Halamka: Meaningful Use, HIT certification program need reforms
The Meaningful Use program is stifling technical innovation and lacks a focus on outcomes-based care, while the certification program is “filled with outdated requirements” and is a significant drain on health IT developer resources.
That’s the contention of John Halamka, MD, outspoken chief information officer at Boston’s Beth Israel Deaconess Medical Center.
“Meaningful Use served a very useful purpose when (National Coordinator for Health IT) Dave Blumenthal did Stage 1—which is, it built a floor, and it ensured that doctors and hospitals had the basics of functionality that would be foundational for anything we’d do in the future,” says Halamka, who’s also been active on federal HIT committees.
However, he contends that Meaningful Use “went on with far too much prescriptive detail, and we’re now to the point where we just need to morph the program into something else,” such as outcomes- and quality-based payment models for providers, “giving vendors and clinicians more latitude in how they achieve them.
“It’s time to rethink what it is we’re going to ask clinicians to do and how we’re going to measure it, instead of just issuing prescriptive regulations,” adds Halamka. “In short, the Meaningful Use Stage 3 concept should be morphed into a different program.”
Under the new Quality Payment Program from the Centers for Medicare and Medicaid Services, Meaningful Use is essentially restructured into a new Advancing Care Information (ACI) performance category as part of MIPS for purposes of calculating payment. At the same time, the measures found within the ACI category are based on the measures adopted by the Electronic Health Records Incentive Programs for Stage 3.
The objectives in the ACI performance category of MIPS emphasize measures that support clinical effectiveness, information security and patient safety, patient engagement, as well as health information exchange. The new ACI performance category score under MIPS defines a meaningful EHR user as a MIPS-eligible clinician who possesses certified EHR technology, uses the functionality of CEHRT, and reports on applicable objectives and measures.
But, according to Halamka, while CMS has made progress toward simplifying Meaningful Use and the ACI category of MIPS, ONC has not followed suit with its certification program. Consequently, he says the certification program is “filled with outdated requirements and is a significant drain on health IT developer resources, with no incremental gain to patient care.”
Halamka charges that, in some cases, ONC’s certification program has “gone way beyond the Meaningful Use program and the intended scope of HITECH by being highly prescriptive in areas unrelated to Meaningful Use, as opposed to being functional.”
Nonetheless, he says he’s “not opposed to certification in principle” but “it’s just that the certification rule as currently written is too broad.”