After the presentation, they were confronted with a line of representatives from various professional and other interest groups who suggested they pause to fix problems with Stage 2 instead of making Stage 3 more difficult.
Stage 2 got underway for eligible hospitals on Oct. 1, 2013, and Jan. 1, 2014, for physicians and the rest.
However, Chantal Worzala, policy director for the American Hospital Association, told committee members all is not as well with the program.
Vendors have been slow getting their EHRs tested and certified to the federally created 2014 Edition technical standards needed for use in Stage 2 requirements, and Stage 1 in 2014.
With five months already elapsed since the start of Stage 2 for hospitals, Worzala said, “If there are any hospitals that have met Stage 2, it can only be a few. Vendors are behind in delivery product. It's urgent that we get a signal very soon whether we will get more time to meet Stage 2.”
Worzala reminded committee members that the AHA wrote in December to HHS about the problem EHR system developers were having buying and reconfiguring their systems to the updated 2014 Edition testing and certification criteria. A survey of 500 larger hospitals and hospital systems, she said, indicated that “40% are at risk of failing to meet meaningful use in time of the requirements and time limits stay the same.
A hospital that fails to meet meaningful use in 2014 is punished with a Medicare payment penalty as well as a lost of incentive payment, she said. “Everyone is working very, very hard,” she said. “It's just a question of scope and pace.”
Mari Savickis, director of federal affairs for the American Medical Association, said “some our physicians are still in Stage 1. Without flexibility, some of them will be dropping out.” In addition, Savickis said the testing and certification criteria for EHRs “need to make systems more usable.”
There also were “very broad concerns” with the proposals the work group was discussing with Stage 3, according to Mark Segal, vice president, government and industry affairs for EHR developer GE Healthcare IT, who also chairs the public policy work group of the Electronic Health Record Association, an affiliate of the Chicago-based trade group, the Healthcare Information and Management Systems Society. The EHRA claims about 40 EHR developers as members.
“Based on what we've learned from Stages 1 and 2, emphasis (in Stage 3) should be on greater use of Stage 2 capabilities,” with a focus on enhancements to system interoperability to support care coordination, Segal said. But specific functionality for population management and care coordination is best left outside of federal regulations in the Stage 3 criteria, he said. “The market will produce the right functionality our customers need.”
HITPC member Paul Egerman, a health IT entrepreneur, also warned work group members that he was “hearing a lot of resistance” from the developers about the technical burdens of programming for Stage 2.
The number of vendors that have systems tested and certified to the new 2014 Edition standards needed for Stage 2 has dropped compared to those with systems qualified for use in Stage 2, he said. “I'm worried that this (Stage 3) will cause that to occur again.” Egerman also noted that “by the time you get to Stage 3, a fair amount of the incentive money will have been used up,” leaving only penalties, a reduction in Medicare reimbursements, as an inducement for providers to meet the higher Stage 3 requirements.
But several committee members also offered a spirited defense of the work group's setting stretch goals for Stage 3.
“I do think we have a public accountability for the amount of money we've put into these systems,” said Dr. Neil Calman, chair of the Department of Family Medicine and Community Health at the Icahn School of Medicine at Mount Sinai Medical Center in New York. “We've driven this huge industry with dollars. I think what you've seen in Stage 1 and Stage 2 and later in Stage 3 create a reasonable middle point in driving things that wouldn't have happened.”
Fellow committee member Dr. Arthur Davidson, director of Public Health Informatics at Denver Public Health, agreed. “We need to put the burden on the vendors,” he said. “We're spending so much. We need to get value for our investment. We have an opportunity with the certification criteria—to build standards we can share.”
The Health IT Policy Committee was created by the American Recovery and Reinvestment Act, chiefly to advise HHS on how to run the multibillion dollar EHR incentive payment program, also part of the 2009 fiscal stimulus law.
So far, through December, according to the latest CMS numbers, the EHR incentive payment program has paid out $19.2 billion of an estimated total $22.5 billion to 4,400 hospitals, or 88% of the 5,011 hospitals deemed eligible to participate and to 334,650 physicians and other “EPs,” about 64% of the estimate 527,200 eligible physicians and EPs.
Follow Joseph Conn on Twitter: @MHJConn