A Closer Look: The Debate Over Meaningful Use Stage 2 Delay

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The College of Healthcare Information Management Executives and six U.S. senators demand a delay of the October 1, 2013 Meaningful Use Stage 2 deadline. A group of nurses are now saying electronic health record schedules are moving too fast.

But consumer groups insist deadlines should hold; the country cannot afford to slow down the already overdue process of Health IT adoption.

Should Meaningful Use be delayed? HealthBiz Decoded asked experts on each side of the story. 

Mark Savage
Director of Health IT Policy and Programs
National Partnership for Women & Families
Washington, D.C.

Mark-Savage copyWe cannot afford to delay bringing America’s health information system into the 21st Century.

When Congress passed the bipartisan HITECH Act in 2009, it created a national strategy to transform our siloed, paper-based information systems into electronic systems that connect health information anytime and anywhere.  This enables the kind of care, coordination and communication that patients, families and providers want and need now.

The HITECH Act established a national goal that everyone have an electronic health record by 2014.  Recognizing that we cannot transform our health information infrastructure on a dime, Congress enacted a strategic, phased approach where providers and hospitals would adopt increasingly robust electronic health record technology, and make increasingly sophisticated and meaningful use of that technology to improve patient and population health care, improve quality, and reduce cost.  The National Coordinator for Health Information Technology and the Centers for Medicare and Medicaid Services have convened stakeholders, experts and innovators across the nation to recommend and advise this transition.

These efforts have been effective.  To date, more than 87 percent of eligible hospitals and 75 percent of eligible providers have registered for the Meaningful Use program, with almost all successful in meeting the requirements for meaningful use of EHRs to improve individual and population health.  They cover the gamut of critical access, rural and urban providers that serve a significant portion of patients.  The program has moved standards development toward a common set of requirements for certified EHR technology, thus creating interoperability at greater and faster rates so that health information can be more uniformly collected, shared and used.

Systemic change is never simple, and some have asked for delay.  The National Partnership for Women & Families recognizes that this work is difficult.  The Meaningful Use program, however, presents the best way to incorporate new learning and resolve unexpected problems.  We must leverage the program, not delay it.  Congress asked us to be smart, not slow.

Patients and consumers overwhelmingly support these efforts.  In 2010, some 83 percent of doctors were transmitting patients’ information predominantly by paper or fax‑-not electronically‑-according to a survey by the Markle Foundation.  The survey found that most people instead wanted electronic access to health information for themselves and their providers.  Two thirds of patients and doctors say patients should be able to view and download their personal health information online.  Almost three fourths of doctors prefer to share patients’ information electronically with other providers when needed.  By considerable margins (73%-85%), the public and doctors strongly support using electronic health information exchange to reduce medical errors, cut avoidable costs like duplicate tests, better coordinate patient care, and measure health care quality and patient safety.

The National Partnership then conducted a nationwide survey in 2011 after the program launched.  When patients have online access to doctors with EHRs, 80 percent use it.

In short, consumers do not want further delays.  The Meaningful Use program does not need it.  The nation cannot afford it.


Dr. Steven Stack
Board Chair
American Medical Association
Lexington, Kentucky

stack copyWhenever I discuss this with outside audiences I want to qualify right at the beginning, we have been and remain strong advocates for Health IT. I think if you were to poll doctors you would find that an overwhelming majority of us believe we need to embrace Health IT and use it more effectively for the betterment of our healthcare in this nation.

For Stage 2, and really all of these stages, we are taking nearly a fifth of the U.S. economy and trying to transform it using tools that do not currently exist, in six years. We are mandating the use of things that vendors have not yet created and that currently are not being done.

Until we had the delay for which we were grateful, for Stage 1 to 2, we were attempting to progress that in less than a 2 year cycle. Developers were getting things with less than 6 months to develop them, get them to market, and have them in the hands of physicians, all against the backdrop of a universally acknowledged insufficiency in Health IT workforce. There’s just not nearly enough of those types of folks to make this happen.

Our comments are on the pace and the trajectory, and secondly with the structure of the Meaningful Use program. It’s the only pass/fail test (and I’ve taken quite a few in my professional and educational life) that I am aware of where the only passing score is 100 percent. We believe that bar is set very falsely and artificially high. As these stages progress, larger and larger numbers of well-intentioned physicians and hospitals are going to fall off the rails and fail through no fault of their own.

The major barriers to this have not been technology, it’s been policy. State laws vary across all jurisdictions. There’s no business case or imperative that makes sense for hospitals or large care providers to share data from their silos, unless specifically requested – it’s not free flowing or open.

We’ve advocated that you should have a pass rate more along the lines of 75 percent, so that providers have more flexibility to either identify those measures that seem entirely irrelevant to them or that which they tried in good faith to accomplish but simply were unable to, that would allow them to preserve the good that they have put together in the program while acknowledging that by it’s very design it is going to be imperfect, and to have a lower threshold for what would pass as meaningful use.

That’s not a delay in time or years, but it is a modification of the program that is simple and clean and easy to understand.

I would say that to pull the plug on Meaningful Use would be wrong, I think al of us would agree on that, it would be harmful and disruptive and have profound negative consequences on the benefits of patients, the government and providers of care.

But to adjust it and recognize the pace between these stages is simply too fast for the policy to be done ideally, for the vendors to create the products, to be responsive to the market’s needs and for the providers to use it for the benefits of patients, I’m not sure there’s any downside to a delay for that reason.

Let’s put it this way: before meaningful use stage 1 rules had even been put in place, the EHR vendor community said “we’re ready, we an do this, it’s just those doctors and hospitals that refuse to do the right thing.”

By the time we got to rulemaking for Stage 2, the vendors were joining the chorus with the provider community and saying, we can’t do this so quickly, this is too fast.

Thankfully they delayed Stage 3 rulemaking, which if you think about it is farcical. Stage 1 hasn’t even been undertaken be nearly half of the providers in the country, Stage 2 wouldn’t even begin until 2014, so we have no good data, and stage 3 we’re already trying to create the rules for and the regs and make that cemented in regulation, when we have no idea about stage 1 let alone stage 2?

From my experience I hear a consistently louder and more frustrated voice within the provider community and even within some facets of the vendor community. We can’t move at the pace that we are being artificially compelled to move.

I still see people trying to work together in doing it, and I’m hopeful that things like a delay and a modification in the threshold for success could be fairly targeted ways to address the concerns that are being raised without otherwise doing significant harm to the good sides of meaningful use.

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