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Wednesday, July 24, 2013

Delay Stage 2?

That seems to be the consensus of testimony before the Senate Finance Committee this morning (I'm watching and listening live).

Senator Hatch Statement:
...I am most interested in hearing the thoughts of today’s witnesses about the timing of the various stages of Meaningful Use, and the requirements involved. Let me be clear, I think we need to hold people’s feet to the fire so that we continue to make strides in delivering high quality care.

If that means making requirements more stringent, then let’s have that conversation. However, as I said to our witnesses last week, we have to give organizations enough time to acquire certified technologies and appropriately train staff to use them.

Ignoring the question of whether providers have the ability to keep up will only hurt the

This transformation won’t happen overnight. But, having the right timelines in place is nothing short of a necessity for success.

Providers cannot afford to waste resources on systems that quickly become out of date as CMS and ONC change requirements over time. And vendors should be afforded very clear instructions as to what is expected as part of a certified system...
Witness Dr. Glaser advocates for making an additional year before Stage 2 optional, i.e., those who need it, take it; those who don't, commence to Stage 2 in 2014. Witness Mr. Fattig advocates three years in each stage.

Discussion comments consensus: "Interoperability" and "patient engagement" are the "most important elements of Stage 2.

11:55 EDT update: Witness Statements (PDFs) have been posted.

11:59: Hearing adjourned. Wow, that was quick. Not much new here.

From Witness Marchibroda's prepared statement:
The U.S. health care system is undergoing significant change, brought about by concerns related to rising health care costs, uneven quality, and eroding coverage. Delivery system and payment reforms which promise to improve both the quality and cost-effectiveness of care are rapidly emerging with leadership by the federal government, states, and the private sector. Such reforms cannot be successful without a strong health information foundation which health IT provides.
 That observation has not changed materially in a decade.

...As we discussed at last week’s hearing, just implementing technology is not the goal. Technology must be used to actually improve health care.

Vendors need to create the right software so that when doctors run quality reports, they get accurate results. If the software isn’t written correctly, it may not recognize drug allergies or dangerous interactions.

Vendors must also create systems that talk to each other, even when those systems are not part of the same network.

Medicare and Medicaid can play a role. Their payment policies can create the right incentives for providers to use health I.T. and for vendors to improve quality.

When it comes to I.T., the vision is there. But as our witnesses today know, it’s the execution that matters. So let us ensure that our health I.T. vision is being executed in a way that lowers costs and improves care for all Americans.


apropos of the foregoing.

Congressional EHR interest brings both opportunity and risk
July 25, 2013 | By Marla Durben Hirsch, FierceEMR
Look at at all of the attention that congress is lavishing on electronic health records.

More than 30 bills aimed directly at EHR use have been introduced since the new session began in January. They cover a lot of ground, including bills to:

Ease the pain of the Meaningful Use program by creating two new exceptions and softening other requirements

  • Expand the Meaningful Use incentive program to safety net clinics
  • Impose strict time limits on interoperability of EHR data between the U.S. Department of Defense (DoD) and the U.S. Department of Veterans Affairs (VA)
  • Increase congressional scrutiny of the DoD/VA joint EHR
  • Exclude pathologists from the Meaningful Use program (HR 1309)
  • Create a prize program for the development of an iEHR (HR 2055)
  • Extend Meaningful Use eligibility to some physician assistants (HR 1790)
  • Use EHRs as part of coverage of voluntary advance care planning (HR 1173)
  • Use EHRs when caring for newborns (HR 1281), mothers and babies (S 425)
  • Provide loan guarantees for small providers who wish to purchase health IT (HR 28)
  • In addition, while not a proposed bill, you've got lawmakers asking the U.S. Department of Health & Human Services Office of Inspector General to extend the legal protections allowing EHR donation programs, which otherwise would sunset at the end of this year.
And this doesn't even count the ongoing attention being given to the beleaguered Meaningful Use Incentive Program, with Republication lawmakers calling for a reboot, freeze or a pause of the initiative...
...this uptick in congressional interest is not without its risks.

For one, not everyone may be in favor of this increase in governmental interest in EHRs. It's one thing to suggest that pathologists be excluded from the Meaningful Use requirements. It's another to require DoD and VA get its iEHR act together in only one year; they've been trying for years to accomplish that. Simply telling them to speed it up might not be that effective.

There's also a risk that the subject will become even more partisan. I hope we don't start seeing repeated votes to repeal the Meaningful Use program, the way the House continues to vote to repeal the Affordable Care Act.  

At the same time, perhaps this is a great opportunity for congress to step in take some positive steps to improve EHR use...
Color me skeptical on Marla's last speculation.


Only ~ half would still choose Medicine as a career?

More to come...

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