Meaningful Use: Glass Half Full or Half Empty?

With much fanfare, on August 7 the Department of Health and Human Services announced the results of two new studies showing that “more physicians and hospitals are using EHRs than before.” Duh! Tell us something we didn’t know.

Published online in the journal Health Affairs, the information in both studies was collected in 2013 by the Centers for Disease Control and Prevention’s National Center for Health Statistics and the American Hospital Association. Forgive me for not getting excited about the results of two studies comparing the EHR adoption rate in 2013 versus what it was in 2009 and 2010, respectively—the year that the HITECH Act was enacted and was just getting off the ground.    

HHS touts the fact that half of doctors had an EHR with advanced functionalities in 2013, double the adoption rate in 2009. And, the department applauds the fact that nearly 60 percent of hospitals last year adopted advanced EHR systems, quadruple the percentage for 2010. But, is that really surprising? Isn’t that what the Medicare and Medicaid EHR Incentive programs are supposed to do? They bloody well better! To date, American taxpayers have spent more than $24 billion on incentives for physicians and hospitals and the dollars keep flowing.   

Baselines are great to chart a program’s progress over the years—in this case, EHR meaningful use and adoption among providers. However, at the same time, HHS needs to temper its enthusiasm and get some perspective not only on how far we’ve come but how far we have yet to go.

Health Affairs also issued its own press release on the two studies with the headline, “Mixed Results for EHR Adoption,” soberly stating that “while basic electronic health record adoption plans have moved forward, more significant implementation remains a daunting challenge for many providers and institutions.” The study on office-based physicians concludes that "despite substantial progress in EHR adoption, health information exchange and patient engagement remain low in office settings." In the study on hospital EHR adoption, researchers specifically note a gap in EHR adoption among small, rural, and critical-access hospitals—a group overrepresented among hospitals that have not even adopted basic EHRs—which continue to lag behind their better resourced counterparts.

What’s more, looking ahead, authors say that the “struggle of many hospitals to meet Stage 2 meaningful-use criteria suggests that the path forward remains challenging." Their study finds that while most hospitals were able to meet many of the stage 2 meaningful-use criteria, as of the end of 2013 only 5.8 percent of hospitals were able meet them all. For its part, HHS did acknowledge in its media advisory that “more work is needed to support widespread health information exchange and providers’ ability to achieve Stage 2 meaningful use requirements under the Medicare and Medicaid EHR Incentive programs.”

As of this writing, a very small number of hospitals—78—have attested to Stage 2. HHS likes to remind us that about 75 percent of eligible professionals and more than 91 percent of hospitals have adopted or demonstrated Stage 1 meaningful use of certified EHRs. Yet, no one should underestimate the requirements necessary to achieve Stage 2—they are much tougher than those required in Stage 1.

As we all know, MU is a program with three stages that are progressively more difficult. Under the current timeline, Stage 2—which begins later this year for providers who first attested to Stage 1 in 2011 or 2012—will be extended through 2016. And, Stage 3 will begin in 2017 for those providers that have completed at least two years in Stage 2. Is the meaningful use glass half full or half empty? It depends on your perspective. But, from where I stand, there’s plenty to fill before we reach the top.