HHS officials said they hope the decision will encourage hospitals and providers to speed up their adoption of EHRs, noting that many providers have delayed participation this year because they'd have to meet Stage 2 requirements in 2013. To buy themselves more time, many providers scheduled entry into the program in 2012, so they would not have to meet Stage 2 standards until 2014.
"We want to provide an added incentive for providers attesting to Meaningful Use in 2011. We encourage any providers who have been waiting until 2012 to attest to Stage 1 meaningful use now," Joe Kuchler, a spokesman for the Centers for Medicare & Medicaid Services, told InformationWeek Healthcare. "Under the Medicare and Medicaid EHR Incentive Programs, providers who attest early receive greater incentives. And now those providers who first attest in 2011 can get three payment years for meeting the Stage 1 expectations, while those first attesting in 2012 can only get two payment years under Stage 1 criteria."
Giving his assessment of the decision to delay the start of Stage 2 for a period of one year for first-time providers attesting to Meaningful Use in 2011, Kuchler said HHS listened to comments from multiple stakeholders, including EHR developers and the provider community.
[For more background on e-prescribing tools, see 6 E-Prescribing Vendors To Watch.]
"Input from the vendor community and the provider community makes clear that the current schedule for compliance with Stage 2 Meaningful Use objectives in 2013 poses a nearly insurmountable timing challenge for those who attest to Meaningful Use in 2011," Kuchler said. "With the anticipated release of the final rule for Stage 2 in June 2012, the current timetable would require EHR vendors to design, develop, and release new functionality, and for eligible hospitals to upgrade, implement and begin using the new functionality by the beginning of the reporting year in October of 2012."
CMS will propose the delay in the Stage 2 Meaningful Use Notice of Proposed Rulemaking (NPRM), which is scheduled to be published in February 2012. This will give vendors added time to develop certified EHR technologies as well as give providers additional time to implement new software to meet the more difficult requirements as they transition from the first phase of the Meaningful Use program to Stage 2, officials at the agency said.
Steven Stack, board chair-elect of the American Medical Association, applauded HHS' decision to delay Stage 2 requirements until 2014, but added: "We continue to urge HHS to fully evaluate Stage 1 and develop solutions to increase physician participation rates prior to finalizing requirements for Stage 2."
Charles Christian, CIO at the Good Samaritan Hospital, based in Vincennes, Ind., said the decision shows that HHS appreciates the fact that the healthcare industry is experiencing a level of change that the industry has not seen before and that EHR installation projects are competing with other health IT initiatives in an environment where resources are scarce.
"Their willingness to modify the timeline speaks to their desire for all those participating to have the highest potential of success without undue penalty," Christian said. "Based upon all the processes that have to be changed to incorporate all the new technology in a safe manner, the timelines have been somewhat aggressive."
Erica Drazen, managing director at CSC's Global Institute for Emerging Healthcare Practices, said that in light of the recently published report from the Institute of Medicine that urged healthcare stakeholder to promote patient safety as they design, install, and use EHRs, HHS seems to be striving for a good balance between achieving the goals of implementing health IT at a fast pace and dealing with the practical realities that providers face when implementing these systems.
"[HHS' decision] reflects the difficulties of balancing the desire to get EHRs implemented as soon as possible, and the need to provide more time for the development, safe implementation, and use of those systems. Both are critically important, but HHS is erring on the side of safe EHR implementation," Drazen said.
When are emerging technologies ready for clinical use? In the new issue of InformationWeek Healthcare, find out how three promising innovations--personalized medicine, clinical analytics, and natural language processing--show the trade-offs. Download the issue now. (Free registration required.)