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10/10/2011
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Athenahealth CEO Says Meaningful Use Needs Performance Data

Physicians should be required to collect and report actual EHR performance data to avoid subjective aspects of Medicare's MU attestation process, says electronic health record vendor CEO.

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Jonathan Bush, the outspoken CEO of Athenahealth, a Watertown, Mass.-based EHR vendor, recently told a federal health IT advisory body that physicians should no longer be allowed to attest that they have met the Meaningful Use (MU) requirements for government EHR incentives. Instead, he said, they should be required to submit actual performance data to the Centers for Medicare and Medicaid Services (CMS).

"To increase the integrity of the program and leverage data that should already be maintained in EHRs, CMS should aggressively pursue a registry-based submission process for provider attestation," Bush remarked to the Meaningful Use workgroup of the Health IT Advisory Committee. "Until Meaningful Use performance data can be electronically submitted from a provider's EHR, attestation unnecessarily remains a subjective and qualitative measure of success--forcing undue stress on providers, creating the need for stringent and costly after-the-fact audits, and underutilizing the capabilities of EHRs."

Currently, CMS requires physicians to attest that they have met 15 core criteria and five other measures chosen from a menu in order to show MU. Because CMS is unable to accept electronic data feeds from all of the certified EHRs in use, the agency recently extended the use of attestation through 2012. However, CMS has also proposed a pilot program in which providers would submit quality data either directly from their EHRs or through registries.

Athenahealth's EHR, like its practice management software, is cloud-based and managed centrally off a single database. Moreover, the vendor requires all of the nearly 5,000 providers using its EHR to utilize a single version of the program without customizing basic functions such as registration, intake, and orders. As a result, Bush told InformationWeek Healthcare, "All the data is harmonized and all the data is measurable and reportable in the same way." Therefore, he said, Athenahealth is capable of reporting client data on all Meaningful Use measures.

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Athenahealth recently started posting a MU dashboard showing where clients who are pursuing the federal incentives stand on various metrics. Most of those physicians have already met the core requirements for MU, except for providing clinical summaries to patients, which only 65% have done. The dashboard shows that 75% have met five of the optional criteria.

Overall, 28% of the physicians going after the incentives have attested to MU, according to Athenahealth, and 56% have only two more criteria to meet. Bush said the company's goal is to have 75% attest by the end of the year.

That would far exceed the percentage of all physician EHR users who have attested. According to the latest CMS data, just 3,722 eligible professionals have attested to MU since last April--although tens of thousands have registered for the program.

This seems to indicate that many doctors are struggling with MU, even though they don't have to submit performance data. But Bush believes that many of those who have attested or will attest might not actually be achieving MU. He said that it is unfair to his customers, who must meet Athenahealth's strict scrutiny before they can attest.

Bush also told the Health IT Advisory Committee workgroup that CMS should strengthen its ability to audit physician practices on MU attestation. And he said that providers and EHR vendors should be held to "higher standards in the implementation of measures that require the exchange of data, as opposed to simply allowing dummy data and failed tests to qualify a provider for payment."

In his interview with InformationWeek Healthcare, Bush explained that the current measure for information exchange requires only that physicians try to send vaccination data from their EHR to an immunization registry. Even if the test fails, they pass for purposes of MU.

As for the auditing process, he said that it's his understanding that CMS will only audit a practice in reaction to a complaint. "Who would complain that a doctor attested inappropriately? No one, so no one will be audited," he said.

Although Bush's statement did mention holding EHR vendors to a higher bar, he told InformationWeek Healthcare, "I don't think we should have a higher bar [for vendors]. That would really be self-interested [on the part of Athenahealth]. If people want a higher bar, they should pay more. Our clients would be happy to provide plenty of data that isn't required today in exchange for more revenue. With Meaningful Use, the price is set, and they make it as easy as possible to get the $44,000. I think they should at least require that you collect the data."

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