Industry Update: Meaningful Use of EHRs and the Digital Divide

By Jennifer Larson, contributor

March 13, 2012 - Just over a year ago, in January of 2011, the registration process for the health information technology “meaningful use” programs with the Centers for Medicare and Medicaid Services (CMS) began. Over the course of 2011, a growing number of hospitals and physician practices signed on to participate so they could receive incentive payments for demonstrating they were effectively using electronic health records (EHRs) and other health IT.

The number of hospitals that have implemented an EHR system, also known as an electronic medical record (EMR) system, doubled between 2009 and 2011, bringing the total to about 35 percent, according to analysis by the U.S. Department of Health and Human Services. In mid-February, HHS reported that about $3.1 billion had been awarded in payments for meaningful use of health IT, most notably EHRs, as part of both the Medicare and Medicaid EHR Incentive Programs.

However, according to the American Hospital Association (AHA), only about 700 hospitals have actually met the stringent criteria for meaningful use of certified EHR technology and thus qualified for Medicare payments for Stage 1. And CMS has noted that only 8 percent of hospitals and 4 percent of physicians actually received payments for the first year.

That’s a sign of progress, but it also shows there’s still a long road ahead, said Chantal Worzala, AHA’s director of policy. 

“I think it’s slower progress than we need,” said Worzala, noting that the bar had been set very high with Stage 1 requirements.

As 2012 unfolds, more and more hospitals and healthcare practices are implementing EHR systems and other technology in an ongoing effort to improve care and to receive payments through the incentive programs. But the road ahead may be challenging for smaller and rural hospitals, too, when it comes to mustering the necessary resources to meet the requirements.

Vendor availability is often cited as one factor. EHR consultant Ron Sterling, who authors a blog called Avoiding EHR Disasters, recently wrote a list of “10 To Dos to Prepare for Stage 2 of Meaningful Use” for the website Kareo. He wrote that the effort required to make changes and meet future requirements may “further challenge EHR vendors and their practice customers.”

“A lot of rural hospitals have difficulty finding technical staff for the implementation, especially when they can only afford a few technical people and those few have to be masters of many skill sets,” said Denni McColm, chief information officer for Citizens Memorial Healthcare in Bolivar, Mo., which has been recognized as a Stage 7 organization by HIMSS Analytics for the highest level of EMR adoption.

Stage 2

On February 23, CMS released the long-anticipated proposed rules for Stage 2 of meaningful use. These rules will determine if providers will qualify for meaningful use payments in 2014 and beyond. They also expanded the number of clinical quality measures from 15 in Stage 1 to 24 in Stage 2.

Sterling noted that organizations that have not yet achieved Stage 1 will need to consider the proposed items in Stage 2 when planning their strategies. “[T]he proposed Stage 2 standards include significant changes to the Stage 1 requirements that will affect your MU strategy and how you use your EHR,” Sterling wrote.

For example, Stage 1 only dealt with the prescriptions in the section devoted to CPOE. But in Stage 2, CPOE will expand to encompass laboratory and radiology orders, too. And 60 percent of prescriptions must be entered, as well.

“That’s a huge shift,” said Robin Raiford, an expert in clinical informatics and meaningful use with the Advisory Board Company and a Health Information Management System Society (HIMSS) fellow.

It’s important that organizations take Stage 2 seriously, Raiford said.

Raiford said some organizations are considering an approach where they just meet the requirements for Stage 1 and avoid the Stage 2 requirements altogether. They should rethink that position, however, as the end goal of the entire exercise is to use technology to make patient care safer. Not only that, but providers that do not comply will face major penalties.

“Getting in the game and staying in the game becomes all the more important when we think about how CMS is levying penalties. It’s not sufficient to simply meet meaningful use once,” Raiford said. “Providers will need to continue to meet meaningful use year-over-year, at increasingly complex stages to avoid penalties. So if you skip out on Stage 2, or let off the brakes, it makes it increasingly challenging for you to recover in future years when CMS raises the bar and ups the ante.”

On the other hand, the organizations that are embracing health IT and working to make it part of their culture will be successful.  “They want to be all they can be and do their best for their patients. They’re the ones who are going to shine here,” Raiford said.

When will providers know if changes will to be made to the Stage 2 rules? First comes the 60-day comment period, which began when the rules were proposed. Many organizations plan to comment, including the AHA, which is concerned that the increase in clinical quality measures, among other factors, may be “too much,” Worzala said.

Said Worzala, “For us, we feel like Stage 1 was about getting started…but we feel like Stage 2 is about getting it right.”

The American Medical Association (AMA) released a statement shortly after the rules were announced, saying it would review the rules and provide its comments.

“We have provided ongoing input since the inception of the EHR incentive program and have stressed the need for flexibility in the program requirements,” AMA board chairman-elect Steven Stack, M.D., said in the statement. “To eliminate roadblocks and encourage greater physician participation, it is important that a full evaluation of the EHR Stage 1 incentive program occurs prior to finalizing Stage 2 requirements.”

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