Work group Co-chairman Paul Tang, a physician and chief medical information officer for the Palo Alto (Calif.) Medical Group, said that the statutory definitions of meaningful use were too limited to administer. But by broadening the scope, there also was a risk of going to the other extreme and producing hundreds of criteria and making compliance too difficult, he said.
The years 2011, 2013 and 2015 were selected based on an assumption that a two-year change cycle was doable and because they logically coincide with break points in the subsidy payment regime, Tang said. For example, physicians who qualify get the same $18,000 initial payment under Medicare if they start in 2011 or 2012, so having the criteria stay the same for both of those years made sense, Tang said.
Kent Gale, president of Orem, Utah-based KLAS Enterprises, a healthcare IT market analysis firm, was the lead author of a report released this month on the provider and vendor readiness of meaningful use. The report was based on a survey and interviews with IT system users and Gales best guess at what meaningful use might entail.
The main piece that I think is significant is that physicians were to enter all orders, which Gale accurately predicted in his report would be a key component of meaningful use.
In a separate survey released in March, KLAS estimated only 12.5% of hospitals had CPOE systems in use and most of them were at hospitals with 200 or more beds. In April, the Leapfrog Group, an arm of the Business Roundtable, reported that just 7% of 1,276 hospitals in its 2008 survey were fully using CPOE systems according to its criteria.
CPOE, Gale said, is a major stretch for some organizations, a significant stretch. There are hospitals that have better funding capabilities than others. Its fair that there is the same bar for everybody, but if youre in a larger city, the funding and the ability to get there would be greater than in smaller community or rural hospitals.
Count Gale among those who thinks having a CPOE requirement so early in the mix may be too much too soon.
I hate to sell American ingenuity short and say we cant do it, Gale said. Some of the best minds can get together. Maybe we can do it, but it sure doesnt seem from upfront its that doable.
Lac Tran, senior vice president and chief information officer at 676-bed Rush University Medical Center in Chicago, said that none of the meaningful-use criteria for any of the three time periods, including CPOE, will present a major challenge to Rush. Rush embarked in 2005 on a $60 million inpatient and outpatient clinical IT system installation that was fully implemented this March.