Senate Finance Hearing: MU Stage 2 delay, interoperability explored

At the second Senate Finance Committee hearing exploring health IT matters, lawmakers heard from witnesses speaking for and against a delay in Meaningful Use (MU) Stage 2. Meanwhile, senators and witnesses alike called for a heightened focus on interoperability and stressed a need to develop a business case to drive exchange efforts.

The first hearing, which took place on July 17, featured Farzad Mostashari, MD, ScM, national coordinator for health IT, and Patrick Conway, chief medical officer and director, Center for Clinical Standards and Quality and acting director, Center for Medicare and Medicaid Innovation. They both advised against temporarily halting the MU program.

The July 24 hearing featured leaders representing a major vendor, healthcare systems and a policy center.

John Glaser, MD, PhD, CEO, Health Services, Siemens Healthcare, stressed that providers are inundated with regulatory requirements, from ICD-10 to MU compliance, and called for a one-year delay. “We may be creating a perfect storm that may be burdening eligible hospitals and providers,” he said. “Many providers are rushing into implementations and may be shortchanging the process and re-engineering what needs to occur.”

Glaser added that with many rural and critical access hospitals failing to achieve Stage 1, moving ahead with Stage 2 next year “runs the risk of creating a have or have not situation.”

Marty Fattig, administrator and CEO, Nemaha County Hospital in Auburn, Neb., echoed concerns about the compounding of the digital divide between urban and rural hospitals.

With vendors scrambling to meet demand for EHR products and services, he said rural hospitals find it more difficult to receive timely attention and in one instance, was informed of a required nine month wait before a software upgrade for Stage 2 was available.

“It is my belief that we need to re-assess the program,” Fattig told the senators. “My opinion is we are making the system more robust before we are even near complete on achieving widespread EHR adoption or significant health information exchange.” Thus, he said, a one-year delay would allow hospitals falling behind to “get Stage 1 right.”

Colin Banas, MD, chief medical information officer and associate professor, Virginia Commonwealth University, Richmond, Va., spoke positively of health IT developments and successful innovation at his institution—specifically a homegrown medical early warning system dashboard that slashed the in-house mortality by five percent. He applauded the vision and roadmap set forth by the Office of the National Coordinator for Health IT.

Janet Marchibroda, director, health innovation initiative, Bipartisan Policy Center, said MU deadlines should proceed as planned. As Stage 2 requires the ability to exchange information at least once with a platform outside of a system, it directly leads to better patient care.

“I hate for us not to benefit from patient engagement and information exchange as soon as we can,” she said.

Interoperability concerns came up time and time again by senators and witnesses.

“There has to be a compelling reason for hospitals to share information with non-affiliated providers. It seems to me those reasons do not currently exist; if they did, we would not be having these issues with interoperability,” said Sen. Orrin Hatch (R-Utah). “This is the elusive Holy Grail of health IT—everyone seems to be talking about it but it seems out of reach.”

Glaser said while new payment models will steer interoperability efforts, there should be more pressure on vendors and regulators and suggested that ONC and the Centers for Medicare & Medicaid Services be given more authority to develop standards and require interoperability. He said while health information exchange is growing rapidly, it is occurring in a patchwork, idiosyncratic manner, and that a national framework is needed.

Focus on making providers accountable for population health would motivate more providers to join exchanges.

“If they hold you accountable for population health, it will motivate you to do the exchange,” he said.