Industry Pushes Back on EHR "Meaningful Use" Definition

When the government's Health IT Policy Committee met a couple of weeks ago, some committee members suggested that a workgroup's preliminary definition of "meaningful use" of electronic health records had gone too far. Now the official comments are in, and it's clear that most of the healthcare industry agrees that the requirements in the workgroup's first draft are overly aggressive. It will interesting to see what the committee comes up with when it reconvenes on July 16.

The "meaningful use" definition is of vital importance to the industry, because physicians and hospitals will have to show that they are using EHRs meaningfully in order to qualify for billions of dollars in government financial incentives. The committee wants to use its power to define the requirements to achieve certain policy objectives. But healthcare providers are concerned that they will be asked to do too much too soon. If the criteria to qualify for incentives in 2011, the first year of the reward program, are too stiff, not many providers will receive the maximum amount of government incentives.

In a letter to the Office of the National Coordinator For Health IT, Mark Leavitt, MD, and Alisa Ray, respectively chair and executive director of the Certification Commission for Health IT, succinctly summed up the problem: "The lag between a decision to invest in EHR technology and its full, meaningful use in a provider organization is 1 to 2 years at best, and more typically, 3 to 5 years. For this reason, we believe most of the measures proposed for 2011 would be difficult to achieve by providers who have not already begun EHR implementations. Given current adoption levels, the incentives would only be available to a small percentage of providers, potentially provoking disillusionment and frustration with the ARRA incentive program."

An AMA-led group of 81 medical specialty societies and state medical associations expressed a similar concern, noting that the committee's timeline "is too aggressive, given that we continue to lack the necessary infrastructure, standards and systems."

On the hospital side, both the AHA and the Federation of American Hospitals (FAH) opposed the timetable. The AHA noted that according to a recent study, only 1.5 percent of hospitals have a comprehensive EHR and 8-12 percent have a basic system. Consequently, the AHA said, the workgroup's schedule for EHR implementation is "not achievable in the time frames proposed." The FAH pointed out that computerized physician order entry (CPOE), which would also be required at an early point, is being used in only a tiny fraction of hospitals today.

Similar points were made by associations of health IT professionals. Bill Bria, MD, the president of the Association of Medical Directors of Information Systems (AMDIS), noted that it takes considerable time and effort to get physicians to use CPOE, even after it's installed.

All of this noise is not about healthcare providers digging in their heels and refusing to play along with President Obama's health IT initiative. Rather, it is a frank admission that implementing this technology will be a gargantuan undertaking that will require tremendous amounts of time and money. As AMDIS put it, there must be a "crawl-walk-jog-run" progression to EHR adoption. "These cycles cannot be skipped or condensed -- without risking failure to 'go the distance' in the marathon that is HIT-powered healthcare transformation," the association said.