EHR Vendors Join Chorus Against Federal Deadlines

Now even some vendors of electronic health records (EHRs) are starting to wonder whether the Meaningful Use incentive program is moving too fast.

The HIMSS EHR Association (EHRA), a group of 40 vendors convened by the Healthcare Information and Management Systems Society (HIMSS), last week asked the U.S. Department of Health and Human Services (HHS) to delay the start of Meaningful Use Stage 3 until three years after a participating provider reaches Stage 2 -- no earlier than 2017. HHS pushed the start of Stage 2 back a year in response to industry-wide concern about the short timetable.

In comments submitted to HHS about Stage 3, the software developers also called on federal officials to shift the focus to interoperability of healthcare information rather than ask providers and their vendors to add capabilities to their EHR systems.

[ Get more specifics on Meaningful Use 3. Read Stage 3 Meaningful Use Proposals: Too Ambitious? ]

"In particular, we believe that any meaningful use and functionality changes should focus primarily on interoperability and building on accelerated momentum and more extensive use of Stage 2 capabilities and clinical quality measurement," the vendor association wrote.

"Our proposed alternative approach is offered in recognition that the public and private sector shifts to accountable care and value-based payment are now creating a business case for providers to adopt and use EHRs and other health IT, and to identify needed functionality to meet their varied technology requirements. More broadly, such market-based demand will drive additional customer-requested functionality and EHR use patterns for those who have already adopted and demonstrated sophisticated use by attesting for Stages 1 and 2," the EHRA cover letter said. "The needs of such experienced and often sophisticated users will best be met by market innovation, while extensive and detailed standardized requirements dictated by the federal government are not only unnecessary but may actually interfere with the pace and direction of needed innovations."

Or, as Siemens Healthcare's CEO of health services, John Glaser, told Forbes, "The pace [of the Meaningful Use program] is too damn high." There just hasn't been enough time to concentrate on interoperability, Glaser explained.

This sentiment echoes other recent criticisms of the direction of EHR implementation. In December, longtime EHR advocate C. Peter Waegemann told InformationWeek Healthcare that there is not one successful EHR system in the whole world" because true interoperability has been so elusive.

"We have been focusing too much on documentation [for the purpose of reimbursement]," Waegemann said. The Obama administration apparently has noticed, because it warned providers last year not to "game the system" with EHRs.

As 2013 started, the RAND Corp. warned in a study appearing in the policy journal Health Affairs that EHR design and implementation problems, a lack of interoperability, and continued resistance among providers to redesign care processes and spend time trying to "master difficult-to-use technology" has prevented EHRs reaching their true potential.

More recently, a report on medical device interoperability from the Association for Advancement of Medical Instrumentation (AAMI) and the U.S. Food and Drug Administration (FDA) suggested that policy makers were ignoring all the data coming from connected medical devices by focusing so much on EHRs.

But none of those voices might have the clout of two of the most powerful healthcare entities in Washington, namely the American Medical Association (AMA) and the American Hospital Association (AHA). In separate comments to HHS last week, those two organizations said it was premature to develop rules for Stage 3 before Stage 2 starts in 2014 and while many providers have not yet achieved Stage 1.

Clinical, patient engagement, and consumer apps promise to re-energize healthcare. Also in the new, all-digital Mobile Power issue of InformationWeek Healthcare: Comparative effectiveness research taps the IT toolbox to compare treatments to determine which ones are most effective. (Free registration required.)