Health IT Stakeholders Find Meaningful Use Goals Aggressive
Electronic health record vendors, healthcare providers, and others say Stage Two and Three timelines, targets, and objectives are too demanding, according to a CCHIT survey.
(click image for larger view)
Slideshow: Health IT Boosts Patient Care, Safety
-- Patient Access to Health Information Within Four Days: Respondents said there is lack of clarity about what constitutes "relevant" information, this objective will require major workflow change at the provider level, and a change of this magnitude at the national level could become a patient safety issue. Respondents recommend staying at Stage One level until this can be further evaluated.
-- Submission of Immunization Data: Ongoing submission of immunization data to state registries is premature given the lack of transmission mechanisms and state systems that can accept the data, respondents said. They recommended no expansion beyond Stage One.
-- Capability to Exchange Key Clinical Information: Anything beyond using an EHR with the capability to submit data requires significant technological and policy work far beyond the scope of clinical practice and individual providers, said respondents. Most states have not yet addressed either the policy or technical challenges necessary to create the supporting infrastructure to meet these objectives in either Stage Two or Three, they said.
-- Clinical Decision Support: Respondents said this is another area where it is premature to go beyond Stage One because a supporting infrastructure is not yet built, beyond a few simple decision-support rules.
-- Submission of Reportable Lab Data (and reconciliation with orders): Respondents believe that this measure is not appropriate until there is more standardized lab results coding (beyond numerical values), transmission, and implementation guidance.
-- Drug Allergy Checks: Respondents registered minimal concern with this becoming a core requirement in Stage Two. There was, however, significant concern about the Stage Three proposal. Commentary identified that there is no consistent library of evidence-based interactions for more complex interactions and the field is more dynamic than existing technology can accommodate.
Bell said almost all respondents mentioned the need for "further maturation that would take longer than the implementation timeline necessary to have them included in EHR technology by 2014."
Bell also said providers want control over the implementation process, especially since the requirements necessary to achieve Stage Two and Stage Three of the meaningful use guidelines have an impact on costs.
"While many of the objectives, and measures proposed by the Workgroup are laudable in their own right, putting individual providers financially at risk for results beyond their control is counterproductive to the overall goal of widespread provider adoption of [health IT] that is used in a meaningful manner."