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January 29, 2014 Readers Write 9 Comments

Ominous Outlook for Meaningful Use
By Evan Steele

1-29-2014 1-18-47 PM

CMS passed up a golden opportunity to stave off the potential demise of the EHR incentive program when it failed to delay the start of Stage 2. What was already a complex program in Stage 1 becomes exponentially so in Stage 2, and its pace is outstripping the realities of medical practice and of software development. The facts speak for themselves:

  • 17 percent of the physicians who successfully attested to 90 days of Meaningful Use at Stage 1 in 2011 walked away from the second incentive ($12,000) in 2012, which required a full year of Meaningful Use. I find this dropout rate very surprising. The requirements were exactly the same as the first reporting period for these physicians, so they and their staffs had already established the necessary workflows. The fact that many of these first attesters were early EHR adopters and therefore already more adept at EHR use than the average physician makes this statistic even more alarming. When surveyed by CMS, many of the dropouts cited the program’s complexity as a key reason for their failure in Year 2. Physicians who gave up on Stage 1 will likely not even attempt Stage 2.
  • 12 percent of attesters who used one of the top 25 EHRs to demonstrate Meaningful Use in Stage 1 do not yet have access to a 2014-certified EHR, according to a January report issued by Wells Fargo Securities, while this year’s reporting period must begin within nine months. Some EHRs will never achieve 2014 certification. The first announcement of a vendor abandoning Meaningful Use came a few weeks ago, leaving its physicians out in the cold. Of the 49 ambulatory EHRs that have been 2014 certified to date — winnowed down from a Stage 1 field of 472 — very few have yet been deployed to physicians. This is clear evidence of the complexities associated with Stage 2 and the significant challenges facing vendors in making their EHRs compliant yet practical.
  • I would estimate that at least another 15 percent will walk away from Stage 2 because of its dramatically increased complexity, added costs, and impact on productivity, particularly when weighed against the declining incentives (as little as $4,000 and $2,000 for physicians whose first year of Meaningful Use was 2011) and penalties that will average only a few thousand dollars.
  • How many additional physicians will be driven to cry “Uncle” and abandon Meaningful Use because they are besieged by the demands of so many other programs at the same time—ICD-10, PQRS, Value-Based Payment Modifier, ACO participation, etc.? Physicians and their clinical teams are weary and can only do so much.

If you add these numbers together (acknowledging some overlap), the conclusion that 40 percent of past attesters will give up on Meaningful Use is inescapable. Then there’s the 37 percent of eligible professionals who have never earned an EHR incentive, including 18 percent who—if failure to even register is an indication of lack of intent—are so overwhelmed by the program that they have no interest in participation even in the “easiest” first stage (Source: CMS Presentation to HIT Policy Committee, January 14, 2014).

The delay of Stage 3 will be too little, too late. What was needed was a more reasonable approach to Stage 2.

Evan Steele is CEO of SRS, Montvale, NJ.

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Currently there are "9 comments" on this Article:

  1. Evan’s post is dead on. Even if all of the vendors were ready, which I think everyone agrees, they aren’t, the hospitals are a mess trying to meet Stage 2 without sacrificing patient care. I am in trenches, working with hospitals every single day on this. I am not Suzy and am I very strong advocate for adoption of electronic systems in Healthcare, but anyone who doesn’t see the mess is blinded by bias, or out of touch with the clinicians and their patients. This simply isn’t the best course. Is CMS and ONC listening?

  2. Here are some alternative for compliance Meaningful year 1 or 2 or Meaningful 2
    Pay the incentives to all health care providers the entire amount in the beginning — similar to stimulus plan for other industry
    Have specific target that within three years health care provider will get stimulated enough for using EHR
    Provide stimulus funds to vendors as by doing it they IT folks are creating jobs
    Once the vendors are certified than have the govt provide stimulus funds for skills developments for health care providers
    This way infrastructure is ready , the health providers are educated and start meaningful use
    EHR adds lots of value so within ten years this will be routine

    In the meantime president Obama on the basis of hardship extend the beginning of meaningful use for minimum 18 months or till the vendors are certified and things are in place including how to operate

    Stop CMS audit — extra expense for all – further frustrates folks to get into meaningful use Icd PQRS and all
    Stop reduction of Medicare money
    In the committee for re determining core and menu include practicing doctors

    Demography based on census is additional burden and the worse is patient involvement –Patient portal
    Spend money to teach citizens how to use patient portal
    Too many issues
    All easy to tackle
    Go slowly and provide incentives early as stimulus plans done for other industrues
    Possible but respect the health care providers concerns and solutions
    Do it
    Worth brainstorming

  3. Contrary to reports the MU sky is not falling. If we went to the moon in the 1960’s we can certainly pull this off. Does anyone really think we will not have an interoperable electronic healthcare system 10 years from now? Sure it is hard and messy. Quite a few who are walking away from MU were specialists who got the easy, early, and big incentives that could be obtained with a nod and a wink. They will come walking back when Medicare and then private payers require the technology. It never pays to be on the wrong side of history.

  4. The benefits of the EHR have been discussed, filtered, and played out. There is little doubt the EHR can be a muli-faceted jewel for increasing patient safety and care and has distinct advantages over paper records. I do support the EHR concept and its reality. However, the process, complexity, multiple different government requirements and agencies involved, the short time frames for vendor building and participant training, and the further reduction of both participation and vendors does show a trend toward collapse or in the attempt at keeping EHR alive. The cost will explode beyond small hospital and physician offices capability of keeping up with funding requirements. In the long run either the small hospital and offices go under or the EHR changes. Regarding the moon – comparing the two vastly different endeavors the moon vs EHR. Just to name a few difference: There were three main vendors in the Apollo program, with literally 1000’s of subcontracts from one person shops, to multi-state, multi-facilitied corporate giants. These contractors where paid up front, tested all systems, retested or redesigned when failed, and dealines moved to accomdate failures or delays, and high risk was accepted as seen in the loss of Apollo 1 and three men. No money was taken back when a failure happened. Essentially only a few thousand men and women were trained in the use of the Apollo systems including mission control. The requirements were known up front and did not change at the whim of a political bureaucrated landscape. For the EHR none of these exist. The majority of cost is absorbed by the hospitals and clinics upfront. The little amount each gets does not cover the cost of EVERYTHING involved. The number of certified vendors is slowing declining, the number of nurses and doctors alone to train and use the systems is in the 100s of thousands, if not millions. This does not include the various ancillary care personnel and their specific requirements. The systems are slowing things down and causing major safety issues as is event with the governments SAFER project. Even they recognize(d) the dangers. I do agree EHR is something that is able to be completed, I do agree with, “but anyone who doesn’t see the mess is blinded by bias, or out of touch with the clinicians and their patients” from a previousl mail. Messes can be cleaned up, but it takes time, attitude adjustments on both sides of the EHR demands, and delays and requirements that are reasonable.

  5. Remember going online with your cell phone before the iPhone ? That’s almost the state of today’s EHR’s. They have a checklist of functions, but their execution ( for 30 or more patients a day) is downright painful.

    Too many EHR companies are living off the stimulus payments, many with tiny software development capabilities.. Think of the 1000s of apple employees just dedicated to user interface and usability. Once the payments cease, we will see rapid consolidation to a few. Only then will meaningful, clinically relevant, pithy, health exchange be possible as one or two open source standards arise.

    Until then I’m holding off on EHR. I wish wish there was a system that was intuitive, and aided our workflow. Of course there will be, every other industry has gone electronic due to efficiency. All of us purchased practice management systems in the last decades without incentives – once an ambulatory EHR can do that – we won’t need a government bribe to use it.

  6. I couldn’t agree more with this article. I think you’ll see a MASSIVE drop out from people who read through Stage 2 and just cry uncle. A more careful, less onerous roll-out of Stage 2 requirements would have saved the program, but I think we’ll look up in 5 years and see MAYBE a 20% participation rate… MAYBE. CMS did this to themselves – too much too soon.

  7. What a shock. Specialists have been saying since Day one that EH ours do not and safety. In fact they slow us down and make sure that our notes are incomplete. Vendors that are out there charge outrageous amounts for the software and then inflict further pain by charging outrageous sums for monthly maintenance. The fact is that most of us can write faster than we can type and that’s just a plain fact. The one and only thing I really like about EH ours is the ability to E prescribe. That way we do not need to worry about prescription pads being stolen or patients not bringing in their prescription or patients losing their prescription. All and I mean all of the other aspects of EHR do nothing to help us in our flow of patients. Since most of the EH ours are also cloud-based if the Internet goes down for some reason whether it is hacked or damaged by whether we have no access to patient records. Idiots in the government have suggested that we printed out our EH ours and keep them in files so that if the Internet goes down we still have access to files. How do you answer idiots like this. One of the big selling points of EH ours from the government was that we will not need to keep paper records and we will have more space in our offices hence less rent. As far as Medicare penalties I submit that physicians will tell the government to go stick it and they will not except the penalties or Medicare in that situation If you add up sequester 2% penalties 5% SUR reductions 30% why would you go to work. People that do not participate in Medicare are not subject to any of these reductions. The initial promise of EHR was that practices could talk to each other electronically. What we have now is hundred 250 different vendors all speaking different languages with no translators. Similar to building the United Nations but leaving out translation ability. Perhaps people who know nothing about healthcare should not be making policy on health care and perhaps they should have not used family practitioners or general practitioners to make up rules for Specialists. I have struggled to meet meaningful use one requirements and have done so i’m not so sure that anybody is going to try and struggle through meaningful use two if you’re getting peanuts as a bonus and the penalties will not be accepted

  8. The whole thing need to be turned on its head if you ask me. Doctors and nurses are vital and deserve respect and support not punishment ! Another thing patients need to be the focus and not government busy work. Electronic records , preventative care, real-time monitoring of high risk patients are all worthy ideals, however innovation and intuitive processes and platforms that focuses on Patients and Doctor is vitally important. The government does not have the understanding or common sense to get out of the way and bring together trained professionals to solve these complicated. Issues.

    Mickey Marks
    American Wellness Innovators

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