Proposed changes in the meaningful use program for hospitals offer a measure of relief for providers, but some healthcare IT executives said the program still will be challenging for healthcare organizations that will pursue federal incentive payments for their use of electronic health records.

While the levels needed to achieve objectives for the program have been lowered, they’re still significantly challenging, they say, and some believe that most providers are just plain weary of the constant pressure, over several years, to meet new goals.

Bill Spooner

On Wednesday, the Centers for Medicare and Medicaid Services announced plans to streamline electronic health record reporting requirements for eligible professionals and hospitals in the Medicare EHR Incentive Program.

The changes include a proposal for clinicians, hospitals and critical access hospitals to use a 90-day EHR reporting period in 2016, eased back from a full calendar year for returning participants. The proposed rule also offers a variety of adjustments in objectives for Stage 3 of the program. CMS says it lowered thresholds for achieving objectives in response to industry feedback on provider IT capabilities, as well as the readiness of HIT vendors, and their patients and consumers.

CMS’s proposed rule changes came in response to industry complaints that the incentive program for using EHRs makes it difficult to meet requirements for objectives. Some of the major areas of change within the proposed rule would simply reduce the threshold for qualification, which was disappointing to Bill Spooner, a consultant in HIT and former CIO at Sharp Healthcare in San Diego. CMS is “raising a surrender flag” by lowering thresholds, he says.

Provisions of the proposed rule lowered the levels for demonstrating patient engagement, but Spooner doesn’t believe the objectives really show that it’s meaningful engagement. “I wish that they had come up with a little more creativity for engaging with the patient,” he adds.

Other executives say they are relieved that CMS has stepped in to lessen the overly challenging metrics for meeting objectives.

“Clinicians are exhausted from running the Meaningful Use marathon and need time to optimize usability, refine workflow and realize the efficiencies possible from automation done right,” says John Halamka, MD, CIO of Beth Israel Deaconess Medical Center.

“The CMS changes acknowledge these human factors and grant relief to hospitals so they can work through the cultural change that is foundational to technology adoption,” Halamka adds.

Smaller hospitals, in particular, are struggling with the amount of effort needed to continue with the meaningful use program, HIT executives say. Spooner says small providers still will be challenged in interoperability, while bigger providers have more resources available to achieve those objectives. “The cost of the exchange of information is still going to be a challenge for them,” he says.

Marc Probst, CIO of Intermountain Healthcare, says the type of challenges for providers are going to depend on their particular situation, but he believes the proposed changes offer some relief. “If they were able to achieve MU last year, they should have a fairly straightforward path to achieve it with the relaxed requirements,” he says.

New thresholds represent right-sizing of objectives that are relevant to the concept of meaningful use, some say.

“The recent CMS announcements are very consistent with recommendations that we made on Stage 3 a year ago, namely, that the intent was right but that the actual thresholds were too high in most cases, especially in new areas such as receiving information,” says Micky Tripathi, CEO of the Massachusetts eHealth Collaborative and also chair of the Interoperability and Health Information Exchange Working Group of the Health IT Policy Committee.

“Now, with a year more of experience behind us, we’re seeing the reality that those thresholds were indeed too high,” Tripathi adds. “CMS is looking at the actual performance of providers and calibrating the thresholds to reasonable stretch goals rather than pie-in-the-sky hopes and prayers.”

Picking the right amount of “stretch” in a goal is important, in moving the healthcare industry forward to meaningfully use technology, he adds. 

“Process innovation always lags technology innovation, and that is even more true in healthcare because of the fragmentation of the system, the complexity of patient care and the need to maintain safety above all other concerns,” he adds. “With market demand for interoperability growing every day, and more modern approaches being developed such as FHIR and patient- and provider-facing apps, we can be confident that health information exchange with patients and providers will continue to grow, regardless of whether government regulations say it should.”

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