Is There a Realistic Approach to Meaningful Use?

Compromise and balance will be the key to meaningful use success.

At the College of Healthcare Information Management Executives (CHIME) 2010 CIO forum held in Atlanta, GA, this week, participants in a town hall meeting made that clear as they discussed a variety of topics, from getting physicians to embrace technology, such as computerized physician order entry (CPOE), to the wisdom of telling your executive team that it must invest in technology to be eligible for stimulus funds under the HITECH provision of the American Recovery and Reinvestment Act (ARRA), which some fear will end up an unfunded mandate.

In a CHIME member survey released at the event, nearly 30% of respondents listed EHR upgrades or implementation as their biggest hurdle. And 41% listed it among their top three concerns. But culture, not systems, will hamper adoption, said panelist Paul Tang, MD, vice president and CIO of Palo Alto (CA) Medical Foundation, who is the vice chair of the HIT Policy Committee and chair of the Meaningful Use Work Group.

Clearly not all healthcare organizations are prepared to meet the requirements. "Everybody is trying to do the right thing," Tang said. "But it's a call to action. … It's up to us to figure out how to get it done."

One audience member asked what CIOs can do to ensure the government takes a more realistic approach to meaningful use. It can't be an all-or-nothing proposition, he said, but must be a "palette approach."

It's impossible to predict what parts of HITECH will be difficult for individual hospitals or health systems to employ—they should be able to choose some aspects of the requirements to postpone. Another way to achieve more flexibility is to "significantly lower" the threshold in the early years while still committing to improvement over time.

CHIMES' comment to the Centers for Medicare and Medicaid Services' (CMS) on its EHR Incentive Program stressed that point, saying that it doesn't take into account providers' need for flexibility and does not reward incremental progress. CHIME wants CMS to give providers until 2017 to achieve EHR implementation. Their proposed incremental approach would deem a provider a meaningful user if it can achieve 25% of objectives by 2011, 50% by 2013, 75% by 2015, and "substantially all" by 2017.