Criteria for Stage 3 of meaningful use of EHRs were released recently and there is lots of controversy, as would have been predicted. One set of recommendations that is raising eyebrows is around patient engagement.
The recommendations include three measures of engagement, and providers would have to report on all three of them, but successfully meet thresholds on two.
Following on the Stage 2 measure of getting patients to view, download, and transmit their personal health data, the Office of the National Coordinator (ONC) has proposed an increase from five to 25 percent.
The second measure requires that more than 35 percent of all patients seen by the provider or discharged from the hospital receive a secure message using the electronic health record’s (EHR) electronic messaging function or in response to a secure message sent by the patient (or the patient’s authorized representative).
The third measure calls for more than 15 percent of patients to contribute patient-generated health data or data from a non-clinical setting, to the EHR.
Epic reveals plans for a fifth campus, which is slated to include half a million square feet of office space and pay homage to literary classics like “Charlie and the Chocolate Factory” and “The Wizard of Oz.”
A Setback for MyMedicalRecords
A US District Court rules against MyMedicalRecords in its patent case against Walgreens, Quest Diagnostics, and others. MyMedicalRecords, a company that many label a patent troll, contends its patents covered a method of providing online PHRs in a private, secure way. However, a judge ruled that “the concept of secure record access and management, in the context of personal health records or not, is an age-old idea,” and is therefore abstract.
Despite the setback, I doubt MyMedicalRecords will stop demanding organizations to pay up or risk facing a lawsuit. I predict they’ll make some tweaks to their business plan, such as focusing only on organizations with not-quite-so-deep pockets that are willing to settle without a fight.
What Has $564 million Bought Us?
Sens. Lamar Alexander (R-TN), Richard Burr (R-NC), and Mike Enzi (R-WY) ask the General Accounting Office to review the ONC-funded health information exchanges to determine what exactly the exchanges created with the government’s $564 million in grant money.
It’s a valid concern, given the significant number of providers and regions still lacking electronic exchange capabilities and the millions that have been spent.
Physicians Reject Stage 2 Attestation
Fifty-five percent of physicians say they won’t attest for Stage 2 MU in 2015, according to a SERMO survey of about 2,000 physicians. Respondents cite several reasons for not attesting including financial concerns, difficulty engaging older patients, and lack of software usability.
Given the lackluster Stage 2 attestation numbers so far, the findings are not particularly surprising. It will be interesting to see what CMS and ONC intend to do in the face of the overwhelming evidence that many providers simply don’t think it is worth the effort.
On To Stage 3
The Office of Management and Budget is currently reviewing the proposed Stage 3 MU rules and will likely publish them in February. CMS states that Stage 3 will include changes to the reporting period, timelines, and structure of the program, including a single definition of Meaningful Use. CMS also adds that “these changes will provide a flexible, yet clearer, framework to ensure future sustainability of the EHR program and reduce confusion from multiple stage requirements.”
Can’t wait to see what is included. And, I can’t help but be a little amused that it’s been six years since the passage of the HITECH legislation and we are just now getting a definition for “Meaningful Use.”
Show Me the Money
Allina Health and Health Catalyst sign a $100 million definitive agreement to combine technologies, clinical content, and front-line personnel.
Rush University Medical Center will implement Merge Healthcare’s cardiology PACS.
Healthcare operating system platform provider Par80 closes $10.5 million in Series A funding led by Atlas Ventures, Founder Collective, and CHV Capital.
Health analytics provider Apervita, formerly knowns as Pervasive Health, completes an $18 million Series A round of funding led by GE Ventures and Baird Capital.
Teledermatology provider PocketDerm raises $2.85 million from an undisclosed investor.
Caremerge, developers of a care coordination platform, raises $4 million in a second round of funding. Investors include Cambia Health Solutions, GE Ventures, Arsenal Health, and Ziegler-LinkAge Longevity Fund.
The Meaningful Use program is at a critical inflection point. On one hand, the payers could jump on the MU bandwagon, follow Medicare’s example and demand provider MU attestation.
On the other hand, they could throw private practice a bone and help them weather the storm until MU goes away or loses its teeth. Let me explain.
Payers could take the easy money and penalize according to the upcoming ACA “adjustment” schedule. Lots of people think this is inevitable. This would certainly provide an easy way to increase payer revenue and is as simple as letting the practices [continue] to do all the work.
What this tells me is that the stress and time-cost of MDs and their staff is not worth the benefits of Meaningful Use. Don’t get me wrong – there are some great things in the MU guidelines, and we are implementing them in the software we create, but they are overshadowed by the onerous, less-effective 5% and it’s all or nothing. There is no MU wiggle-room. These days you have to have real grit and determination to stay in private practice, no matter your specialty.
Without financial support or legislative reform, Meaningful Use will eventually drive independent doctors out of business.
In a detailed letter sent this week to CMS Administrator Marilyn Tavenner and National Coordinator Karen DeSalvo, MD, the American Medical Association presented a long list of ideas to make Meaningful Use better for doctors.
The AMA warned that “unless significant changes are made to the current program and future stages,” doctors will drop out of the meaningful use program, patients will suffer as existing EHRs fail to migrate data for coordinated care, thousands of doctors will incur financial penalties, and new delivery models requiring data will be jeopardized.”
All of which is true. But the AMA didn’t go far enough.
Meaningful use is well intentioned, but like a teacher who “teaches to the test,” the program has created a byzantine system that might pass the test of meaningful use stages, but is not producing meaningful results for patients and clinicians.
A formal study published in the April 2014 issue of JAMA Internal Medicine reveals there’s no correlation between quality of care and meaningful use adherence. This study validates what common sense has told many of us for the last few years.
Meaningful Use Stage 1 was a jump-start for EMR adoption in the industry. That’s a good thing, I suppose, although meaningful use also created a false economic demand for mediocre products. It’s time to put an end to the federal meaningful use program, eliminate the costly administrative overhead of meaningful use, remove the government subsidies that also create perverse incentives, and let “survival of the fittest” play a bigger part in the process.
Let the fruits of EMR utilization go to the organizations that commit, on their own and without government incentives, to maximizing the value of their EMR investments toward quality improvement, cost reduction, and clinical efficiency.