House bill would ease 'meaningful use' provisions on EHRs

Doctors and hospitals are increasingly pushing back on the schedule for adoption and demonstrating meaningful use of electronic health records that is part of a years-long, $25 billion-plus government plan to usher in a new digital age in health care.

And they have an ally in Congress: Former nurse Renee Ellmers, a North Carolina Republican, introduced a bill Sept. 16 designed to give some breathing room to providers who say they can't hit the targets set by the Office of the National Coordinator for Health Information Technology.

The ONC, which helped subsidize electronic health record adoption, requires first hospitals and then providers to demonstrate that their systems are being used to keep patient records in stage one, and in stage two to exchange information among providers, and to provide a platform for patient access. Each stage has a precise and still-controversial set of metrics that govern compliance.

Physicians groups complain about poor usability of existing electronics health records systems. "Physician experiences documented by the AMA and RAND demonstrate that most electronic health record systems fail to support efficient and effective clinical work," said Steven J. Stack, president-elect of the American Medical Association.

Jacob Reider, deputy national coordinator for health IT, doesn't discount these complaints. "They're used to iPhones, iPads, Google and Yahoo. Products that are designed smoothly and nicely. Health IT really isn't quite there yet," Reider said at a Sept. 17 health IT event hosted by FCW.

After spending more than $25 billion on incentives to encourage electronic health record adoption, officials are insisting that the transformation proceed apace, with small adjustments as needed. Elizabeth Holland, who heads the Health IT Initiatives Group at HHS, likened the shift to electronic health records to the move to electronic banking, saying that once people get used to the convenience of their ATM card, they don't go back to passbook accounts.

Officials are looking more to the next stage of the meaningful use program, due to take effect in 2017, than in re-litigating existing regulations. The third stage is going to focus on improving the existing standards. Holland said that the regulation is written, but is subject to change until it is "put on display in the Federal Register." Officials couldn't comment directly on what might be in the stage three regulation, but the rulemaking process involved "looking at what worked and what didn't worked in [stages] one and two," Holland said at the FCW event. Comments from vendors and health care providers suggested going with a simpler, more flexible, approach, Holland said.

Health care providers are worried about more than just usability. Those who can't meet meaningful use requirements will see changes to their compensation by government payers in the future.

"The incentives start going away and instead of the carrot that we're offering, the stick comes, and we start making Medicare payment adjustments. So either you are in the party or you're going to get your payments dinged," Holland said.

‘Rigid mandates’

Ellmers’ legislation would allow providers to demonstrate their compliance with the meaningful use requirements over a single quarter of 2015, rather than for the entire calendar year.

"HHS is imposing rigid mandates that will cause unbearable financial burdens on the men and women who provide care to millions of Americans. Dealing with these inflexible mandates is causing doctors, nurses, and their staff to focus more on avoiding financial penalties and less on their patients," Ellmers said in a statement.

The Department of Health and Human Services released its own rule in late August to try to offer some relief -- basically offering providers a choice of complying with either the 2011 or 2014 certified electronic health record requirements for the 2014 reporting period. The rule keeps providers on track to hit their meaningful use targets in 2015. For providers who received their first payments for electronic health record adoption between 2011 and 2013, that means hitting meaningful use stage two requirements in 2015.

HHS Secretary Sylvia Burwell stressed the importance of hitting those markers in a Sept. 16 blog post. "[W]hen all of a patient's doctors talk to each other, patients get more personal attention and better care. That's why the ability of health information technology systems to talk to each other -- interoperability -- is also a significant part of this," Burwell wrote.