The ONC has given guidance which is adding more roadblocks for hospitals and health systems working to become meaningful users of EHRs. As I posted on the ONC blog, they have published on the ONC website an FAQ stating that hospitals must have EHRs that have been certified against all 24 objectives of meaningful use, not just the 19 they plan to use to demonstrate meaningful use. This means that hospitals will need to purchase and implement technology beyond that required to comply with the meaningful use requirements, delaying many hospitals’ efforts to become meaningful users. The ONC FAQ takes away the flexibility to defer objectives and requires hospitals and physicians to have in place EHRs certified against all 24 objectives of meaningful use.
HIStalk believes that this guidance is applicable only to providers with self-certified, homegrown EHRs. But, the FAQ is pretty clear that to qualify for the incentive payments, hospitals must have an EHR certified against all 24 objectives of meaningful use, while demonstrating meaningful use against only 19 objectives. Thus, they will need to buy now technology that CMS does not require them to use until later, and which may need to be replaced or upgraded when new certification criteria are adopted for later stages of meaningful use. As an example we will need to purchase or upgrade to the technology to support reporting of biosurveillance and immunization data to public health departments directly from the EHR, even if the public health departments in our state are not capable of receiving the data in the standardized electronic formats required by ONC and CMS. In the final rule, CMS provided specific exclusions from the public health objectives in the event that a hospital’s public health department cannot receive the data.
While CCHIT is providing is providing certification for self- developed, legacy or customized hospital EHR technology through its EACH™ program, this may be outside the financial capabilities of some systems, although fortunately they are offering scholarships for some critical access hospitals. This program will allow hospitals and health systems to certify their facility, but I think we still need additional guidance from ONC on the use of modular certification for achieving meaningful use.
At this critical time in planning for meaningful use, ONC should provide clear guidance on what the requirements for those planning a modular approach to meeting meaningful use are going to be. This guidance from the FAQ has seriously muddied the water towards using modular EHR solution. It almost appears that ONC is trying to sneak the all-or-nothing approach they originally had in the proposed rule through the certification guidance.
Brian Ahier says
In a letter to Department of Health and Human Services Secretary Kathleen Sebelius the American Hospital Association has voiced its concern on this issue. In its letter, AHA urges HHS to use its regulatory discretion to clarify and implement consistently the ONC and CMS rules in a way that fully realizes the flexibility hospitals were provided by CMS and “requires hospitals to have EHR technology certified against only those 19 objectives they will use to demonstrate meaningful use.”
The letter is available here:
http://www.aha.org/aha/letter/2010/101201-let-umbdenstock-hhs.pdf
flpoggio says
Brian,
In my opinion, the ONC is viewing self developed systems as ‘quasi’ vendor systems. Particularly if the HIT department serves multi facilities. In effect the HIT haas to cover all the criteria, and the end user only has to MU the subset. In some cases I am familiar with a larger hospital serves, or even sells, on a retail basis, or via an internal SLA HIT applications. In that situation, the ONC appraoch actually is defensible.
Frank Poggio
The Kelzon Group
Brian Ahier says
Frank, thank you very much for your comments.
Some hospitals or provider groups have chosen certain certified modules to achieve meaningful use specific to the stage one measures and objectives they are seeking to attain. I think that by forcing them to purchase modules for the menu set measures they have not chosen for this phase of meaningful use flies against the entire modular approach. If this interpretation is only deemed to apply to site certification it is defensible. If this is to be applied to facilities that are already using certified modules for each of the stage one criteria they are attesting to, then it will provide a significant barrier to some organizations being able to receive incentive payments for 2011. This is why the AHA is so concerned…
And since at the highest level (see Aneesh Chopra http://ahier.blogspot.com/2010/12/information-technology-and-priorities.html beginning at slide 13) a modular approach is being praised, there seems to be some inconsistency between CMS, OSTP, and the ONC in the interpretation of the standards criteria.