Three health IT experts told members of a Senate committee Tuesday to stay the course on the federal electronic health-record incentive payment program and its increasingly tough meaningful-use requirements, arguing that the program's benefits outweigh its problems.
Sen. Lamar Alexander (R-Tenn.), chairman of the Senate Health, Education, Labor and Pensions Committee, put the question to the three panelists directly, pointing to the proposed rule for Stage 3 of the program issued in March, which would become effective in 2018.
The hearing, the second by the HELP committee on EHRs in six days, was focused on what providers and HHS could do to improve user experiences with EHRs. In recent months, some members of Congress have grown increasingly critical of the EHR program and the lack of EHR interoperability. Interoperability problems were the focus of a HELP Committee hearing last week at which witnesses counseled legislators to use persuasion, not regulation, in addressing that issue.
Until suggested improvements can be worked out, “would it be wiser to slow down the finalization of this rule?” Alexander asked the witnesses. “Or would it be better just to push ahead?”
The witnesses complained about some aspects of EHRs and meaningful-use requirements but touted the advantages of digital records in terms of quality of care.
Tweak the problem areas, recommended Dr. Boyd Vindell Washington, chief medical information officer for the Franciscan Missionaries of Our Lady Health System in Baton Rouge, La. He testified that physicians are reorganizing their workflows to leverage the benefits of EHRs but that the workflows for completing the documentation required for insurance claims are still stuck in the old ways of the paper age, requiring physicians to do data entry work that could be performed by nurses or technicians. He suggested having nurses or technicians do keyboard entry of data.
Still, Washington urged Alexander to “keep the spirit of meaningful use alive” by preserving the program. Parts of it, he said, have been “very beneficial” to him and his medical group colleagues.
Meryl Moss, chief operating officer of Coastal Medical, Providence, R.I., testified that it's “onerous” and “inefficient” for her multisite medical group practice to report on 129 quality measures. On the other hand, Moss said her group has made dramatic improvements in meeting some quality measures, such as the percentage of senior citizen patients receiving flu shots, because the EHR has helped the group quickly store and calculate those rates.
“We can't do any of this work without the (EHR) and using it robustly.” The meaningful-use requirements forced her group to improve to meet those metrics, resulting in improved patient care. “We can't go back.”
About 6 million electronic clinical messages a week are flowing between Michigan EHR systems via health information exchanges, Timothy Pletcher, executive director of the Michigan Health Information Network Shared Services, testified Tuesday.
His exchange coordinates the writing of legal agreements to fit each so-called use case and then tries to align financial incentives to promote their use. For example, insurers included hospital performance on notifying doctors when one of their patients is admitted, discharged or transferred in their quality improvement payments.
“We absolutely have to stay the course,” Pletcher said. “We're getting better and we're all learning.”