Only one week ago, Andy Slavitt, acting administrator at the Centers for Medicare and Medicaid Services, surprised the healthcare IT world by announcing that CMS’s meaningful use program would end in 2016, to be replaced by “something better.”

Since then, it’s clear that the electronic health record incentive project will likely become a supporting pillar for other federal initiatives. The likelihood of a redefinition of the meaningful use program is prompting widespread discussion of the role it should play in the future.

Many healthcare IT leaders want federal agencies to quickly provide clarity on how the Meaningful Use program will be overhauled and how it will be included as one of the components of new reimbursement programs. For example, the Merit-Based Incentive Payment System (MIPS) will combine parts of the Physician Quality Reporting System, the Value-based Payment modifier and the Medicare Electronic Health Record incentive program, and a portion of that program will be based on the meaningful use of certified EHR technology.

There’s wide agreement that the approach should be something other than collecting data merely for the sake of meeting meaningful use requirements, which has been an increasingly frustrating practice that, many say, draws resources and attention away from improving care delivery and outcomes.

John Showalter, MD, chief health information officer at the University of Mississippi Medical Center, hopes “something better” means the end of “jumping through hoops to meet the criteria of an incentives program to something that encourages actions that make a difference for patients.

John Showalter, MD
John Showalter, MD

“I believe we can do powerful things for patients with the data we have been collecting, but using the data has not been a focus of Meaningful Use,” he notes, adding that he hopes the next phase of the program opens the door for innovation around use of data to improve care and outcomes. “It will need to be a program more concerned with outcomes than process, so processes can be flexible and better integrate with a variety of clinical workflows.”

Marshall Ruffin, MD, executive vice president and CIO at Inova Health System, believes the meaningful use program did its job in providing strong incentives for hospitals and physician practices to adopt EHRs, which now have become indispensable to modern and safe medical practices, as well as supporting population health management initiatives. He says the next hurdle to cross is the lack of interoperability and he’d like to see that issue prioritized. That means having the government determine interoperability standards that govern more than the Continuity of Care Document, which is all it’s dictated to this point.

“The velocity and accuracy of care would increase tremendously,” he contends. “The government needs to give incentives to the community of vendors to make their products interoperable with health information exchanges.”

Ruffin also would like the feds to take another look at HIPAA privacy and security rules that “have built enormous impediments to the legitimate and necessary exchange of clinical information.” HIPAA, he believes, should be amended to promote, rather than discourage, information exchange.

Todd Richardson, senior vice president and CIO at Aspirus Inc., an eight-hospital delivery system serving northeast Wisconsin and parts of Michigan’s Upper Peninsula, agrees. He says what’s needed is a concerted effort to create true interoperability “rather than wasting millions of dollars and countless hours building HIEs that are unsustainable and only lead to increased costs and being held hostage to unneeded middleware infrastructure.”

Imagine, he asks, if Verizon made its users pay charges to a third-party if they wanted to call someone using AT&T. “We would scoff at the idea, yet here we sit.” Nothing would help facilitate interoperability more than a true patient identifier, Richardson asserts. Not having that identifier is like asking the IRS “to do their jobs without each of us having a Social Security number.”

Chuck Christian, vice president of technology and engagement at the Indiana Health Information Exchange and a veteran CIO, also sees quality and outcomes as the core of “something better,” rather than a focus on what functionality each EHR should have. But there needs to be more, in particular, a true patient identifier. “With the renewed focus on interoperability, the need for a method by which we can positively identify our patients is more important than ever,” Christian says.

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If I could envision 'something better,' it would be one program that provides the right economic incentives to improve outcomes with one set of objectives and requirements.

“This need goes beyond the regular hospital and physician practice settings. There are many other areas that have the same need, such as public health agencies. We also need to consider the other levels of care such as post-acute and mental health. These care providers are not included in the current programs; however, they provide valuable services to the same population that we all serve.”

The focus of any new approach should be maximizing investments already made in the initial infrastructure of EHRs to help clinicians improve care processes rather than checking off requirements that sometimes make no sense, says Roland Garcia, senior vice president and CIO at Baptist Health in Jacksonville, Fla.

“Most organizations now have significant pockets of information about patients, and the inventory of this electronic data grows each day. We need to find a way to harvest this in a truly clinically meaningful way for the betterment of patient treatment,” Garcia says. “By always keeping the patient at the center of our focus, we should find the right approach to deliver ‘something better.’ ” Realistic requirements and deadlines in federal rules also would help, he adds.

"If I could envision 'something better,' it would be one program that provides the right economic incentives to improve outcomes with one set of objectives and requirements," says Deborah Gash, vice president and CIO at Saint Luke's Health System in Kansas City, Mo. "Having multiple programs with different rules and requirements is burdensome and difficult to manage, adding overhead and cost to the healthcare system, not only for providers but also the regulatory agencies that must administer the programs."

The messages from CMS and ONC on new approaches really describe an evolution from meaningful use to the Merit-Based Incentive Program, says Eric Yablonka, vice president and CIO at The University of Chicago Medicine and Biological Sciences. “Measuring quality is the underlying theme,” he explains.

MIPS combines meaningful use and PQRS incentives into a consolidated platform that should reduce some of the pressure for eligible professionals to meet some of the MU requirements, but it’s unclear what the transition will mean for eligible hospitals.

Just as important, the announcement of new approaches focused on a strong push for quality, Yablonka adds, and that’s how it should be. “We believe that healthcare as an industry has moved past the need for MU to be the ‘stick’ for EHR adoption and utilization, and our focus must be on the outcomes. Our patients expect it, and that is our core mission. If a shift in what the requirements are and how they are measured is what we need to move forward, then we are supportive.”

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