EHR program at 'inflection point'

Sen. Max Baucus (D-MT) began the July 24 Senate Finance Committee hearing on health IT with a Thomas Edison quote: “Vision without execution is hallucination.”

Following last week’s call from Sen. Orrin Hatch (R-UT) to pause the meaningful use program and determine whether “the bar is too low,” Edison’s words were apropos to the hearing, in which providers and a tech vendor recommended expanding the timeline for meaningful use because the next phase is overly prescriptive and threatens to hinder hospitals and patients alike while creating a digital divide among caregivers.

“The program is reaching an inflection point," said John Glaser, CEO of Siemens Health Services. "The requirements for Stage 2 are more stringent.”

Along with other mandates, such as the “massive overhaul” required for ICD-10, payment reform, and new care models, Glaser said the government may be creating “a perfect storm” with the potential to essentially cripple hospitals, which is why he recommended “delaying Stage 2 until October 1, 2015,” and ultimately adjusting the program such that each stage spans three years.

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Colin Banas, MD, CMIO at Virginia Commonwealth University, agreed. “Slowing down is prudent because the literature and experience has shown that these things take time,” he said.

Adding that the industry and government “should refocus efforts on widespread adoption and information exchange before rushing ahead” because the two-year cycle is not enough for his hospital, Marty Fattig, CEO of Nemaha County Hospital, in Auburn, Neb., said that “progress is being made but the digital divide between urban and rural hospitals persists.”

Among the reasons that Fattig pointed to is the fact that “rural hospitals find it more difficult to get timely attention from vendors,” which makes things hard enough if everything goes well, but even getting a bug fix can take several months.

Glaser explained that for those small and rural hospitals “it may be on the edge of impossible” to even implement an EHR. “So we run the risk of a haves and have-nots [scenario],” he commented.

Sen. John Thune (R –S.D.) recounted parts of last week’s hearing, which, he said, left him concerned that the administration does not adequately understand the challenges rural and critical access hospitals face.

One of those obstacles, of course, is resources, be they financial, technological or personnel-related. Fattig told the committee that one of his hospital’s staffers splits her time between serving as a nurse and the lead informaticist.

“Let’s step back, take stock, keep the program going but revise where we need to,” Glaser said. “Let’s move into more centricity on the outcomes and more focus on interoperability, and worry less about whether this feature or that feature is present.”

Baucus, pointing out the apparent consensus among Banas, Fattig and Glaser, turned to Janet Marchibroda, health innovation initiative director at the Bipartisan Policy Center, and asked point-blank what she thought about pushing back Stage 2.

“So this is the thing: Stage 2 advances considerably the engagement of patients and you don’t see that much of it in Stage 1,” Marchibroda began. “Information sharing is the primary driver in reductions in costs that we’ll see through health IT.”

Marchibroda inquired whether there might be a way to let those who are already far down that path, like accountable care organizations, be able to reap the advantages of Stage 2 while also giving rural and critical access hospitals more time.

“I’d hate to see us not benefit from those important patient engagement and information sharing requirements in Stage 2 as soon as we can,” she said. “Don't delay the start of Stage 2. Align expectations for information sharing with payment both inside and outside meaningful use.”

Referencing his opening quote from Edison, Baucus concluded, “The good news is we all tend to agree on the goal, the question is the execution. How do we do it right?”