The Meaningful Use NPRM outlines an “all-or-nothing” approach that is too ambitious, doesn’t take into account the need for flexibility by providers and does not reward incremental progress, according to comments CHIME will file today with CMS. “Without an approach that rewards progress or provides sufficient time, organizations with limited resources will likely have little chance of qualifying for payments, thus widening the ‘digital divide’ in the country,” CHIME’s comments say.
In its recommendations, CHIME wants CMS to give providers until 2017 to adequately achieve all components for EHR implementation; develop an expanded suite of 34 core objectives, some of which can scale over time; use an incremental approach that would deem a provider a meaningful user if it can achieve 25 percent of objectives by 2011, 50 percent by 2013, 75 percent by 2015, and substantially all by 2017.
Contending that the “HIT marketplace does not have the capacity to support the timeframe imposed by the proposed regulations,” CHIME notes that the lack of a certification approach is resulting in industry uncertainty which heightens time pressures for providers and vendors.
CHIME proposes that the final regulations extend the timeframe during which Stage 1 objectives will be used, and asks CMS to adopt a “grandfathering provision” under which existing EHR systems that meet Meaningful Use objectives be accepted as certified for two years. CHIME’s comments contend that quality reporting requirements in the proposed regulation are unrealistic at the early stages of the incentive program, and it asks for a delay in implementing quality reporting until 2012. “While automated quality reporting is critically important to the Meaningful Use of electronic health records, no EHR system in use today is able to automatically report the full set of (35) proposed measures.”
CHIME also comments on specific objectives and HIT functionality measures included in the proposed regulations. The organization seeks the elimination of administrative measures, such as
EHRs producing metrics on automated claims submissions and insurance eligibility. CHIME also is making recommendations regarding CPOE, medication reconciliation, data submission to public health agencies and HIT functionality data submissions.
The Ann Arbor, Mich.-based organization is seeking:
- Reassessment of impact analyses that “seriously underestimate the total cost of ownership for these systems, and overstate the amount of incentive payments in aggregate that will be paid if the proposed rules are implemented.”
- Reconsideration of the hospital-based professional provisions of the regulations that exclude some hospital-based ambulatory clinics from participating in the program.
- Clarification of certification guidelines for EHR systems, given that “the vast majority of EHR systems are not one product but instead incorporate different systems from multiple vendors.”
- Further explanation on how the EHR Incentive Program will be administered.
- Review of provisions regarding HIE, and a recommendation to develop and widely use a national patient identifier.
An executive summary of CHIME’s comments on the regulations can be found at:
To view CHIME’s letter to the CMS in its entirety visit: