WASHINGTON, DC—Federal officials sought to reassure a House subcommittee that guidelines issued by the federal government to promote widespread adoption of electronic health records (EHRs) strike the right balance.
As a way to encourage hospitals and providers to adopt EHRs, Congress in 2009 passed a law creating incentive payments for providers and hospitals that choose to adopt and use certified EHR technology in a “meaningful” way. Starting in 2015, providers are expected to be actively utilizing an EHR in compliance with the “meaningful use” definition or they will be subject to financial penalties under Medicare.
In July, HHS issued its final rule defining the standards of “meaningful use” that physicians and hospitals adopting EHRs must follow to receive incentive payments for the first stage of the initiative. The final rule was released after a draft regulation was made public and open for comment in January.
At a hearing in July, some Republicans voiced concern that the final rule contains less stringent requirements to receive the payments than the draft proposal that had been under consideration. The original draft proposal stated that providers must meet 25 objectives to qualify as a meaningful user and hospitals must meet 24 objectives. The final rule requires providers to meet 20 of those requirements while hospitals must meet 19. “By watering down the regulations, we have missed an opportunity to advance healthcare delivery and ensure wise use of taxpayer money,” said Rep Wally Herger, R-CA, the ranking Republican on the House Ways and Means Subcommittee on Health.
Adoption of EHRs
The draft regulations were modified as a result of concerns raised by a number of groups about the ability of providers and hospitals to meet the requirements, according to federal officials.
David Blumenthal, MD, national coordinator in the Office of the National Coordinator for Health IT at HHS, explained to the subcommittee that the government wanted to make it as possible for a small rural practice to meet the requirements as it is for a larger urban practice. “If we ask too much too soon from a single rule, we might increase the disparities in care across these geographic and other areas.”
Blumenthal told the subcommittee that standards for meaningful use will be raised in 2013 during the second phase of the incentive initiative program. He called the two-year incentives “just the first step in getting providers on the escalator,” in terms of using EHRs.
Officials also noted that the program establishes a national Health IT Research Center (HITRC) and a nationwide network of Regional Extension Centers (RECs) to help providers who are adopting EHRs. The RECs are designed to provide technical assistance to small groups or individual practices since these providers may have fewer resources to implement or maintain their systems. So far, grants to 60 RECs throughout the US have been awarded.
Representatives from the private sector also weighed in on the new meaningful use guidelines. Eugene Heslin, MD, a physician in Saugerties, NY, spoke about how EHRs improve care. He told of a patient of his who was disoriented and had given the paramedics a list of his medications. When the medications were read to him over the phone, Heslin accessed the patient’s electronic medical record from his home computer and realized that the patient had mistakenly given the paramedics his wife’s medication list.
Heslin said in written testimony that the incentives the government is offering will help offset the costs of health IT adoption and practice, though meeting that criteria will not be easy for physicians and hospitals.
Phyllis Teater, chief information officer at The Ohio State University Medical Center, testified that one problem with the new rule for hospitals was that it reduced the number of hospitals that can receive incentives, since the rule does not recognize individual hospital campuses as distinct hospitals when they are part of a hospital system with one Medicare provider number.
On his part, Subcommittee Chairman Pete Stark, D-CA, said he felt that the new regulations set “realistic goals,” and that “HHS took a responsible position in its final rule.”
The American Medical Association, which did not testify at the hearing, said in written testimony that while the final requirements for the meaningful use definition are an improvement over prior drafts, “challenges still remain that will make it difficult for physicians to meet the requirements, especially physicians in solo and small practices.”
Moving toward EHRs
The move toward EHR adoption is important to public health efforts, a CDC official said. “We believe that the widespread use of the electronic health record is inevitable across the US. If that is our future that we are all moving towards, then we have an opportunity here,” said Judith Monroe, MD, deputy director for CDC and director of CDC’s Office of State, Tribal, Local and Territorial Support at a forum.
Electronically garnered population-level data can be particularly helpful for those in public health in addressing chronic diseases, Monroe said. “If we have physicians adopting electronic health records in larger numbers and really start to make this all happen, that data can get bidirectional use where we can have population-level data to know what is happening in our communities.”
Federal Medicine Will Benefit from Nationwide Adoption of EHRs
Military patients will benefit as the nation moves toward widespread adoption of EHRs, according to Navy Capt Michael Weiner, MD, deputy program manager and chief medical officer for the Defense Health Information Management System.
While VA and DoD have had EHRs in place for many years now and continue to work to increase the amount of data they share, the use of EHRs are far less common in the civilian sector, where civilians as well as military patients also receive care. “Knowing that we send a fair amount of patients to the outside, we look forward to the nation catching up and moving towards a fully adopted electronic health record so that we can easily and seamlessly share that data on our patients with our civilian counterparts,” said Weiner.
Currently, civilian and military providers exchange patient records via fax. “We currently get our civilian consultations sent back to us through fax and we keep a record of those,” explained Weiner. “What I think we are all excited about is the future of having computable data from our civilian colleagues.”
Weiner acknowledged that there will be challenges along the way for providers in the civilian sector adopting EHRs. “I think where the challenge comes for the commercial world is what we faced two decades ago and that was the actual implementation of it, getting a system that supports the work flow in your private practice office, getting a system that you can afford.”
Everyone simply having EHRs is not enough, however. Another major challenge that the nation will face is having everything built on standards to facilitate the seamless exchange of information among different entities. “Once those standards are fully agreed upon we will then be able to share a little more seamlessly than what we have historically been able to do with a lot of point-to-point connections.”
DoD and VA are working with the civilian sector in pilot projects to exchange patient information electronically. Earlier this year, DoD and VA finished a project for the Virtual Lifetime Electronic Record (VLER) in San Diego in which it shared some electronic health data with Kaiser Permanente. DoD and VA are planning another demonstration project of VLER in the Hampton Roads area with a civilian partner to expand the data set that it exchanges.
Given that DoD and VA have been working for many years on Health IT, the lessons that these agencies have learned will be invaluable to the nation, Weiner said. “We believe we have a responsibility to share those lessons with the nation and help everyone get onto an electronic health record platform that will benefit not just the DoD, but the entire country.”
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