New government regulations covering meaningful use of electronic medical records are winning kudos from EMR and healthcare providers alike, with few naysayers piping up.
New regulations governing how healthcare providers can prove meaningful use of electronic medical records technology, a hallmark of President Barack Obama’s healthcare reform law, are winning praise from both EMR and healthcare providers.
To tap into the $27 billion being made available over the next decade to promote EMR adoption, healthcare providers must demonstrate meaningful use of an EMR system. Exactly what that entailed, however, wasn’t clear until the U.S. Dept. of Health & Human Services issued MU regulations Tuesday.
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The finalized rules require that providers meet 14 to 15 core requirements and choose five more from a menu of 10 options. Mark Segal, vice president of government and industry affairs for GE Healthcare, told MassDevice that the new rules accomplish “two very important things.”
“One was that core and menu. The other was that, for a number of the items, they substantially reduced the numerical thresholds,” Segal told us. “For example, they eliminated two items that had been proposed for Stage 1 that were really more revenue-cycle-focused. We think those are very important, electronic eligibility checks and electronic claims submission and we’ve got products that are focused on that, but many EHRs don’t have those as part of their core functionality. Keeping them in would have complicated the rollout of the program.”
Dr. Tom Giannulli is chief medical information officer for Epocrates, which is developing its own EMR offering slated for release some time this fall. Giannulli told us that he’s “very positive” about the new regulations.
“I commend the group under [national HIT coordinator] Dr. David Blumenthal. They did a great job. They really executed well against a really short timeframe and used a lot of common sense,” he said. “From a physician’s perspective, they’ve really metered down the more burdensome requirements and they’ve created this staged approach where a user can use the EMR in a very basic way and solve the meaningful use puzzle for the first two years. Once they’ve had that runway and the chance to get used to the technology, they can become more sophisticated users and solve the meaningful use concerns for Stages 2 and 3.”
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That said, there are some unaddressed issues remaining, Giannulli noted, including usability standards.
“The usability standards for these products need to be looked at, because most of the EMRs that are out there are unusable in the production environment. They have to be struggled with in order to be productive and often don’t fulfill the requirements of going through a real-time [patient] encounter,” he explained. “They have to be done after the fact and add additional time to the encounter flow. In reality, if they’re designed correctly they can be operated in real time and actually enhance the efficiency of the doctor.”
Poor or non-existent infrastructure is another problem, Giannulli said, citing the immunization reporting requirement.
“There are these registries for immunizations. Those registries are state-region-by-state-region controlled. A lot of states don’t even have registries and some states, like California, have four registries. The interface used to report data to these registries is not standardized, so even though there’s a spec that says you have to submit to a state registry, that may be impossible or near-impossible based on that infrastructure. There are a lot of connectivity and interoperability assumptions built into the guidelines that are going to be really hard to implement until the infrastructure gets to a state where it’s more streamlined,” he said. “I would really appreciate it if the government spent some of that $27 billion to create a hub that every EMR could talk to to facilitate immunization or other types of data submission. If I’m a nationwide system and I want to satisfy every state or regional user’s immunization registry requirement, I’d have to build something like 80 different interfaces. They really need to step up their game and say, ‘Look, we understand there are these roadblocks and there isn’t a lot of infrastructure. We’re going to patch that infrastructure by spending a little bit of this money and building these kind of interfaces.'”
John Hallock, director of corporate communications for Athenahealth Inc. (NSDQ:ATHN), called his company “neutral” on the new rules.
“The consensus is that many of the criteria were lessened, certainly around [computerized physician order entry] and other key issues hospitals had regarding their legacy IT systems. Stage 1 of the HITECH Act, 2011 and 2012, will be relatively mild. Stage 2 has not been defined,” Hallock told us. “Part of the HITECH Act stipulates much stricter parameters around security and privacy of patient data and the onus is not on the vendors, it’s on the hospitals and doctors. It remains to be seen how all that plays out.”
Last September, Athenahealth took the bold step of guaranteeing doctors and hospitals their share of the stimulus cash if they sign up for the company’s EMR offering. Earlier this month the companywon preliminary certification for its web-based EMR product from the Certification Commission for Health Information Technology.
The Wall Street Journal‘s Health Blog has a roundup of other reactions to the new regulations:
Association of American Medical Colleges: While the AAMC praises relaxation of some of the requirements, it “remains concerned” that “it may be unrealistic for some teaching hospitals and faculty physicians” to meet the requirements in two years. In a statement, the group also says it had hoped that eligibility would be determined by hospital systems, not individual hospitals. (Each hospital in a multi-hospital system must qualify on its own to receive incentives.)
American Hospital Association: The group also says even the looser requirements may make it tough for hospitals to qualify. It criticizes the individual hospital requirement, and says that “the rule requires hospitals to immediately use Computerized Provider Order Entry (CPOE),” which it calls complicated, costly and time-consuming.
Allscripts, a health IT company: Leigh Burchell, the company’s director of government relations, tells the Health Blog that the shift from a mandated list of at least 23 requirements to a more flexible approach is “the most momentous” change from the draft version. She also says reporting requirements for things not captured in an electronic health record have eased, making things “much more user friendly” for providers. The role of ER personnel in meeting the requirements has also been clarified, for the better, she says.
Kern Medical Center, Bakersfield, Calif.: CEO Paul Hensler tells the Health Blog he’s “pleasantly surprised” by the more flexible approach. “It really lets each hospital customize its approach according to its needs and abilities,” he says. This will likely help hospitals with the capital to invest to focus on and implement a smaller set of requirements in order to qualify for incentives.
Deloitte Consulting: Mitch Morris, national leader of health IT, notes in an e-mail that he was surprised that there’s no word yet on when the third stage of requirements will be announced. (The next wave of stage 2 requirements will be announced in late 2011.)
NextGen, a medical software company: Charlie Jarvis, vice president of healthcare services and government relations, says the looser requirements will “help the provider community adapt more quickly,” but that some levels of compliance were still kept pretty high, at the 80% level. (Get 78% of patients and you don’t meet the requirement.) In addition, he says it may be tough for some clients to be ready to go for the next set of requirements if they aren’t released until late next year.
Reid Conant, emergency physician, Tri-City Medical Center, Oceanside, Calif.: Conant, chief medical informatics officer for his med center’s emergency group, wishes there had been a requirement that detailed physician notes be part of a patient’s electronic medical records. Without such a physician narrative requirement, he fears the records will “be reduced to point-and-click documents” that don’t distinguish between patients.
The Massachusetts Medical Devices Journal is the online journal of the medical devices industry in the Commonwealth and New England, providing day-to-day coverage of the devices that save lives, the people behind them, and the burgeoning trends and developments within the industry.
