In a three-page preamble to the report, the group invited feedback on whether the balance it sought to strike was overly aggressive based on the current state of technology and the demands on new provider workflows, or not challenging enough to result in significant transformation.
Multiple healthcare industry groups plan to answer the invitation. How successful the advisory panel was in finding the proper balance depends on whom you ask. Still, a consensus of healthcare information technology users and experts said that the committee produced an imperfect but serviceable framework.
There is good news and not so good news, said Robert Tennant, senior policy adviser at the Medical Group Management Association. The good news is they sort of heeded the advice of the MGMA and other providers in tiering the process. Theyre going to phase it in.
Tennant also lauded the work group for keeping things simple. They produced a matrix that does a good job of outlining the goals and objectives and measures, he said.
Rod Piechowski, senior associate director of policy for the American Hospital Association, along with Tennant and several others, expressed worry, however, that the work group may have set the bar too high in several placessuch as an early call for adoption and use of a complex EHR subsystem called computerized physician order entry, or CPOE. If the group stands firm with that recommendation, it could risk slowing EHR adoption, several experts said.
Piechowski said that the AHA is still polling its members reactions, but added that the first draft got things headed in the right direction. We have to see whether its achievable in their time frames, Piechowski said. I expect theyll have plenty of input on that.
William Bernstein, the New York-based partner and chairman of the healthcare division of the law firm Manatt, Phelps & Phillips, said, I like the fact that this proposal is about functionality and use and wasnt about products. I think thats a good thing. I think technology is going to change in tremendous ways, and tying this to products would be a mistake. They were clearly trying to say this is about clinical results.
For better or worse, it is now the starting point for what surely will be months of debate on meaningful use before the federal rulemaking is completed. That is expected to happen sometime early next year.
Even then, the meaning of meaningful use will remain fluid throughout the life of the EHR subsidy program, which is now slated to run through 2015.
The work group, following congressional guidance in the stimulus law, recommended ratcheting up the meaningful use standards over time.
The CMS, which will oversee final rulemaking on meaningful use, also may have thrown a wrench into the works. A CMS official said that the agencys interpretation of the stimulus law wont allow physician practices or hospitals that get off to a late start in their IT programssay, not until 2013to qualify for subsidies using the same lower, initial meaningful use standards afforded earlier adopters with IT programs begun or already under way in 2011.
That interpretation also could have several unintended adverse effects on nationwide EHR adoption, IT experts said. There is such an opportunity for a too-rapid, headlong rush, that will just set us back, says William Bria, chief medical information officer for Shriners Hospitals for Children, Tampa, Fla., and chairman of the Association of Medical Directors of Information Systems.
AMDIS is one of many organizations, including the MGMA, AHA and Healthcare Information and Management Systems Society, that is preparing a written response to the draft definition. The public-comment period opened June 16 and will run just 10 days. The work group is to review the comments for possible incorporation in a second draft of its meaningful use definitions due for submission at the next HIT Policy Committee meeting July 16.
A version of this story initially appeared in this week's edition of Modern Healthcare magazine.
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