The healthcare IT (HIT) industry waits with baited breath for the release of preliminary meaningful use (MU) rules, scheduled for later this month. Why the baited breath? Market has basically stalled as physicians & hospital CIOs hold off HIT purchases awaiting what will actually be asked of them to get those ARRA reimbursement checks. Will the pain of adopting a “certified EHR” and demonstrating “meaningful use” be greater than the gain? Will those meaningful use requirements be too onerous to encourage broad adoption, particularly among smaller ambulatory practices?
Looking across the market, following various HIT Policy and Standards Committee meetings, listening to HIT vendor pitches, private conversations with physicians and following various announcements coming out of HHS, be they press releases or Blog postings, Chilmark Research has come to several conclusions as to what one can expect in the near term:
1) HIT vendor pronouncements and promises that they will meet any and all MU criteria are extremely misleading.
Yes, HIT vendors may put in the minimum feature set to become a “certified EHR” (we still do not know what a certified EHR is yet) and they will likely have the capabilities embedded in their solution to meet MU criteria (especially in 2011), but the challenge is not so much the software, but how it is implemented. Implement it poorly and physicians/hospitals will struggle mightily to demonstrate meaningful use of their EHR.
2) CMS will release MU rules with very low barriers to entry in 2011, but 2013 will have much higher barriers/hurdles to jump and same holds true for 2015.
HHS recognizes that the healthcare market is very immature in its adoption of HIT, that ARRA legislation has demanded certain criteria be met (MU) and that it is on a very tight time schedule. A delicate balance is required to drive early adoption while concurrently meeting legislative intent. Thus, for 2011 we can expect simple. basic MU criteria that does not require significant reporting, that is not burdensome to the practice and that HIT vendors can readily deliver upon today. Chilmark Research also foresees 2011 data exchange requirements for care coordination to be extremely simple without a heavy reliance on HIEs.
3) The biggest challenge in 2011 and for that matter the entire HITECH Act is the successful implementation of certified EHRs that have a glide path leading the adopter on a clear upgrade and workflow optimization path for meeting MU criteria in 2013 and 2015.
That almost bears repeating (read it again folks). The successful implementation of certified EHRs is a huge challenge that unfortunately is largely being overlooked with most of the attention being paid to broader policy and standards issues. Granted, HHS is expending a significant amount of energy and resources to address this issue with nearly $600M going to the establishment of regional extension centers, another $80M in grants for training IT professionals in community colleges and today’s announcement on the Beacon Community Cooperative Agreement Program. But again, we are dealing with a very aggressive adoption and reimbursement schedule. Couple that with the rule that there is no partial reimbursement for partially meeting MU criteria and one has the makings of “Day the Earth Stood Still” scenario.
4) The infrastructure for data exchange in support of care coordination is simply not there.
ONC head, Dr. Blumenthal made it quite clear that exchanging data within a private HIE (IDN sponsored) will not meet MU criteria. Problem is, of the 200 or so public HIEs that are now in existence, only 25% are actually moving data of any type (most of that data is very simple labs, med lists, etc. and not what HITECH/MU envision), another 25% are still in PowerPoint and the remaining 50% somewhere in between. Again, HHS is putting significant resources behind this issue, but HIEs just don’t appear out of nowhere. HIEs take time to develop, put in place data use and sharing agreements (DURSAs), define a business model, staff up, implement a vendor’s solution, tie the network together and finally begin moving data. Chilmark still does not see a path on how to get from where we are today to what draft MU guidelines will require for data sharing in support of care coordination. You can’t force a river folks. Major rethink required.
Congress, in its infinite wisdom, gave HHS an albatross in the HITECH Act. That is not to say we need to throw out the entire Act, far from it. What is needed is a relaxation of the aggressive HIT adoption schedule that this legislation has written into law.
As proposed, we are looking at a coming train wreck of major proportions wherein by our estimates, over 35% of the estimated $44B that US taxpayers will be spending on the HITECH Act will be wasted. Before we get any further down the road, it is time for HHS and administration leadership to go back to Congress to modify this Act, extending deadlines to insure adoption of HIT is thoughtful, effective and ultimately successful.
Note: This post was written during a flight delay. Unfortunately, did not have the time to provide links to various supporting points in this post. And thanks to Google for providing free Internet access at Logan airport over the holidays.