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MU Slides into Summer of Discontent

 |  By smace@healthleadersmedia.com  
   July 08, 2014

If the top dog in the EHR food chain is feeling like he is dragging regulatory chains around, then we have a technology modernization program that is, at best, troubled, and at worst, in crisis.

The federal government's EHR certification program is in disarray and may not be able to achieve its most important outstanding aim—to provide interoperability between different vendors' EHRs—anytime soon.

This despite CMS's meaningful use audit program striking terror in the hearts of even the staunchest healthcare CIOs, who fear an overlooked detail will lead to hefty givebacks of EHR incentive payments.

ONC's distracting effort to push forward with a 2015 set of EHR standards itself has generated a massive amount of negative feedback, and accusations that the organization hasn't incorporated three years of extensive public feedback into a troubled program. Now the program is facing considerable budgetary limitations as its original Congressional funding runs out.

Carl Dvorak, chief operating officer of Epic, the largest, and probably most profitable EHR vendor, recently testified that his job makes him "one of the people who wears the chains and drags the cinderblocks of [EHR] certification through life."

Meanwhile, Dvorak says he watches ONC "stand on the stage with West Venture Capital Funds people and… shuttle money to the smart medical record people in Boston, and I do get a sense of disparity."

Regulatory Chains
Folks, if the COO of the top dog in the EHR food chain, at a company swollen with much of the $23 billion handed out in meaningful use incentive payments, is feeling like he is dragging regulatory chains around, then we have a technology modernization program that is, at best, troubled, and at worst, in crisis.

Meanwhile, in response to a banshee-howl from the AMA, CHIME, AHA and just about every other professional organization in healthcare IT, ONC and CMS are methodically in the process of extending Stage 2 of the meaningful use incentive program such that the obligations of providers to attest to achieving Stage 2 are extended at least into 2015.

This spring's finger pointing in Washington at vendors failing to get certified products to market has long since faded, replaced by a chorus of criticism that regulators at CMS and ONC created a hydra-headed set of implementation guidelines which made Stage 2 attestation reachable by only a handful of providers so far.

"Whether you call it evolution or revolution, there is groundswell among the peasantry calling for sweeping changes to the CMS EHR incentive programs," wrote meaningful use audit expert Jim Tate in late May.

Triggering Tate's rant was a CMS proposed rule, called for by most of the industry, offering relaxation in the requirements to achieve meaningful use in 2014.

A Backlog
The proposal is a byzantine menu of options for providers, with the common running theme of providing relief from deadlines which would have come crashing down upon their heads this October. "Although 2014 Edition CEHRT may be available for adoption, there is a backlog of many months for the updated version to be installed and implemented so that providers can successfully attest for 2014," the NPRM states.

The NPRM proposes that providers be able to continue using 2011 edition certified software, or a combination of 2011 and 2014 certified software, during calendar year 2014, but withhold incentive payments for any provider still running 2011 edition software.

The comment period for this proposed rule ends July 21, and CHIME for one, likes what it sees.

"CHIME supports the new pathways as defined in the proposed rule," CHIME's letter to CMS reads:

"We believe these options will provide needed flexibility for EHR optimization, encourage continued participation in the program and help maintain the upward trajectory of EHR adoption in the US. This is a necessary extension to give policymakers time to evaluate past experience and incorporate lessons learned into the third stage of Meaningful Use."

But a theme of public comment so far is that even a one-year relaxation of stage 2 deadlines is not enough.

One of CHIME's primary requests is that the Centers for Medicare & Medicaid Services allow providers to choose any three-month quarter for an EHR reporting period in the next federal fiscal year or calendar year to qualify for Meaningful Use in 2015. As currently structured, the program requires providers to report a full year of data to qualify for incentives.

'EHRs are Seen as Cumbersome'
The AMA, which traditionally takes more issue with the requirements of EHR implementation or meaningful use than CHIME or other groups, wants more relief than that. "EHRs are seen as cumbersome" by AMA members, testified Mari Savickis, AMA assistant director for medical affairs, at an ONC hearing in May.

Meaningful use adds "extra steps in their workflow. Many of these steps are smattered across the EHR with little identification to how they provide value back to the care of the patients," Savickis added.

Instead, AMA continues to urge that meaningful use be pared back to a program "focused on promoting meaningful data exchange, improving the ability to report clinical quality measures, areas which are mandated under HITECH and with the industry as a whole experiencing serious challenges."

The capper to AMA's proposal: providers should only have to achieve 75 percent of stage 2's requirements to obtain an incentive payment, and only 50 percent in order to avoid a penalty.

While ONC and CMS are unlikely to agree to AMA's demands—indeed have shown a history of fairly ignoring many such demands in the past—it seems like meaningful use at this rate may end with a whimper and a bang. Whittled down by some combination of government mismanagement, vendor burnout and/or malfeasance, and provider exhaustion, meaningful use may be about to enter a kind of life support status, at least for a year.

The bang will come when Congress comes asking where the $24 billion went.

After public comment ends, the other missing continuency, the patients, will probably also weigh in. It's a sad state of affairs that the continuing dialogue about how to fix this increasingly troubled program hardly ever seems to get around to what's best for them. Clearly, what the industry is trying to do for them right now isn't working very well at all.

Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

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