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Guerra On Healthcare: Meaningful Objections To Meaningful Use

Healthcare providers are criticizing exclusions and the all-or-nothing approach of the final draft definition for meaningful use of e-health records.
Since the HITECH provision of the American Recovery and Reinvestment Act was first issued a year ago, hospital CIOs have been on an emotional roller coaster that’s nowhere near slowing down. In those heady days of March and April, euphoria over what was initially considered a windfall for hospitals quickly turned into panic, as CIOs realized they’d really have to earn this money by demonstrating “meaningful use” of the electronic health record systems they deploy.

Right off the bat, the notion that institutions were being prodded to implement expensive systems without any upfront funding seemed odd. On top of that, legislators were giving policy wonks 12 months to define “meaningful use” but not giving providers even that much time to comply. When the Department of Health and Human Services’ Centers for Medicare and Medicaid released the near-final Meaningful Use definition at the end of December, the 500+-page Interim Final Regulation gave even the most ardent healthcare IT enthusiasts plenty to chew on. It wasn’t long before some serious issues were taken with this first attempt at explaining just what providers must do with their clinical and financial software to be eligible for incentive payments.

First off, some insiders are displeased with the exclusion of many “hospital-based” physicians. Hospitals, critics say, will have less incentive to help these doctors--by some counts almost 30 percent of physicians, including radiologists, pathologists, hospitalists and emergency department physicians--in their electronic journey.

Some see this paring of eligibility as an attempt to scale down spending. In the December draft, the Centers for Medicare and Medicaid estimated the program would cost between $14 billion and $27 billion, rather than the original estimate of $34 billion from the Congressional Budget Office. One wonders if the post-stimulus hangover is at work here.

But what’s perhaps most disturbing for providers is they get no “E” for effort--as it’s currently laid out, HITECH is an all or nothing proposition. Providers must install a yet-to-be-defined certified e-health record system, meet all Meaningful Use objectives, and report all 23 physician or 25 hospital measures (many of which are completely new) to get any payout.

Speaking of certification, guidance that was anticipated to be available before the end of January never came, leaving many growing increasingly concerned that there just won’t be enough time to have their complex IT environments certified by a site visit.

Also, an additional requirement that hospitals report Computerized Physician Order Entry orders as a fraction of all orders--electronic and non-electronic--means hospitals will have an enormous amount of administrative work just to report correctly.

CIOs I’ve spoken with are beyond passionate in their desire to see the comment process change quite a bit of the interim regulation. They’re pleading with colleagues to speak out, either as part of their hospital or a larger industry organization, such as HIMSS or CHIME. Interested parties have until the Ides of March.

Anthony Guerra is the founder and editor of, a site dedicated to serving the strategic information needs of healthcare CIOs. He can be reached at [email protected]

Blue Cross of Northeast Pennsylvania, the University of Louisville School of Medicine, and a range of large and small healthcare providers are using mobile apps to improve care and help patients manage their health. Find out how. Download the report here (registration required).