Some hospital executives are questioning whether health care organizations are really meeting the spirit and intent of the HITECH Act as they race to check off the boxes necessary to comply with Stage 2 of the meaningful use incentive program.
Last week, the College of Healthcare Information Management Executives hosted a Capitol Hill Public Policy Forum where hospital CIOs and information management executives reflected on the health IT progress their organizations have made since the passage of HITECH Act more than five years ago, as well as the challenges they face going forward.
Many of the executives said the meaningful use incentive program aligns with and complements their own organization’s health IT strategy. However, they said that the program’s prescriptive nature and the rigorous timeline has led to challenges that could be detracting from its real goals.
Skip Hubbard, senior vice president of business intelligence and performance improvement at Bon Secours Health System in Marriotsville, Md., said, “We started doing it before we heard of meaningful use.” After the government’s electronic health record incentive program launched, Hubbard said his organization determined that they were already “95% of the way there” in meeting Stage 1 of the program.
Still, he said it took a lot of hard work — including significant cultural and workflow changes — to successfully attest to Stage 1. Since then, Bon Secours also has attested to Stage 2 of the program. However, despite being an early attester, Hubbard questioned whether an organization’s ability to meet the regulations means it is really meeting the spirit of the law.
Indranil “Neal” Ganguly, vice president and CIO at JFK Health System in Edison, N.J., said timing is a big part of his organization’s challenge. Like Bon Secours, Ganguly reported that JFK Health System was “along that journey before meaningful use came” but said that his organization was not “necessarily focusing on the same things” that were prioritized in the regulations.
The health system has not yet attested to Stage 2 of the program and is facing challenges meeting certain measures, such as medication reconciliation, he said. The health system’s vendor did not provide certified EHR technology for Stage 2 until December 2013, making the time crunch even more acute. “We’re at risk, frankly, for Stage 2,” Ganguly said.
Ganguly called the meaningful use program the “right thing to do” but said his organization is having issues with the timeframe.
Michael Martz, CIO of Meadville Medical Center in Meadville, Penn., echoed the other hospital executives’ sentiments, saying that the meaningful use program “absolutely aligns with what we’re trying to do” but that the “timing is tough.”
Meadville Medical Center didn’t have an EHR system that was certified for Stage 2 until last summer and then had to roll out a software patch in January and a series of patches after that, he said, noting that the hospital didn’t have a completely ready EHR system until April.
Rural Hospitals Face Steep Challenges
As a rural hospital, St. Claire Regional Medical Center in Morehead, Ky., also is feeling significant pressure from the EHR incentive program, according to Randy McCleese, the hospital’s CIO and vice president of information services.
Because demonstrating meaningful use of EHRs requires a big investment, the hospital had to move around funds and delay other projects, McCleese said. The hospital also has had to redirect staff to work on the organization’s health IT efforts, taking them away from direct patient care, he said. St. Claire attested to Stage 1 of the program in 2013 and now is working on Stage 2.
However, the hospital wasn’t scheduled to receive its patient portal until May 1, giving St. Claire just 60 days to get it up and running. McCleese said that patient portal implementation should take at least six months and that the accelerated timetable could be risky.
Challenging Measures Detract From Goals
Dallas-based Methodist Health System is a much larger health care organization than St. Claire, but it is facing its own issues with the patient portal requirements of the meaningful use program.
Stage 2 requires eligible hospitals to provide patients with the ability to view online, download and transmit their health information and requires at least 5% of unique patients to take advantage of the offering. Stage 2 also requires eligible hospitals to supply a transition of care document electronically for 10% of referrals.
Pam McNutt, senior vice president and CIO at Methodist, said that while the requirements are “well intended,” they may be “before [their] time.” She explained that the measures that hold the hospitals responsible for someone else’s actions are particularly difficult.
McNutt said that Methodist still will meet those measures — such as ensuring that patients use the health system’s portal — but that doing so “could be contrived” and won’t necessarily be “meaningful.” If the patient portal measure didn’t exist, McNutt said the health system would focus on patient engagement and interaction that would be more meaningful to patients than providing them with a continuity of care record.
McCleese agreed that the measures and objectives of the meaningful use program are dictating how organizations focus their efforts. He said that if patient portal use wasn’t a requirement, St. Claire would be focusing more on “hands-on care.”
Liz Johnson, vice president of applied clinical informatics for Tenet Healthcare, has served on the Health IT Standards Committee since being appointed in 2009 by HHS Secretary Kathleen Sebelius.
Johnson called the country’s progress in adopting health IT “nothing short of miraculous.” But when she put on her hospital information management executive hat, she said that implementation is hard, noting that vendors are not always ready and physician workflow changes are difficult.
She also raised concerns about the providers that were left out of the meaningful use incentive program, such as behavioral health providers, community health centers, rehab facilities, nursing homes and assisted living facilities. Johnson said that the exclusion of such groups has made it difficult to ensure patients’ quality of care after they leave the health system.
What Hospital Executives Would Change if They Had a ‘Do Over’
When the panelists were asked what changes they would make to the meaningful use program if they could travel back in time, McCleese said he would create a better long-term roadmap so providers had more clarity around what they need to achieve.
Johnson said she would have extended the timeline of the program. She said that the complex work vendors need to do and the provider implementation process take at least three years after regulations are released. “The timelines were not long enough,” she said.
McNutt said she would create more flexibility and options, noting that the program could include more menu items and less core items. She said that health care organizations “need to have many more options” and that the program should be “a little less prescriptive.” According to McNutt, the added flexibility would let organizations take their own paths and wouldn’t assume or require a certain implementation strategy.
