Responding to a flood of provider protests regarding the federal government's electronic health records meaningful use program, the Centers for Medicare and Medicaid Services and Office of the National Coordinator for Health IT late yesterday announced a proposed rule allowing providers to use the 2011 Edition of certified EHR technology (CEHRT) for calendar and fiscal year 2014.

This flexibility is seen as a welcomed reprieve by providers allowing them to use EHRs that have been certified under the 2011 Edition for either Stage 1 or Stage 2 for the purposes of the 2014 reporting year. Daniel Griess, CEO of Box Butte General Hospital, a small critical access hospital in Alliance, Neb., is representative of providers who have been struggling to fully implement the 2014 Edition CEHRT. 

At a May 20 listening session held by the Health IT Policy Committee's Meaningful Use Workgroup, Griess urged CMS to extend the fiscal year 2014 reporting requirements into fiscal year 2015. "We would be much better positioned if we could use our existing certified EHR--the 2011 Edition--for our second year at Stage 1, rather than taking a mandatory upgrade to the 2014 edition," he told the MU workgroup. "It is not a question of commitment or effort," Griess added. "We simply find that vendor capacities and operational realities have put us in a precarious position."

Under the proposed rule from CMS and ONC, all eligible providers would be required to report using 2014 Edition CEHRT beginning in 2015. In addition, the proposed rule includes a provision that would formalize CMS and ONC's recommended timeline to extend Stage 2 through 2016 and the earliest a provider would participate in Stage 3 would be 2017.

Hospital executive Griess told the workgroup that the two-year cycle for meaningful use is not realistic and that CMS should extend the length of each MU stage to three years for all providers. "The current two-year cycle is simply too short for vendors to develop safe, usable products that providers can then deploy in safe, efficient ways that really help them better coordinate care, engage patients, and control healthcare costs," he said. "The cultural changes that are needed to fully realize the promise of EHRs requires more time than the current year-over-year changes in meaningful use allow." And in the proposed rule, Griess and others will get that third year.

Similarly, Stephen Stewart, chief information officer for Henry County Health Center, a small critical access hospital in Mt. Pleasant, Iowa, told the workgroup that the amount of change that clinicians--especially physicians--have been asked to adapt to has been overwhelming. In addition, Stewart said that the EHR vendor community "nearly universally admits that some things have been added to applications just to meet the requirements, with little or no consideration as to the impact on workflows."

He pleaded before the workgroup for a period of time following Stage 2 to allow the healthcare community as a whole (both EHR partners and the providers) to optimize work already completed. "We need to go back and fix processes to make them more efficient and time sensitive for the providers," Stewart said.

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