Healthcare // Electronic Health Records
Commentary
5/27/2014
11:25 AM
David F Carr
David F Carr
Commentary
Connect Directly
LinkedIn
Google+
Twitter
RSS
E-Mail
50%
50%

Meaningful Use Deadlines Clash With Software Best Practices

Hospitals find themselves implementing new releases of EHR software, certified to 2014 standards, almost as soon as vendors release certified versions. That's almost like implementing Windows 8 immediately after release.

When federal regulators announced plans to stretch the schedule for electronic health record (EHR) implementation under the Meaningful Use incentives program, they said one of the complaints they were responding to was a compressed timeline.

By the time requirements for software capabilities intended to enable Meaningful Use Stage 2 were finalized, vendors had too little time to translate them into working software, and healthcare enterprises had too little time to test, configure, and deploy the software. Those who managed to do so anyway -- or are well on their way to implementing software certified to the 2014 requirements -- may have felt a little foolish after learning of the proposed rule to allow users of software meeting the 2011 edition of the software to continue to qualify for the program.

Given more notice, most would have chosen to take the implementation a lot more slowly. One of the big reasons Meaningful Use is so challenging is the conflict between the program's ambitions for rapid change and the more cautious software implementation schedule favored by large enterprises, including hospital systems.

[Familiar pattern? Read ICD-10 Remains High Priority Despite Delay.]

In a joint announcement last week, the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health IT also said they would extend the Stage 2 phase of the program by a year, through the end of 2016, giving the healthcare industry more time to absorb and optimize the technology it has already implemented. Stage 3, which is expected to focus more on the outcomes that can be achieved with technology than on new IT requirements, would then begin in 2017.

It's more complicated than that, because the program really has two halves. One is the certification of software that meets the requirements of each Meaningful Use stage, known as certified electronic health records technology (CEHRT). The other is a set of quality metrics healthcare organizations are expected to meet to show they have used the technology in a meaningful way. Although this is the year of Meaningful Use Stage 2 for those organizations that started with Meaningful Use Stage 1 back in 2011 or 2012, organizations just now entering the program start at Stage 1. At the same time that they formulated their 2014 technology requirements, regulators adjusted the Stage 1 requirements to match what organizations ought to be able to accomplish with 2014 editions of the software.

To "clarify" the proposed rule, CMS had to publish a matrix of requirements that will now apply depending on whether an organization has implemented 2011 CEHRT, 2014 CEHRT, or a mix of the two -- and also depending on whether the organization plans to attest for Stage 1 or Stage 2 compliance this year. This is what that looks like:

Table 1: How Required Metrics Map To EHR Certification Year

Current Stage 2011 CEHRT 2011/2014 CEHRT 2014 CEHRT
Stage 1 2013 Stage 1 objectives and measures* 2013 Stage 1 objectives and measures*
-OR-
2014 Stage 1 objectives and measures*
2014 Stage 1 objectives and measures
Stage 2 2013 Stage 1 objectives and measures* 2013 Stage 1 objectives and measures*
-OR-
2014 Stage 1 objectives and measures*
-OR-
Stage 2 objectives and measures*
2014 Stage 1 objectives and measures*
-OR-
Stage 2 objectives and measures
*Only providers that could not fully implement 2014 Edition CEHRT for the reporting period in 2014 due to delays in 2014 Edition CEHRT availability.

Dr. Robert Wah, chief medical officer at consulting firm Computer Sciences Corp., welcomes the "encouraging signs of flexibility" demonstrated by the extension. He suggests every organization needs to study the proposed rule in detail to understand how it applies to them. Although the proposal still has to pass through a 60-day comment period, the proposal is a clear signal that the deadlines will be extended by at least this much.

True, the timing is such that organizations in the middle of the process of deploying technology or attesting for Stage 2 can't afford to slow down. However, the proposed rule suggests that the aim is to provide relief for organizations that were unable to obtain 2014 certified software in time to meet this year's Meaningful Use goals.

"The people who are on schedule will be fine," says Wah. "But there are a large number of people who will benefit from this flexibility."

Nevertheless, the ruling generated complaints from the American Medical Association, saying the requirements are still coming too fast, and the National Partnership for Women and Families, worrying that the promised benefits of health IT are being delayed. The College of Healthcare Information Management Executives (CHIME) welcomed the rule change but urged CMS to finalize it as quickly as possible.

As part of my research for our Healthcare IT Priorities Survey report, I recently spoke with CHIME board chair Randy McCleese, CIO of St. Claire Regional Medical Center, about the forced march that hospitals

Next Page

David F. Carr oversees InformationWeek's coverage of government and healthcare IT. He previously led coverage of social business and education technologies and continues to contribute in those areas. He is the editor of Social Collaboration for Dummies (Wiley, Oct. 2013) and ... View Full Bio
Previous
1 of 2
Next
Comment  | 
Print  | 
More Insights
Comments
Newest First  |  Oldest First  |  Threaded View
SteveRobbin
IW Pick
100%
0%
SteveRobbin,
User Rank: Apprentice
6/10/2014 | 9:19:24 PM
Personal experience
I am working as an EHR consultant with an EHR Vendor Nortec Software Inc. I completely agree with the author because i know personally that how much problems are going to be arrive due to this clash. Because the most imprtant factor is also the most time gainning,training. Tranning of human resource to use the software properly.
batye
50%
50%
batye,
User Rank: Ninja
6/2/2014 | 2:47:09 AM
Re: John Halamka on Meaningful Use Extension, need for further simplification
thanks for a link, interesting to know... 
David F. Carr
50%
50%
David F. Carr,
User Rank: Author
5/29/2014 | 11:09:42 AM
John Halamka on Meaningful Use Extension, need for further simplification
Noted health IT CIO John Halamka has posted his analysis of the schedule change and the reaction from his peers here:

http://geekdoctor.blogspot.com/2014/05/early-reaction-to-electronic-health.html

Key observation: "layering fixes on top of existing Meaningful Use regulation, some of which was written by CMS and some of which was written by ONC creates too much complexity.   I have direct access to the authors of the regulations and email them on a daily basis.   It's getting to the point that even the authors cannot answer questions about the regulations because there are too many layers."
fpoggio600
50%
50%
fpoggio600,
User Rank: Apprentice
5/28/2014 | 9:22:27 PM
MU Deadlines and buggy software
I have two observations:

1) It makes absolutely no difference whether you deploy software on the cloud or turnkey. If your product is buggy on a turnkey deployment you nick only one client. On a cloud you nick all clients. Buggy apps know no difference in platform.

2) The certification proces (of which I have been through over 30) is constantly watching for buggy software and unstable product. If the tester sees this happen more than once they can 'flunk' you immediately. So if you make it thru the certificatin process your code must be stable. If after you deliver it, it is not stable then you must have made additional revisions after certification that can't be blamed on the certification process.

Frank Poggio

The Kelzon Group

KelzonGroup.com
ThemosPentakalos
50%
50%
ThemosPentakalos,
User Rank: Apprentice
5/28/2014 | 7:17:43 PM
Re: Regarding the recent proposed changes
David, we have to go by the numbers already posted. As of  May 1'st, CMS published that only 4 hospitals and 50 providers had attested for stage 2. It's still early but those numbers paint a bleak picture.

Let's see how this all plays out!

-Themos
David F. Carr
50%
50%
David F. Carr,
User Rank: Author
5/28/2014 | 6:19:30 PM
Re: Regarding the recent proposed changes
So how close to the breaking point do you think most healthcare organizations are?
ThemosPentakalos
100%
0%
ThemosPentakalos,
User Rank: Apprentice
5/28/2014 | 5:50:55 PM
Regarding the recent proposed changes
At ChiroTouch, we have been working on implementing the new 2014 requirements for stage 1 and stage 2 for 8 months and were, in fact, one of very few software companies to get certified in time. To our knowledge, roughly 10% of software vendors are certified thus-far and there are only a few weeks left before the July 1 deadline.

Whether there is a delay or not, this engineering effort had to happen. If we knew of this delay earlier, we would have been postponing the scrambling to next year. Furthermore, the proposal calls for a 60-day review cycle so in a sense people that are attesting for the first time can't really wait. There is always the possibility that they wait and not start on time. If the proposal is declined, these doctors/hospitals would have to incur a penalty as they should, according to the rules, start operating under meaningful use measures no-later-than July 1. The government decision doesn't come out until the end of July.

The biggest risk for the government is that they wind up making this too complicated from an operational and technological perspective, at which point the whole stimulus program falls flat on its face. Clinical offices and hospitals run as businesses. At some point, the pain and cost of compliance outweighs the financial benefit and the program falls apart as a result of non-compliance.
David F. Carr
50%
50%
David F. Carr,
User Rank: Author
5/28/2014 | 9:37:32 AM
Does enterprise health IT need to move faster?
Healthcare organizations are often rapped for being behind other industries in the use of IT, which is one reason the Meaningful Use program has often prescribed a faster pace. Is it appropriate to expect healthcare organizations to move faster? The Facebook mantra of "Go fast, break things" doesn't sound so great in the context of healthcare. Lagging on information security, as pointed to in our story comparing healthcare to retail, but whether rushing new features into production helps or hurts patient safety / healthcare quality is debatable.
Alison_Diana
50%
50%
Alison_Diana,
User Rank: Author
5/28/2014 | 9:32:37 AM
Over Reach
While the goals are laudable and hindsight's always simple, I'd imagine CMS now wishes it had created a less ambitious, much more manageable set of schedules for this complex series of rollouts. One thing that struck me over and over is wondering who was involved in recommending these timelines from an IT perspective, what experience did they have in HIT, and how much weight was their insight given into the development of these schedules. From the get-go, it was apparent healthcare providers wouldn't have adequate time for testing; as a result, they'll have expensive fixes (perhaps as costly as ripping and replacing EHRs, which we're seeing already).

However, if the government had not stepped in I sincerely doubt most healthcare orgs would have adopted EHRs. We must be careful about how and who accesses 'deidentified' and 'anonymized' data -- and ensure it truly meets those classifications -- but providing patients with access to their own records is certainly a big step forward in a market that was well behind most, if not all, other verticals in basic IT adoption.
Register for InformationWeek Newsletters
White Papers
Current Issue
InformationWeek Tech Digest - July 22, 2014
Sophisticated attacks demand real-time risk management and continuous monitoring. Here's how federal agencies are meeting that challenge.
Flash Poll
Video
Slideshows
Twitter Feed
InformationWeek Radio
Live Streaming Video
Everything You've Been Told About Mobility Is Wrong
Attend this video symposium with Sean Wisdom, Global Director of Mobility Solutions, and learn about how you can harness powerful new products to mobilize your business potential.