To better inform the HIT Policy Committee and Meaningful Use workgroup about the real-world challenges faced by organizations working to comply with their requirements, the Adoption and Certification Workgroup presented findings it obtained during two days of recent hearings.
After stating that the hearings showed “good appreciation” for the work being done by those committees and “overall, I felt a pretty positive attitude,” HIT Policy Committee Member Marc Probst, CIO at Intermountain Healthcare and Co-Chair of the Adoption and Certification Workgroup, went on to highlight the challenges cited.
One of those had to with “confusion about the rules of the road around certification. It’s not so much that the rules have changed, but through clarification they have changed as people understand them, at least that is the perception,” he said. “It has been very frustrating.”
Larry Wolf, member of the Adoption and Certification Workgroup and senior consulting application/data architect at Kindred Healthcare, said the continually evolving rules cause difficulties for both producers and implementers of software. “That can create big operational issues,” he said.
The duo also reported that since Meaningful Use has, in fact, become the three-to-five-year strategic plan for organizations dedicated to achieving it, ONC and CMS had a responsibility to deliver a sound one.
“People need to understand where they’re going and how they’re going to get there so they can start to align resources. They don’t want to just be saying, ‘I know the next two years,’ and then scramble to get there, ‘I know next two years,’ and then scramble to get there, ‘I know next two years,’ and then scramble to get there. That’s not an effective way to do anything,” said Wolf. “I know the Meaningful Use workgroup has been discussing their vision of Stage 3, so Stage 2 can actually be taking us there.”
HIT Policy Committee Member David Lansky, CEO of the Pacific Business Group on Health, suggested revising ONC’s original strategic plan. HITECH was passed two years ago, he noted, and has a relatively long lifespan. “We are all struggling to take the lessons learned and get them back into the program. It makes me think we should consider an update of our strategic plan which would give the country a second-generation of guidance on where we think we can get with this six-year planning window.”
Another issue raised was around the HIT workforce — not so much the lack of it, but more the increased investment. “Someone said, ‘I can find people to work – they just cost twice this year what they did last year,’ so there has clearly been a huge increase in demand, but not supply,” said Wolf.
Probst described the workforce issue as, “clearly out there like a looming cliff.”
But the biggest problem overall revolved around the issue of having to do so much in so little time, described as “the layering on of various federal requirements,” by Probst. Among those, he cited Meaningful Use, along with requirements around privacy, security and quality reporting.
Undoubtedly the largest project competing for the same pot of HIT resources is the conversion to ICD-10. “That impact of that alone on AR (accounts receivable) days, as we look at 2013, could make the Meaningful Use incentives look like a small number,” said Probst, “I think we must be conscious of that, discussing it and having it on the table, so that when we provide information, we do it in context, understanding the scope of everything that’s being asked.”
Those things being asked are falling hardest on the little guy, Probst commented, asking the committee to, “keep in mind there are smaller groups that have to do very big thing which they’re not used to doing in the past.”
With such emphasis on the time crunch, Policy Committee Member Charles Kennedy, M.D., VP for Health Information Technology, WellPoint, Inc., asked if going to Congress to request adjustments to HITECH’s timeline was possible. Probst responded that it might be best to adjust the requirements — something the committee definitely could do.
With more time not forthcoming, Wolf cautioned that any major adjustments to the program could have far-reaching consequences.
“I would take it under advisement that we are asking people to run fast, and so we should make the best of their running fast and get things aligned so Stages 2 and 2 look like a reasonable progression,” Wolf said, “Looking at the PCAST report, we don’t want to create a mid-course correction that’s a 90-degree turn, because that really would push people over the edge. If our goals are shifting, how do we do that in a sane way that’s going to support people in the transition?”
Looking forward, Probst said his workgroup would work with the Standards Committee to “better influence the Meaningful Use workgroup.”
One issue that came up during the hearings — which will be slated for hearings of its own — had to do with testimony indicating malpractice insurance rates were rising for those who’ve adopted EMRs. This was cited as surprising by some committee members, because some insurance companies were thought to be offering discounts for their use.