CMS eHealth Summit: MU lessons, challenges shared

With the start of Meaningful Use Stage 2 only weeks away, industry stakeholders discussed successes of the EHR incentive program to date while offering their views on current challenges and how to best move forward.

“This is a historic program,” Robert Tennant, MA, senior policy advisor at the Medical Group Management Association, said at the Centers for Medicare & Medicaid Services (CMS) eHealth Summit on Dec. 6. He said incentives and CMS’ “unprecedented outreach effort” clearly have succeeded in driving EHR adoption, but noted several concerns.

Specifically, he said MU was developed to align with the needs of primary care, with many of the requirements not applicable to specialists. Also, Tennant said with 17 to 20 percent of installs ripped out and replaced, there are downtimes, staffing issues, connectivity issues and vendor issues that affect patient care.

Also, Tennant took issue with an MU requirement that five percent of patients access their data via an online portal. “Having technology is one thing, but twisting the arms of patients to use it is another thing,” he said.

Areas requiring evaluation before developing Stage 3 requirements, he said, include the concept of engaging patients, not forcing them; considering usability criteria instead of additional functionality; and expanding funding for regional extension centers to allow them to assist with Stages 2 and 3, as well as other health IT areas.

Overall, Tennant said implementation of MU Stage 2 is occurring during a time when providers already are inundated with ICD-10 preparedness, complying with the HIPAA privacy and security rules and working with new health insurance exchanges. “Everything is happening at the same time.”

Shiv Gopalkrishnan, vice president and general manager, health system solutions, General Electric, agreed, noting that all the new requirements are affecting vendors as well.

“The amount of software vendors have to develop is very challenging,” Gopalkrishnan said, noting that systems supporting MU Stages 1 and 2 require numerous iterations. To that end, he urged CMS to allow for at least three years between Stages 2 and 3, to accommodate the minimum of 18 months needed to ready EHR products and implement them on the customer side. Also, he said, more time is needed to train providers to get value out of the system and make usability more robust. Also, he feels that the “all or nothing” approach of attestation should be reconsidered.

David Chou, MD, CTO, information technology services at the University of Washington, expressed concern about the growing complexity of MU requirements. Chou said the University of Washington runs four different EHRs from three different vendors on the inpatient side, and encompasses academic medical centers as well as newly acquired hospitals.

Thus, he related his experience as “a microcosm of healthcare across the U.S.—both as healthcare and IT systems.”

“We were proud of what we’d done, until we started working on Stage 2. Stage 2 has proven to be challenging,” he said.

Some issues tied to interoperability of systems. He said the Direct protocol model assumes that providers are communicating with a patient, when actually care teams—which entail a rotation of physicians week to week—are handling care. “This has required quite a few work-arounds,” he said. He added that there is a lack of clarity on how communities should handle Direct email addresses.

Like Tennant, Chou said software updates to accommodate new MU requirements and testing took time away from providers doing their job of proving care. The varied schedules of the multiple EHR vendors required the University of Washington to thoroughly keep track of the status of each physician's EHR system, he said.

Chou offered what he has learned about MU:

• Both vendors and users need time to hardwire changes; each MU stage is a two-year cycle.
• Academic medical centers are complex, and this complexity becomes a problem with order sets, he said, noting that the academic centers use 800 order sets, compared to the 200 used in primary care.
• Specialist teams work differently than practioners, and often workflows adopted by primary care practices are not attuned for specialists.
• The act of replacing old systems and implementing new ones has an impact on healthcare as much as MU.