The long-awaited definition of meaningful use is finally here. Just before the New Year, the Centers for Medicare & Medicaid Services and the Office of the National Coordinator released both the definition of "meaningful use" for electronic health records and the standards to improve the efficiency of health information technology.
Hospital and provider group organizations have already offered their criticism of the proposed regulations. Yesterday, my colleague Janice Simmons offered a good evaluation of the American Hospital Association, Medical Group Management Association, and the American Medical Association concerns.
I was curious what individual providers thought of the definition, so I asked physicians, chief information officers, and other industry leaders whether they thought the meaningful use bar was set too high or low, and what they thought was the most significant change to the HIT Policy Committee's recommendations, if any. Many executives are still delving into the 700+ page document, but here are their initial reactions.
The ONC and CMS have set the bar at an appropriate level. While everyone does not agree with everything they are doing, it is very clear that the health IT agenda in the United States will be driven by the ONC agenda. There is considerably more health "reform" in the HITECH legislation than is likely to come out of the current healthcare reform debate going on in Washington. This legislation will likely prove to be the biggest and most transformational quality and safety initiative ever launched in this country. A huge national experiment is about to take place, and I am looking forward to being involved in it!
John L. Haughom, MD
Senior vice president, clinical and patient safety
Chief Information Officer
Parkland Hospital and Health System
Some providers will think the bar is too low. But when you examine the measures, it becomes clear that the low threshold will almost be immediately exceeded by the mere implementation of the functionality. If an organization is going to all the trouble of CPOE, it is hard to envision that they would stop at 10%.
Naturally, the requirements around HIE are the most daunting. I think the ONC is doing the right thing by including them in the requirements, if for no other reason than to continue to put pressure on communities to develop functioning HIEs that will meet the criteria. I don't think HIE would occur naturally otherwise as it is quite laborious and lacks an immediate ROI to make it attractive.
Richard Vaughn, MD
Corporate Vice President Clinical Decision Support and Medical Director, Project Beacon
SSM Health Care
St. Louis, MO
We are extremely disappointed that CMS has decided to exclude critical access hospitals from the Medicaid (as opposed to Medicare) portion of the incentives. We are concerned that CAHs still don't have the all the information they need to understand what constitutes an "eligible EHR expense." The objectives have not significantly changed from the HIT Policy Committee's recommendations. The bar has been set much too high for small and rural facilities. The key question for all to consider is how one can set the same bar for providers at early stages of adoption and at advanced stages of adoption. The result of this single-bar strategy is that providers who already have EHRs—and therefore don't need assistance—will get the lion's share of the incentives. Disadvantaged providers at low stages of adoption who especially need the assistance will be much less likely to get help. CMS and ONC have structured the incentive program in a way that will dramatically expand the digital divide between our country's EHR haves and have-nots, large proportions of which are small and rural providers.
Director of Health Information Technology
Rural Wisconsin Health Cooperative
These barriers mean that CAHs must rely on CMS and ONC to issue instructions that are sensitive to the realities of community hospital EHR vendor models, the numerous systems that generally fall outside of the certified EHR vendor offerings, certification organization capabilities, and how all of this impacts CAHs' costs incurred.
Terry J. Hill
Rural Health Resource Center