Federal EHR Incentive Program a Hindrance to Data Exchange, GAO Says

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By Alex Ruoff

Sept. 28 — Health information exchange groups widely blame the federal EHR incentive program for making it too difficult for doctors and hospitals to digitally share patient information according to a GAO report made available to Bloomberg BNA Sept. 28.

The report, requested by Senate Republicans, was an analysis of interviews with officials from 18 health information exchange organizations. Those officials told Government Accountability Office that the meaningful use program has diverted resources and attention away from efforts to improve the interoperability of electronic health records and hindered exchange initiatives.

The government watchdog also found that exchange organizations don't believe that the meaningful use program will ultimately help improve the interoperability of EHRs, which is a major goal of the program.

The meaningful use program offers Medicare and Medicaid incentive payments to health-care providers and hospitals that adopt EHR systems. The program has paid more than $30 billion to more than 5,000 hospitals and more than 400,000 providers since 2011.

The report (GAO-15-817) was requested by Sens. Lamar Alexander (R-Tenn.), John Thune (R-S.D.), Pat Roberts (R-Kansas), Richard Burr (R-N.C.) and Mike Enzi (R-Wyo.). The Government Accountability Office said in the report it expects to release the findings in October.

The report will likely be used to buttress lawmakers' call for a delay to rulemaking on the meaningful use program.

Alexander and other Senate Republicans earlier in September called for a delay of the meaningful use program. Alexander said the program wasn't achieving its goals of improving care for patients or improving the interoperability of EHRs.

The CMS issued a proposed Stage 3 rule in March (80 Fed. Reg. 16732, March 30, 2014). The final rule is expected to be released soon.

Issues With Meaningful Use

The report reflected widespread frustration with the meaningful use program and industry groups' view of the meaningful use program's role in promoting the interoperability of health IT systems.

According to the report, five of the 18 exchange groups interviewed suggested pausing or stopping the meaningful use program. Ten of the groups said that “efforts to meet the program's requirements divert resources and attention from other efforts to enable interoperability.”

“For example, some initiative representatives explained that the EHR program’s criteria require EHR vendors to incorporate messaging capabilities into EHR systems, but this capability generally does not enable interoperability at this time,” the report said.

Ten of the groups also said the requirements of the federal government's EHR certification program, which sets standards for EHRs used in the meaningful use program, aren't sufficient to achieve interoperability.

Groups interviewed by the GAO for the report include the eHealth Exchange, the Electronic Healthcare Network Accreditation Commission, the eHealth Initiative, the Statewide Health Information Network of New York and the CommonWell Health Alliance.

All were involved in efforts to improve the interoperability of EHRs nationwide and none were federal entities.

Issues Achieving Interoperability

The GAO report was a review of the status of efforts by nonfederal entities to develop infrastructure that could lead to nationwide interoperability of health information.

The GAO concluded there are five main barriers to interoperability:

• insufficiencies in health data standards;

• variation in state privacy rules;

• accurately matching patients’ health records;

• costs associated with interoperability; and

• the need for governance and trust among entities, such as agreements to facilitate the sharing of information among all participants in an initiative.


To contact the reporter on this story: Alex Ruoff in Washington at aruoff@bna.com

To contact the editor responsible for this story: Kendra Casey Plank at kcasey@bna.com