It's no secret that primary care physicians are frustrated with certain aspects of their electronic records, and they are not alone in calling for change. Fortunately, it has become increasingly clear that federal government officials have heard that call.
In a strong sign that federal officials are well aware that the requirements associated with supporting greater technology use are causing considerable angst in the health care community, Brett Meeks, health counsel for the Senate Committee on Health, Education, Labor and Pensions (HELP), recently offered a review of the government's electronic health record (EHR) incentive program that showcased many of the objections made by primary care physicians.
"No, we don't think it is working very well," Meeks said of the program during a recent Brookings Institution event(www.brookings.edu) that focused on health care connectivity, including the problems associated with its implementation. "We think stage one of meaningful use was very good at getting physicians and hospitals to adopt EHRs and health IT in general, but stage two and stage three we see as very troublesome," he noted.
- Panelists at a recent Brookings Institution event discussed challenges associated with achieving health care connectivity.
- One panelist offered insight on what members of the Senate Committee on Health, Education, Labor and Pensions are doing to address those concerns.
- Another panelist described successes her company has had in establishing accountable care organizations capable of exchanging information on a statewide level.
"It was well intended, but the consequence and penalties it levies on physicians and hospitals are very serious," said Meeks. "We have to determine whether we are going to continue to penalize people for not checking boxes that are arbitrary in their practice. Do these things really help us improve care or is it just some regulation that is not well thought out?"
During stage two, for example, 5 percent of physicians were required to allow their patients to view, download and transmit their health information, he said.
"That seems very reasonable, right? Five percent?" Meeks asked. "The problem is it makes a physician liable for the actions of a patient. You can't force a patient to go home and send a message if they don't want to."
Modifications to stage two of the program now mean that the physician needs to receive a message from only one patient. However, in stage three, the threshold goes back up to 30 percent or more. It's a clear sign, Meeks said, that HHS needs to consider easing the standards.
"If everyone is complaining about this, why are we raising the bar?" he asked.
Even Karen DeSalvo, M.D., M.P.H., HHS acting assistant secretary for health, and CMS Acting Administrator Andy Slavitt recently acknowledged that the plan to expand technology use has hit some speed bumps.
"The EHR incentive programs were designed in the initial years to encourage the adoption of new technology and measure the benefits for patients," they wrote Jan. 19 in The CMS Blog.(blog.cms.gov) "And while it helped us make progress, it has also created real concerns about placing too much of a burden on physicians and pulling their time away from caring for patients."
Another challenge the federal government has confronted in pursuing its health IT goals has been integrating EHR systems on a national level. It's an issue that's very much on the minds of those in the Office of the National Coordinator for Health IT (ONC), said Elise Anthony, J.D., acting director of policy for the ONC.
She noted that although ONC and CMS have certainly worked together on strategies to encourage and facilitate health care professionals' adoption of EHRs and to determine what sorts of overarching requirements should pertain to health IT, the two agencies have very different perspectives.
"ONC tries to think about what are the health information technology pieces that are integral, that are important for providers to be able to service their patients in the best way possible," Anthony told attendees at the event.
So, as CMS thinks about the ongoing shift from volume- to value-based payment envisioned in the Medicare Access and CHIP Reauthorization Act (MACRA) and how to incentivize physicians to move toward the types of alternative payment models (APMs) that MACRA lays out, "the part that we at ONC are thinking about is how to support health information technology that could benefit providers who are moving toward that APM world, that value-based payment world," she explained.
Obviously, interoperability is a big part of that conversation, said Anthony. And given the many elements of realizing that integration that must be reconciled, it's a discussion that's likely to be ongoing.
In describing her own company's struggles to achieve interoperability on a smaller scale, Alice Borrelli, M.P.A., director of global health and workforce policy for Intel Corp., underscored the difficulty of meeting this goal.
Intel has created its own accountable care organizations (ACOs) for employees in three states with the intent of having integrated health records in each state.
According to Borrelli, the company failed to achieve interoperability in its first ACO foray, which involved 6,000 of its employees in New Mexico. Company officials learned from the experience, however, and made changes before establishing the company's Oregon ACO, which covers 17,000 employees and includes two major hospitals and multiple clinics where all records are available at the point of care. In seven months, they were able to achieve interoperability, she said.
And just last month, the company launched an ACO for 5,000 employees in Arizona, Borrelli said. That process called for some 150 EHR companies to be integrated, so Intel chose the Sequoia Project to serve as the health information exchange network because "they have a certain set of standards that all of the providers using this myriad of EHRs had to subscribe to," she explained.
Some of those companies that were unable to comply with the standards dropped out, Borrelli acknowledged, but this month, the ACO went live with all of the state's Intel employees having point of care access.
The point, she said, is that with the right dedication and motivation, interoperability can be achieved. "It's a miracle when it happens," Borelli said. "It can be done, but we may need additional pushes with legislation."
That help may well be on the horizon.
Meeks said the Senate HELP Committee is even now crafting legislation addressing interoperability and exchange of health information which would include a requirement that health information systems communicate with patient registries. The committee is seeking feedback from physicians and the medical community.
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