Citing 'System Failure,' AHA Urges Delay of MU Stage 2

The processing of federally mandated quality measures by electronic health records systems "raises costs and effort for providers without leading to accurate data and is not sustainable," the American Hospital Association asserts.

The American Hospital Association is continuing its call to delay the Oct. 1 deadline for Meaningful Use Stage 2 because of widespread complaints that electronic health records cannot accurately process federally mandated quality measures.

"(The) successful implementation of current policy requirements for eCQMs (electronic clinical quality measures) must be redirected so that the EHRs are working for the clinicians rather than the clinicians spending extensive amounts of time working for the EHRs," AHA recommended in a report.

AHA said that EHRs were initially expected to collect data through the routine care process and that the eCQM reporting tool would accurately extract and report measurements from the existing data and reduce provider burden. So far that hasn't happened because much of the needed data was not captured in the required format.

Instead, the report said "the current process raises costs and effort for providers without leading to accurate data and is not sustainable. More time is needed to develop and test a smaller set of eCQMs and demonstrate their feasibility."

Diane Jones, senior associate director of policy at AHA, declined to offer a definite timeframe for the rollback her association is seeking.

"We don't really have that," Jones says. "Our challenge is that we really need to see some evaluation about the real experience. We did this study based on our members and I would imagine that (Centers for Medicare & Medicaid Services) and others would have even more resources available to understand the larger scope of the problem. But we are very concerned about these requirements and the current pace of the program."
Jones says there are a number of reasons for the problems that have dogged EHR quality measures.

"The cumulative effect of all of these problems was system failure," she says. "It started out with the whole design of the policy itself, that we have this requirement that we report using specifications that are published after the final rule for the meaningful use program are published and there is a mad dash to actually implement them."

"Slow down the timeline to bring forward these specifications so that the vendors know what it is they are supposed to support and the providers have a clear understanding of what it is they are expected to do with this technology."

The AHA report examines the efforts of four hospitals of varying sizes and locations across the country as they try to make operational quality measures within their EHRs. The hospitals were not identified in the report.

"We decided to not focus on the 'who' and focus the uniform experience across the hospitals," Jones says. "We made a point of reaching out to hospitals that are not just champions of EHR but had experience using EHR even prior to the Meaningful Use program, and yet these folks were experiencing challenges. This is a diverse group. It is not one region of the country. They didn't use the same EHR technology and yet their experience was the same."

The report recommends:

• Slowing the pace of the transition to electronic quality reporting with fewer, but better-tested measures, starting with Stage 2. The additional time would allow: policymakers to create a reliable policy process for eCQM implementation, a mechanism to provide eCQM updates, and a robust EHR testing/certification program; vendors to develop tools that support logical workflows, produce accurate measures and leverage all data already in the EHR; and hospitals to implement the tools in a way that supports their quality goals without excessive burden or risk to patients.
• Making EHRs and eCQM reporting tools more flexible so that data capture can be aligned with workflow and interoperable so that data can be shared across hospital department systems.
• Improving health IT standards for EHRs and eCQM reporting tools to address usability and data management to achieve Meaningful Use program expectations. Additional EHR fields to capture structured clinical information disrupts the usual clinical workflow, increases time on narrative and structured data documentation and decreases time for patient care.
• Testing eCQMs for reliability and validity before adopting them in national programs. Implement eCQMs within hospitals as part of testing to ensure information flow is accurate and there is no adverse impact on quality and patient safety.
• Providing clear guidance and tested tools to support successful hospital transition to increased electronic quality reporting requirements.

The report marks the latest public push by the AHA to roll back the MU Stage 2 Deadlines. Last week AHA President and CEO Rich Umbdenstock and AMA CEO James. L Madara, MD, sent a joint letter to Health and Human Services Secretary Kathleen Sebelius urging more "flexibility" in meeting the program's "all or nothing requirements."

"Our members, and the vendors they work with, report growing concerns that the rapidly approaching start date for Stage 2 is on a trajectory that will not provide enough time or adequate flexibility for a safe and orderly transition unless certain changes are made," the letter states.