HITPC: Stakeholders identify MU Stage 2 challenges, solutions

Stakeholders agree that Meaningful Use (MU) Stage 1 was a resounding success, but characterize MU Stage 2 as challenging and difficult, the MU Workgroup reported at the Health IT Policy Committee meeting on July 8.

“The scope and pace of change caused vendors and providers to focus on meeting the letter of Meaningful Use and less on the spirit of Meaningful Use,” said workgroup co-chair George Hripcsak, MD, MS, who summarized key conclusions from two listening sessions on MU that took place in May. The sessions had convened eligible professionals, eligible hospitals, health IT support of advanced models of care and vendors.

As the Centers for Medicare & Medicaid Services (CMS) is gearing up to release its final rulemaking on MU Stage 3, “it helps us build up additional feedback,” said workgroup chair Paul Tang, MD, of the sessions.

The workgroup presented a number of themes that emerged from the listening sessions:

• Transitions of care is the most challenging part of MU Stage 2. Requirements of effective transitions of care were not defined, and required workflow changes challenged providers. “It’s not just about measuring something, but changing the way they do something,” Hripcsak said. Also, there is difficulty in identifying electronic recipients ready to accept electronic data, and Direct is not working well.
• Proprietary business interests and legacy technologies are impeding data exchange. There is a need to prioritize data exchange for care coordination and patient engagement, and to focus these efforts on the local community. Also, more policies are needed for exchange across state boundaries and patient matching.
• Timelines are unaligned or misaligned. The late delivery of final rules and guidance has impeded delivery of certified EHR technology, and providers and vendors need more time to prepare for Stage 3 and learn from Stage 2.
• Multiple patient portals fragment records and workflows for patients. “That leads to the fragmenting of care and confusion,” Hripcsak said.
• Patients believe that EHRs are useful across the range of clinical and patient-facing functions. However, patients' ability to understand fully and benefit from the information may be affected by health literacy.

With this feedback, the stakeholders offered the following suggestions for federal health agencies:

• Focus on challenges only the government can solve, including the development of interoperability infrastructure and standards to facilitate exchange.
• Avoid penalizing early adopters, who depend on recipients being ready, and establish governance for interoperability.
• Require health IT implementation, especially in support of care coordination, but leave details flexible.
• Focus on what functions to include in certification, and fix what is not working as intended (e.g., Direct). Make results of certification transparent.
• Emphasize clinical quality measures that measure outcomes that matter to patients.
• Create coordinated, aligned end-to-end certification process, but avoid being overly prescriptive to allow more innovation and greater focus on usability.
• Provide the required 18-month timeline and align it among program participants and across all government agencies.
• Provide a national database of public health agencies ready to receive reports.
• Build public feedback mechanisms with clear, authoritative FAQ answers and rapid turnaround time.

• Reduce complexity and burden of compliance documentation, such as certification and MU.

“The feedback is very rich, poignant, and gives us a lot to think about at ONC and CMS. We do listen about what happens on the front lines. We’re still pushing forward, but doing it thoughtfully,” ONC chief Karen DeSalvo, MD, MPH, MSc, said. “We’ve learned a lot about Direct and there does seem to be appropriate use cases to communicate with entities, like long-term post-acute care. We’re all learning as we go; it’s a continuous learning process.”