September 11th, 2013
As 2014 draws closer and the realities of meaningful use Stage 2 set in, many stakeholders are experiencing an increasing and justifiable level of anxiety about the consequences of a program that is advancing too rapidly. Following on the heels of the letter from a group of senators to the secretary of HHS that suggested a “pause” in the meaningful use program, there has been a recent avalanche of pleadings for a delay of Stage 2. These have come from such venerable groups as the AMA and AHA, MGMA, AAFP, HIMSS (the Healthcare IT industry organization), and CHIME (College of Healthcare Information Management Executives), all of which represent sizeable and varied constituencies.
The proposals offer a range of suggestions, and their solutions vary in scope and complexity, but the message is clear, consistent, and undeniable: the meaningful use train is simply moving too fast, and the future success of the program depends on an application of the brakes.
Recommendations include variations on the following:
- Delay the start of Stage 2.
- Expand the period for Stage 2 compliance (attestation) by up to a year.
- Suspend the penalties, at least for those physicians who have successfully attested to Stage 1.
- Add some needed flexibility by relaxing the “all or nothing” requirements for demonstrating meaningful use.
- Extend the schedule so that physicians have 3 years at each stage before moving to the next.
Some lay the blame on the EHR vendors, citing lack of preparedness. To some extent they are correct—the certification website reveals that only 15 complete ambulatory EHRs from 12 different vendors have been certified for 2014 and Stage 2 so far—that’s just 3% of the 472 EHRs that were available to physicians in Stage 1. While some physicians will be left without a certified EHR in 2014, it is likely that the remaining major vendors will manage to get their EHRs certified by the end of the year. The fact remains, however, that more time before deployment can only improve the (sorely lacking) usability of the final products. One only has to look at the low average KLAS scores—now in the mid-70s—to appreciate the effects of rushed software development and implementation. Without a relaxing of the timeline, many physicians will be left with EHRs that are certified, but unusable.
The EHR Incentive Program is suffering, and its long-term success is at stake. A full 17% of the physicians who attested for the first year of Stage 1 failed to attest for the second incentive payment. (See “Alarming Fact” EMR Straight Talk post.) They simply could not sustain the use of their certified EHR—with which they were already familiar—for a full year of compliance with the complex rules of meaningful use—with which they were also already familiar. Unless we stop and evaluate why this is happening and make the necessary adjustments, the dropout rate is guaranteed to rise with Stage 2.
We have to stop and assess where we are trying to go in light of where we are now. Stage 3 is hurtling toward the final proposal without the benefit of any experience in Stage 2. The measure of the program’s success cannot continue to be the number of dollars paid in incentives, but should rather be providers’ satisfaction with the EHRs that they have been encouraged to adopt.