The federal government's $31.7 billion electronic health-record incentive payment program needs to be refocused on promoting interoperability of electronic health-record systems, improving their usability and enhancing outcomes instead of measuring processes, according to comments on the feds' latest round of program rules.
The program also needs more flexibility, according to several organizations that filed suggestions within the 60-day public comment period that ended this week. The unusual move to request comments on a final rule reflects the pressure the Obama administration is feeling from the healthcare industry to ease up on the use of EHRs.
Several groups, including the American College of Cardiology, asked CMS rulemakers to scrap full-year reporting periods for meaningful-use metrics, replacing them with 90-day periods.
The groups also asked the CMS to end the program's pass-fail requirement, which has been in place since its inception. It requires hospitals, physicians and other eligible professionals to meet every meaningful-use criteria to receive incentives payments and avoid program penalties.
“They should give credit for partially meeting the threshold,” said Dr. Michael Mirro, chief academic research officer at Parkview Health System in Fort Wayne, Ind., and past chairman of the ACC's informatics and health information technology task force. Ending pass-fail could stem declining physician participation, a problem since 2014.
The cardiologists also asked the CMS to “remove requirements that hold physicians accountable for actions beyond their control,” a reference to patient engagement measures in the CMS final rule released in October. Providers would have to attest that 10% of their patients have viewed, downloaded and/or transferred their records from a providers' EHR.
The College of Healthcare Information Management Executives, a professional organization of hospital chief information officers and other health information systems leaders, in its 15 pages of criticism and advice, called for either dropping or scaling back a number of meaningful-use criteria and delaying the start of Stage 3 until at least 2019, and only then “after 75% of all eligible providers have met Stage 2” requirements.
The American Hospital Association echoed CHIME's comments.
CHIME members have considered recommending an end to the EHR incentive payment program altogether, but “we don't believe the program needs to be scrapped,” said CHIME board chair Charles Christian, who is also vice president of technology and engagement at the Indiana Health Information Exchange based in Indianapolis. “The program just needs some modifications,” Christian said, and chief among them is to slow down and give everyone involved—providers, EHR developers and federal program planners—time to reassess.
“We're racing forward, almost like generals sending their soldiers to war without reconnaissance,” Christian said.
The AHA specified that the CMS should “commission an independent study” of Stage 2 “and use the findings to inform Stage 3 requirements.”
Last year, a core group of major EHR developers began working to improve interoperability of their systems in a coalition called the Argonaut project.
The group seeks to use application programming interfaces or APIs and an interoperability framework based on them called Fast Healthcare Interoperability Resources, or FHIR, with the hopes of allowing developers of mobile applications and other software systems freer access to the data in legacy EHR systems commonly used by hospitals and physicians.
The Commonwell Alliance, an interoperability consortium, already uses FHIR technology in its member services.
But Health Level Seven, a healthcare standards development organization, is still working to develop FHIR, whose second version remains a draft standard for trial use.
As such, CHIME and the AHA asked the CMS to abandon its Stage 3 API requirement, at least for the time being.
The AHA noted that providers should not be required to use APIs that have not been federally certified. The federal agency has not recognized a standard for APIs, citing "standards immaturity."
APIs “hold promise,” CHIME said, also questioning “whether they'll be readily available in vendor products by 2018” when the rule requirements are slated to go into effect. The AHA also cites privacy concerns for not moving forward with APIs.
But a leading patient privacy advocacy organization asked the CMS to stay the course on its Stage 3 requirement for EHR accessibility using APIs. The Austin, Texas-based Patient Privacy Rights Foundation in its comments said, “It is imperative that we advance the interoperability components of Meaningful Use Stage 3." The group, in a letter from its founder and CEO, Dr. Deborah Peel, said APIs could be used to enable patients and their authorized caregivers, such as a family members, to have access to a patient's medical records.
The Stage 3 API requirement “will be the centerpiece of interoperability because only patient-directed exchange can solve the challenges of patient matching and governance,” Peel wrote.
The Obama administration, under pressure from Congress and the healthcare industry to ease its mandates for the use of electronic health records, issued regulations for the current and final stages of its incentive program for the technology. But officials also acknowledged the new rules are almost guaranteed to be revised in the coming months.