On Friday, CMS released its latest guidelines for meaningful use, allowing for public comment through May 29. Stage 3 meaningful use is meant to be the final stage of the Federal EHR Incentive program, so the most important announcement was the allowance for future changes to the rules. It states: “We understand that multiple technological and clinical care standard changes associated with EHR technology may result in the need to consider changes to the objectives and measures of meaningful use under the EHR Incentive Programs. Accordingly, we note that, as circumstances warrant, we would consider addressing such changes in future rulemaking.”
Meaningful use essentially calls for providers to utilize electronic health records in a meaningful way—that providers are using certified EHRs in a way that can be measured, such as e-prescribing, the ability to exchange health information to improve the quality of care, and the use of EHRs to measure quality metrics. The purpose of the incentive program is to improve population and public health, enhance care coordination, reduce disparities in care, engage patients and their families, and protect patient privacy. The proposed rule requires that all providers attest to being at Stage 3 by 2018.
The U.S. Senate Committee on Health, Education, Labor and Pensions also held a hearing with several panelists on meaningful use and data interoperability, reports Healthcare Informatics and Becker’s Hospital Review. Peter DeVault, director of interoperability with Epic Systems, was the key industry representative and focus of much of the hearing.
In a key moment, Sen. Tammy Baldwin (D-Wis.) asked DeVault why Epic had declined to be a member of CommonWell Health Alliance, an industry group dedicated to seamless data exchange among health systems. In fact, CommonWell includes a number of Epic competitors, including Cerner, McKesson, athenahealth, Allscripts and CPSI. DeVault said the company had concerns about entering into a nondisclosure agreement with the other members of CommonWell, and called the venture an “aspiring” network that will be expensive to achieve.
Epic favors another nonprofit organization, CareEquality, with similar interoperability goals.
DeVault defended Epic’s stance, noting that true interoperability is years away. “No single network attempts to address all interoperability use cases and scenarios, and no single technical platform operated by a single provider can meet the needs of all the diverse players in healthcare. Just as ATMs and cell phones rely on multiple, interconnected networks, healthcare must connect its interoperability networks to achieve universal connectivity,” he said.
In a written statement, Cerner responded sharply: "Today's rhetoric is a slap in the face to many parties working to advance interoperability. It was discouraging to hear more potshots and false statements when it's clear there is real work to be done. We're committed to CommonWell as a practical, market-led way to achieve meaningful interoperability."
Our Take: As the market leader, Epic has little incentive to ensure that its software is able to talk to its competitors. But increased pressure on providers to attest to meaningful use could force lawmakers to force interoperability on Epic and others. EHRs are a critical component to reducing costs over time, although many providers have taken issue with the initial expense involved, as well as the changing dynamic between patient and provider in the exam room.
More controversial and polarizing is the meaningful use concept being driven by the federal government. During the hearing, committee chair Sen. Lamar Alexander (R-Tenn.) said EHRs “should have been a really good idea,” but the meaningful use program has failed because of it was mandated by the federal government. Sen. Sheldon Whitehouse (D-RI) said the program should be scrapped and rebuilt to include behavioral health facilities and long-term care. On the other hand, it has provided fuel for software innovation and has increased competition among the large players vying for major contracts.
EHRs shine when being used for analytics; as a means to store data they are marginally more useful than paper. Considering the ongoing drive for population health measures by the Federal government, meaningful use is here to stay—at least until the next election.