Last week, a work group of the federal Health Information Technology Policy Committee uncorked its first draft of proposed meaningful use standards under the American Recovery and Reinvestment Act.
And though final rules by the CMS on standards that physicians and hospitals must meet to receive subsidy payments for electronic health records under the economic stimulus law wont be completed until early next year, meaningful use already is having an impact on existing healthcare IT promotion programs.
Also last week, the federally supported, not-for-profit Certification Commission for Health Information Technology announced it was making several profound changes to its framework for testing and certification of IT systems.
CCHIT will retain its existing, top-shelf certification program thats been around since 2006 and has produced three increasingly stringent iterations with a fourth pending that features 303 testing criteria for outpatient EHRs and 298 criteria for inpatient systems.
IT systems certified under that testing regimen are expected to exceed federal standards requirements under the stimulus law, according to CCHIT Chairman Mark Leavitt. But while the latest criteria under that testing scheme have been released, they wont be complete until the new meaningful-use criteria are available for review and, if necessary, incorporation in the CCHIT testing program, Leavitt announced. Meanwhile, there will be a hiatus in CCHIT testing and certification of EHR systems. The cost to vendors for testing under the conventional CCHIT certification scheme will run in the $30,000 to $50,000 range, according to last weeks CCHIT announcement.
The big changes, however, come in two new testing and certification programs that CCHIT plans to develop. Leavitt said the organization proposes to test IT systems by module against the new meaningful-use criteria. Modular testing targets those practices and hospitals that piece together an IT system from legacy or best-of-breed certified components. Modular testing and certification are estimated to cost $5,000 to $35,000, with scholarships possible to help subsidize costs for certain providers.
CCHIT also will test and certify compliance with meaningful-use standards for a providers location, an approach useful to providers who self-develop an EHR or assemble an EHR from noncertified sources, according to CCHIT. Site testing will cost $150 to $300 per licensed provider for physician practices. Pricing for hospitals has yet to be determined.
Since its founding in 2004, CCHIT has been listening to requests for change, Leavitt said. People kept bringing up small developers who claimed hardship, citing what they described as the high costs of certification, Leavitt said. More recently, the open-source software community has criticized CCHIT for a testing system they say is ill-suited to their development model. But the driver toward increased flexibility was the federal IT subsidy program included in the stimulus bill that became law in February.
As soon as the legislation was being formulated, we realized we needed to change, Leavitt said. There was a stampede to the incentives and never stand in the way of a stampede.
Of all the medical specialties, family physicians have been among the leaders in EHR use. While the adoption rate for all physicians for a basic EHR was pegged at just 13% in a HHS-funded survey released earlier this year, 42% of members of the American Academy of Family Physicians responding to a survey last summer indicated they had finished implementing an EHR and another 13% had purchased a system, according to Steve Waldren, a physician and director of the AAFPs Center for Health Information Technology.
But among the EHR users in the AAFP survey, those pushing their systems to measure quality and outcomes run at the teens to 30%, Waldren said. From a financial standpoint, there is nothing driving those functions. Now, there potentially will be.
The meaningful-use work group was all over the map in what it wanted to measure, Waldren said, but it seemed like they were saying they were leading with quality and safety measures, and that was good. The biggest issue is timing, and several of the patient-engagement criteria, such as providing a care-summary report to a patient after every physician encounter, present a challenge. Thats going to be difficult for several of the EHR vendors. The two commonly used standards for creating summariesthe Continuity of Care Record, or CCR, and the Continuity of Care Document, or CCDare in different stages of use acceptance among EHR vendors, he said.
After the first CCHIT criteria came out in 2006, demand for EHRs picked up, and in talking with AAFP members, the adoption rate dipped, Waldren said, while wait times from purchase to implementation rose from about six months to nine months. In addition, We noticed an increase in complaints about lack of support. I think well see that again. We tell our docs, on one hand, youre making a decision on partial information, but at the same token, the longer you wait, the top vendors are going to get saturated with new clients.
Lyle Berkowitz is a practicing internist, medical informaticist, healthcare IT blogger and the program director of the Chicago-based Szollosi Healthcare Innovation Program. Berkowitz said it might be possible for a physician with an electronic practice-management system and access via the Internet to new Web-based applications to piece together an electronic ecosystem that could meet many of the meaningful-use criteria.
A lot of these measures can be achieved by a doctor who doesnt use an EHR in their daily practice, Berkowitz said. Whether there will be enough compliance to qualify for meaningful use remains to be seen, he said.
But in a recent blog post, Berkowitz said the CCHIT changes could foster a variety of innovative approaches to achieve meaningful use. Some physicians might use a homegrown system that patches together multiple components, and still others might just use HIT on the back end to reach the majority of the metrics required. In other words, it will be interesting to see how many of the measures could be achieved without requiring a physician to touch a keyboard at all (e.g., no data input). If we can accomplish thatthen we may get both significant and meaningful use.
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