Intermountain to Miss 2014 Meaningful Use Attestation Deadline, Citing Safety Concerns

Despite its sophistication in healthcare IT, the CIO of Intermountain Healthcare says the organization is unready and will forgo incentive payments and trigger penalties. Federal officials acknowledge that many health systems take issue with the meaningful use deadlines.

Update: CMS Administrator Marilyn Tavenner, speaking at the HIMSS 2014 conference in Orlando Thursday morning, announced that CMS has decided to permit flexibility on how hardship exemptions will be granted for meeting 2014 Meaningful Use Stage 2 attestation deadlines. "I must stress we expect all providers to meet requirements in 2015. I urge you to meet the requirements this year."

In an exclusive interview with HealthLeaders Media, Intermountain Healthcare CIO Marc Probst says the organization is planning not to attest for meaningful use Stage 2 in 2014, forgoing a sizable incentive payment and triggering penalties in 2016 from CMS.

"We don't feel confident we can attest in 2014 and maintain our current level of patient safety," Probst says.

Intermountain has begun transitioning from its own homegrown electronic health record software to software provided by Cerner, but that transition is such a lengthy process that only three of Intermountain's hospitals will be running on the new EHR by the end of the year, Probst says. He spoke with HealthLeaders Media at the HIMSS 2014 conference in Orlando.

The remainder of those hospitals will continue to run Intermountain's own EHR, which the health system will certify for MU Stage 2 this year. But the attestation will take place next year, Probst says.

The buzz at this week's HIMSS annual conference in Orlando was that some large providers could miss their 2014 attestations, although there were few public acknowledgements. The topic has also been of great interest recently on the member-only list serve of the Association of Medical Directors of Information Systems, according to Lyle Berkowitz, MD, a Chicago-area physician leader.

Elsewhere at the HIMSS conference, numerous physician practice leaders interviewed by HealthLeaders Media indicated their confidence in meeting the 2014 attestation deadline, reaping incentive money and avoiding penalties.

Another large hospital using homegrown software is better positioned than Intermountain to attest this year. "The short answer is we are finished with our certification at Beth Israel Deaconness [as of] March," says John Halamka, CIO of Beth Israel Deaconess Medical Center in Boston.

"We'll use April through June as our attestation period, and then we'll attest in July," Halamka told HealthLeaders. "Of course we do this to avoid penalties, and it's unclear whether an extension will be offered to the attestation timeframe, although certainly there are many organizations that require such an extension.

"It's touch and go, and the only reason that we are able to achieve the timeframe is because we self-build the software and therefore are very agile. If we would have had to depend on vendor software, chances are we would not have been able to hit the deadlines that are currently in force for Stage 2."

Halamka echoes the hope that many other CIOs at HIMSS expressed: that the Department of Health and Human Services and its Office of the National Coordinator for Health Information Technology will give significant consideration to a letter sent by many organizations to HHS Secretary Kathleen Sebelius earlier this week asking for relief from pending meaningful use deadlines.

In another exclusive interview with HealthLeaders Media, ONC Chief Medical Officer Jacob Reider acknowledged that Intermountain had been warning the agency for some time that it would miss the 2014 attestation deadline, and that other large healthcare systems were in similar straits.

"A number of organizations have expressed to ONC and CMS their concern about the trajectory of the program," Reider says.

"What's the next step of the value stream?" Reider says. "It's implementing certified product, and I think that's where you're hearing from…many [leaders] that in order to incorporate all of the workflow changes and the use of new functionality that's in new certified product, this isn't a flip-the-switch, especially for a large care delivery organization."

"When we talk to vendors of products that serve small markets, and we talk to the users of those products in small markets, they're not as concerned. They're concerned, but they're also not quite as sophisticated as an organization like Intermountain," Reider adds.

"A small practice is thinking, what's going to happen next month. Intermountain is thinking 6, 12, 18 months in the future. So I think we heard ahead of time and we're hearing now that they're concerned that this too high a hill to climb."

Reider says that if providers fall short of the 2014 deadlines, it should not mean that the meaningful use program is a failure.

"Some may characterize this as a failure. I don't see it as a failure," Reider says. "I see it as a challenge, because we want them to get their incentive dollars. We want them to avoid a penalty. We want those things to happen, and so we want them to attest to meaningful use. Don't get me wrong. If they, for various reasons, make choices not to, we still don't see that as a failure of the program. We don't see that as a failure of health information technology. We're still on the path."