The College of Healthcare Information Management Executives recently called for a one-year extension of Stage 2 of the electronic health records meaningful program, and on July 23 several CIOs testified before federal advisory committees on why the extension is needed.

The American Medical Association and multiple other stakeholders also testified before the HIT Policy Committee’s workgroups on certification/adoption and implementation.

In a letter to members of Congress in May, CHIME explained how extending Stage 2 by a year and delaying Stage 3 by a year would maximize the opportunity for success of the meaningful use program. “An extension is vital for providers, vendors and policymakers to ensure the outcomes sought in Stage 3 are realized. A year extension of Stage 2 will give providers the opportunity to optimize their EHR technology and achieve the benefits of Stage 1 and Stage 2; it will give vendors the time needed to prepare, develop and deliver needed technology to correspond with Stage 3; and it will give policymakers time to assess and evaluate programmatic trends needed to craft thoughtful Stage 3 rules.”

At the July 23 meeting, CIOs further explained why more time is needed. “All of the objectives listed as challenges require significant work to implement after upgrading to 2014 certified software,” said Pamela McNutt, senior vice president and CIO at Methodist Health System in Dallas. “For example, after delivery of the patient portal we will have to map data elements from the patient record and clinical staff will need to ensure that the data is representing accurately.”

Other CIOs noted that vendors must select a specific workflow to certify, but providers then must ask for modifications or completely change an existing workflow. “We’re not opposed to changing workflow if it is a better workflow, but we are opposed to changing a workflow only to ‘prove’ that we’re meeting the intent of the requirement,” said Rodney Dykehouse, CIO at Penn State Hershey Medical Center and College of Medicine.

CIOs reminded Policy Committee workgroup members that the current timelines for Stages 2 and 3 create a timing crunch in 2014 when more than 500,000 hospitals and physicians are trying to get ready for Stage 2 and demonstrate meaningful use. Hospitals, in particular, need to be ready by July 1, 2014, if they are to attest during the first year. “The difficulty in achieving meaningful use, beyond the new, more complex objectives, is compounded by the short timeframes allowed for hospitals to implement 2014-certified EHRs,” testified Randy McCleese, vice president of information systems and CIO at St. Claire Regional Medical Center in Morehead, Ky.

The American Medical Association made multiple recommendations in its testimony, including:

* A Stage 3 certification requirement that structured and non-structured data can be executed in the same patient record, allowing physicians to choose the method that suits their clinical workflow;

* Stage 3 certification requirements should require limits on the amount of time required to perform common orders using computerized physician order entry software;

* Reduce Stage 3 meaningful use requirements that physicians meet 100 percent of the measures to 75 percent so they don’t have to perform additional actions either due to limiting factors or that are outside their patient mix; and

* Above all, there should be more end-user input in the design of ordering, charting, reviewing history of present illnesses, alerts, and data presentation.

Testimony and other materials from the meeting are available here.

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