"Meaningful Use" Goals Still Out of Reach

The Health IT Policy Committee approved revised recommendations for defining "meaningful use" of electronic health records this past Thursday. But for many providers—especially rural community hospitals and solo or small group practices—the objectives for meaningful use are still out of reach.

The bar needs to push providers, while ensuring that a reasonable number of leading-edge organizations can achieve it by 2011, says John Haughom, MD, senior vice president of clinical quality and patient safety at PeaceHealth, a Bellevue, WA-based seven-hospital system with a 500-member medical group. Haughom is no stranger to HIT. Roughly 14 years ago, PeaceHealth implemented a community health record that shares patient information with providers throughout the region—including its competitors. The community health record has roughly 2 million patient records in its database and more than 20,000 clinical users—only a portion of whom are PeaceHealth employees.

The HIT Policy committee's recommendations are "pretty close" to where they need to be, says Haughom. But he's concerned that the current recommendations "will discourage organizations that aren't as far along" in the process of implementing EHRs. The three objectives of the ‘meaningful use' recommendations that he says should be scaled back are:

CPOE. The recommendations call for 10% of all orders of any type to be directly entered by an authorized provider through CPOE by 2011. Haughom wants that bar lowered even further. "I'd cut it in half down to 5%," he says. "That means organizations that are reasonably close–even if they haven't implemented CPOE—could launch pilots and have a chance of hitting it," he says. Haughom would prefer the timeline for CPOE to be something like 5% in 2011, 10% or 15% in 2012, and so on.

Electronic problem list. Providers and hospitals must maintain an up-to-date problem list of current and active diagnoses based in ICD-9 or SNOMED by 2011, according to the recommendations. The challenge with the electronic problem list is who owns and manages the list is always a matter open to debate, says Haughom. For example, primary-care physicians think they own and manage that information, as do specialists who do most of their work in the hospital setting (at least on the inpatient side). Like CPOE, the challenge for many providers is not implementing the technology but changing the culture. "The Office of the National Coordinator should give health systems and physician groups time to work out some of the cultural issues before they push too hard on the problem list," he says.

Personal health records. The 2011 recommendations call for physicians and hospitals to provide patients with an electronic copy of their health information, including lab results, problem lists, medication lists, and allergies upon request (hospitals must also provide discharge summary and procedures). By 2013 physicians must provide patients access to a PHR populated in real time with health data. Whereas, hospitals must provide patients access to a PHR populated with patient health data in real time by 2013. Again the issue is culture, says Haughom. The penetration of PHRs nationally is not very high. Neither group—physicians and patients—are adopting personal health records very fast. Haughom suggests that leading with a patient portal may be a good first step.

One element that both physicians and hospitals are happy about is the revised timeline, which gives them more time to meet the EHR "meaningful use" criteria. If providers want to receive full reimbursement, they need to have systems in place in the first two years of the program. However, if providers can't start adopting IT until 2013 or 2014, they are eligible for less incentive money, but have the opportunity to participate in the program. Their first adoption year will still be considered 2011, regardless when the provider comes in to the program through 2014.

Haughom doesn't think his organization will have difficulty meeting the criteria as it is currently outlined; however, he's concerned that the bar is still too high for other providers and the impact that it may have on the overall success of the HITECH Act.

"My desire is to move healthcare forward broadly nationally and I think [the objectives] are too stretched to make it realistic."