Health IT Summit: Halamka predicts only 20% will achieve MU Stage 2

BOSTON--Only 20 percent of providers will manage to achieve Meaningful Use (MU) Stage 2 this year, John D. Halamka, MD, CIO of Beth Israel Deaconess Medical Center (BIDM), predicted during his talk on federal mandates at the iHT2 Health IT Summit.

“I see a number of providers exiting the program,” he said, adding that many will choose to absorb Medicare penalties as it’s cheaper than the technology and resources needed to attest to MU.

He also reacted to news disclosed at the Health IT Policy Committee (HITPC) last week that only four hospitals to date have successfully attested to MU Stage 2. “So when [Centers for Medicare & Medicaid Services Commissioner Marilyn] Tavenner talks about hardship exemptions, will 4,996 hospitals need a hardship exemption? I’m trying to figure that out,” he said with some humor.

EHR certification and MU requirements should focus more on outcomes and less on prescriptive requirements. When it comes to MU Stage 3, 80 percent of the proposals so far have workflow, standards readiness or vendor burden issues, he said. “The [HITPC] needs to make them more about outcomes so providers and vendors can achieve policy outcomes in a way they think best.”

For example, for MU Stage 3, proposed order tracking requirements that entail a closed loop referral workflow would lead to “a whole lot of complicated transactions” as it’s hard to link together primary care physicians and specialists. At Harvard, it would take 11 different interfaces to achieve referral tracking. “It’s a good idea, but it’s pretty hard,” Halamka said.

Demographic requirements that would mandate collection of sexual orientation and gender identify status under MU Stage 3 also is tricky, as some research points that there isn’t a categorical list for identity as it’s really a spectrum, he said. A registration clerk getting bogged down at 3am going through gender sexual history questions would be time better spent on providing care.

Also, providers would not be able to complete a full discharge summary, with all required signatures, within 24 hours as is currently proposed in MU Stage 3.

Halamka pointed out the ambiguity of the visit clinical summary, which is supposed to tailor information to that which is actionable and relevant. “I don’t know about you, but I don’t know what information is actionable and relevant.”

Notification requirements that would allow a patient’s care team, including family and close friends, to receive electronic communications “is a great idea” but the technology is not yet there as it would require individuals to all have secure email addresses, he said.

In terms of narrowing the scope of requirements, Halamka said providers should not be required to support all registries, but a few key ones.

In other comments, he criticized the ICD-10 delay, noting that most hospitals were ready to comply by the Oct. 1, 2014, deadline and that many providers in Massachusetts plan to achieve readiness anyway by the former deadline, with a focus on fine-tuning clinical quality improvements with the extra time.

“The certification process was a nightmare,” Halamka also said, adding that he hopes the Office of the National Coordinator for Health IT (ONC) takes to heart the challenges physicians and hospitals face in meeting its requirements. At BIDMC, certification took its vendor 320 man-years, he said.

“Our friends at the ONC are in listening mode, and hopefully they won’t do to society with certification like what they did with Meaningful Use Stage 2,” he said, adding that MU Stage 2 co-opted the IT agenda in the payer and provider space for 18 months.

When asked if he thinks there will be a MU Stage 4, he said that hopefully the program will sunset and everything gets rolled into a system that focuses on merit-based incentives. “Merit-based incentives for achievement and innovation instead of regulatory penalties seems like a better idea.”