The Office of the National Coordinator for Health Information Technology on Oct. 9 submitted its annual report to Congress updating lawmakers on the nationwide adoption of health IT and health information exchange. Though “significant” progress has been made, ONC acknowledges that key barriers remain.

As evidence of progress, ONC’s 2014 report points to widespread participation among eligible hospitals and professionals in the EHR Incentive Programs. According to the report, as of June 2014, 75 percent (403,000+) of the nation’s eligible professionals and 92 percent (4,500+) of eligible hospitals and critical access hospitals had received incentive payments under the program. In addition, ONC claims that six in 10 hospitals (59 percent) and one-half of physicians (48 percent) have adopted basic EHRs.

“This progress has laid a strong base for health IT adoption and created a growing demand for its interoperability that not only supports the care continuum, but also supports health generally,” states the report.

ONC also boasts that HIE has increased, saying that in 2013 more than 60 percent of hospitals exchanged clinical data with healthcare providers outside of their system. However, the office acknowledges, only 14 percent of physicians electronically shared patient health information with outside providers.

“Despite progress in establishing standards and services to support health information exchange and interoperability, practice patterns have not changed to the point that healthcare providers share patient health information electronically across organizational, vendor, and geographic boundaries,” concludes the report. “Electronic health information is not yet sufficiently standardized to allow seamless interoperability, as it is still inconsistently expressed through technical and medical vocabulary, structure, and format, thereby limiting the potential uses of the information to improve health and care.”

Another major barrier cited by ONC is that HIT adoption remains a lower priority among providers that are not eligible for incentive payments under the EHR Incentive Programs, such as long-term care, post-acute care, and behavioral health settings. “Despite recent progress, gaps and challenges remain for the widespread use of interoperable systems and HIE across providers, settings of care, consumers and patients, and payers,” according to the report. “There is even more limited HIE involving post-acute and institutional long-term care, most behavioral health, and laboratory providers who are not eligible for incentive payments under the EHR Incentive Programs.”

However, ONC makes the case that “advancing the adoption of certified EHR technology solutions to these providers will support the realization of the goals associated with implementing a nationwide health IT infrastructure and new models of care delivery and coordination.”

While the report highlights the progress and accomplishments made in Stage 1 meaningful use, ONC glosses over the formidable challenges that continue to dog providers in Stage 2 MU. For instance, readers of the report would have no inkling that hospitals in particular continue to struggle with Stage 2 MU requirements. As of the end of August 2014, only 143 eligible hospitals and 3,152 eligible professionals have attested to Stage 2, according to the Centers for Medicare and Medicaid Services.

Still, ONC points out that Stage 2 of the EHR Incentive Programs “should serve as a catalyst for promoting the exchange of clinical information across organizational boundaries and EHR developer platforms” and that a key requirement of Stage 2 requires eligible professionals and hospitals to provide a summary of care record for more than half of their transitions of care. In addition, the report reveals that incorporating clinical laboratory test results into certified EHR technology as structured data is a core requirement in Stage 2, as is providing patients the capability to view online, download, or transmit information from their medical record.

At the same time, the report warns that “eligible professionals, eligible hospitals, and CAHs failing to demonstrate meaningful use of certified EHR technology may be subject to payment adjustments under Medicare beginning in 2015.” Judy Murphy, R.N., ONC’s outgoing chief nursing officer, on Sept. 29 told an audience at AHIMA’s annual conference in San Diego that financial penalties—in the form of lower Medicare reimbursement for failure to become meaningful users of EHRs—will start “kicking in” next year and that over time the penalties to providers could yield savings to the federal government of up to $6 billion.

A week later, the Centers for Medicare and Medicaid Services, under pressure because so many providers are not yet ready to attest for Stage 2, set a new deadline for applying for a hardship exception to avoid the reimbursement penalties.

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