IT leaders share thoughts on MU flexibility rule

A finalized rule that that provides flexibility in how healthcare providers can use certified EHR technology (CEHRT) for the 2014 EHR Incentive Program reporting period “is a welcome relief,” said John D. Halamka, MD, CIO of Beth Israel Deaconess Medical Center in Boston.

“Many CIOs I speak with tell me that they will be ready for transition of care and patient view/download/transmit for the full year October 1, 2014-September 30, 2015. However, the ecosystem (trading partners, patient awareness, policy, etc.) is not ready for the period July 1, 2014-September 30, 2014," he told Clinical Innovation + Technology. 

Under the final rule, eligible providers can use the 2011 Edition CEHRT or a combination of 2011 and 2014 Edition CEHRT for an EHR reporting period in 2014 for the EHR incentive program. The rule also finalizes the extension of Stage 2 through 2016 for certain providers and announces the Stage 3 timeline, which will begin in 2017 for providers who first became meaningful EHR users in 2011 or 2012, according to CMS.

All eligible professionals, eligible hospitals and critical access hospitals are required to use the 2014 Edition CEHRT in 2015.

The added flexibility will allow providers to participate and meet Meaningful Use (MU) objectives like drug interaction and drug allergy checks, providing clinical summaries to patients, electronic prescribing, reporting on key public health data and reporting on quality measures, according to the agency.

"We listened to stakeholder feedback and provided CEHRT flexibility for 2014 to help ensure providers can continue to participate in the EHR incentive programs," said CMS Administrator Marilyn Tavenner in a statement. "We were excited to see that there is overwhelming support for this change."

The College of Healthcare Information Management Executives (CHIME) President and CEO Russell P. Branzell said he was “deeply disappointed” in the decision made by CMS and the Office of the National Coordinator for Health IT to require 365 days of EHR reporting in 2015.

“This single provision has severely muted the positive impacts of this final rule. Further, it has all but ensured that industry struggles will continue well beyond 2014,” he wrote.

Halamka noted one concern--“the rule notes that Stage 1 criteria can be used by those on Stage 2 timelines for ‘Only providers that could not fully implement 2014 Edition CEHRT for the EHR reporting period in 2014 due to delays in 2014 Edition CEHRT availability.’ Although certified products may have been introduced into the marketplace, the time to implement, train and ensure safe use exceeded the Stage 2 time limits.”

He said he hopes federal agencies’ interpretation of delays includes the time needed for successful adoption.

Halamka said at least one hospital in his system is using an EMR system delivered on time for Stage 2 but the hospital depends on another vendor for many certified interoperability components which were implemented late. “Hence they could claim that the implementation of certified components needed for attestation was delayed” and if the federal agencies agree, the Stage 1 option is helpful, he said.

Looking ahead, Lyle Berkowitz, MD, associate chief medical officer of innovation, Northwestern Medicine in Chicago, said the majority of healthcare systems that use the big vendors and own the providers see MU as a “huge win and will push very hard to get to Stage 2. I would assume that most have likely planned to attest in the last 90 days already, so this ruling does not change anything for them.”

He said the independently owned doctors in large groups (i.e., over 20) also will see a good ROI and push hard. “Large groups who have gotten through Stage 1 will continue their run and I think will be reasonably successful. It's simply too much money to pass up and too good an ROI.”

Certain EMR vendors using a business model that involves collecting 5-7 percent of collections have a big incentive to make sure their clients achieve Stage 2 and, therefore, will “do the heavy lifting,” Berkowitz said.

All other EMR users, he said, face a “crapshoot and likely will be based on a local physician champion who really wants to make it happen.” This rule will not get any providers not yet using an EMR to take action, he said.

“I'd suggest that the last two groups might also be watching and waiting to be acquired by the large hospital systems, which is happening at an increasing pace. Thus, they aren't going to worry about it--just assume once they are bought, the bigger entity will take care of it.”

Berkowitz also said he wonders if MU penalties will truly kick in or if the American Medical Association and other professional associations “will push harder to have those repealed or at least delayed a few more years.”