College of Healthcare Information Management Executives warn technology and workflow burdens make EHR reporting nearly impossible.
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Recent comments made by members of the College of Healthcare Information Management Executives (CHIME) make clear the organization doubts hospitals' ability to submit accurate and complete data through electronic health records (EHRs). CHIME members' comments were made in response to a Jan. 3 Request for Information (RFI) issued by the Center for Medicare and Medicaid Services (CMS).
In a statement, CHIME members commended federal efforts made toward "reaching a harmonized approach" for electronic clinical quality measurement and reiterated its support for aligning EHR-based reporting and hospital quality reporting programs. But the "number one thing" the organization wanted to convey to CMS is that quality measurements through EHRs are "extremely time intensive and difficult," said Jeffery Smith, assistant director of public policy at CHIME, in an interview with InformationWeek Healthcare.
"We want to make sure they understand that as far as data coming together in an electronic format, it doesn't seem like sending data electronically will be difficult," Smith said. "But getting accurate and complete measures is really difficult."
Smith added this concern builds on an ongoing conversation that originated with the formation of Meaningful Use. "It is a concern that hospitals submit data or attest to clinical quality measures, even though they know them to be incomplete and inaccurate," he said. Although Smith recognized the idea behind Stages 1 and 2 of Meaningful Use is to make sure reporting is possible – not necessarily accurate, -- "you can see where hospitals and clinicians are nervous whenever they click on a button saying, 'I attest to these measures coming out of the EHR, even though these measures aren't correct.'"
In addition to questioning the readiness of electronic reporting, Smith said CHIME's second concern was in regard to CMS' volunteer pilot program, which allows hospitals to submit clinical quality measure (CQM) data electronically as part of the EHR incentive payments program, rather than through attestation. In CHIME's statement to CMS, the organization urges CMS to broaden the program to more hospitals, while using results from pilot participants to better gauge hospital and vendor readiness of EHRs to support electronic quality measurements.
"We want to support the program," Smith said. However, CHIME believes CMS could do more to endorse it. "We tried to say, go back to the pilot program and find a way to promote it more," he said. "That can help push the ball forward in terms of readiness assessment and getting people to do this. The scary thing in our mind is everyone has to do this in 2014 -- we're not concerned the technology and capabilities won't be there to do it, but the technology and capabilities won't be there to do it in a complete and accurate way."
Lastly, Smith said CHIME wants to reiterate the workflow implications of designing measures for paper that are now meant to transition into an EHR. "Just because there's a note section of the EHR doesn't mean that section is coded in a structured way," he said. "[This is] a plea for CMS to make sure ... they understand and have some sense of what the problem is."
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