Webinar: Meaningful use has positives, uncertainties and a few fantasies

The progress toward defining meaningful use has been impressive, but the timeline may be too compressed for many, said Steven Stack, MD, member of the board of trustees at the American Medical Association (AMA), last week during the eHealth Initiative's second Webinar on meaningful use. “Also, to digitize 20 percent of the U.S. economy in a three- to five-year period, there’s not enough workforce to do that,” Stack said.

Moderated by Dan Garrett, PriceWaterHouse Coopers’ Health Industry advisory group member, the Webinar brought together leading health IT figures to share insider opinions on the meaningful use definitions as defined in the Office of the National Coordinator for Health IT’s (ONC) Interim Final Rule (IFR) and notice of proposed rulemaking (NPRM) on meaningful use.

In addition to Stack, the Webinar last Friday included presentations from Karen Bell, MD, senior vice president for health IT services at Masspro, and Alisa Ray, executive director at the Certification Commission for Health IT.

All panelists heavily encouraged making public comment to the IFR and NPRM before the March 15 deadlines. “Now is the time to speak,” remarked Garrett. The NPRM final rule, after the comment deadline, is to be released late spring, while IFR goes into effect automatically around Feb 15th and can be modified per comments.

Beginning the presentations, Garrett said that the Centers for Medicare & Medicaid Services acknowledged certain challenges lay ahead for concerning meaningful use adoption. One of these challenges is the fact that criteria for the demonstration of meaningful use of certified EHR technology have not been finalized and will change over time. In addition, the U.S. Department of Health and Human Services (HHS) has not yet defined certified EHR technology; the impact of certified EHR technology on expenditures for medical treatments is unkown; and the impact of the financial incentives and payment adjustments on the rate of adoption of certified EHR technology by eligible providers and hospitals is difficult to predict.

“Certifying EHRs for Stage 1 is not overly burdensome,” said Bell, reiterating much of the good, the bad and the potentially ugly characteristics of the NPRM and IFR she stated in an earlier eHealth Initiative Webinar. Although Bell said she does not mean to undermine all of the advances laid out by the ONC and HHS, she noted that a $44,000 maximum stimulus incentive over five years is not "a whole lot of money," given the potential costs it might take to implement the initiatives.

“For doctors in their late 40s and 50s, it may be more beneficial to take the penalties,” and not participate in meaningful use initiatives, Stack said. It could be a better business decision, he concluded.

In addition, Bell reported that an estimated 27 percent of physicians will not be considered eligible professionals to receive stimulus initiatives. “Worst of all, a lot of measures demand additional paper process and add administrative burden,” Bell said. She also warned about the risk of the unintended consequence of a widening digital divide between early adopters and those without resources to pursue the initiatives.

“If you wait until 2014 [to begin Stage 1 adoption], you have a big jump to Stage 3 [the following year],” said Ray. “Quality reporting implementation takes awhile. … Contrasting these stages, this implementation is really fast and the timing isn’t really natural with how practical experience tell us it takes to implement an EHR.”

“For most providers, delaying an EHR adoption means a steeper climb and lower incentive payments,” concluded Ray.  “When you get into how risk-averse you are, there isn’t a moment to wait in terms of implementing. The gains now are probably greater than what they would lose in lost incentives.”

“Emphasis on every American and comprehensive health IT/health information exchange [HIE] distracts from more attainable and beneficial initial focus on selected populations and selected IT/HIE tools,” Stack said. He lauded the incremental nature of the incentives and the appropriate focus on health IT to improve healthcare delivery in the U.S., but reiterated the timeline challenge.

“We have to be honest about what is a real patient and these idealized patients that don’t represent the multitudes of real human beings that interact with the health system the way they do,” concluded Stack. “If we don’t have any flexibility, it’s going to be frustrating a lot of people.”

The Webinar was sponsored by PriceWaterHouse Coopers.