. Branzell, FCHIME, CHCIO.
According to the proposed rule, eligible professionals, eligible hospitals and critical access hospitals will be allowed to use 2011 Edition Certified EHR Technology (CEHRT), 2014 Edition CEHRT or a combination of the two Editions to meet meaningful use requirements in 2014. Because providers are at various Stages and are scheduled to meet different Stage requirements in 2014, CMS and ONC also have proposed giving providers the option of meeting Stage 1 requirements or Stage 2 requirements.
