Providers Share Experiences Achieving Meaningful Use, But Challenges Remain

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By Genevieve Douglas

Providers at the forefront of adopting electronic health record systems and receiving incentive payments for the "meaningful use" of EHRs have found successes in attesting to required EHR capabilities, but challenges remain, according to testimony submitted Oct. 5-6 to the Office of the National Coordinator for Health Information Technology's meaningful use workgroup.

Meaningful use criteria for the use of computerized physician order entry (CPOE), drug-to-drug and drug-to-allergy checks, recording demographics, and creating patient lists have all been "easy [criteria] to meet or exceed" for providers in ambulatory care settings, Paul Kleeberg, clinical director of the Regional Assistance Center for HIT (REACH) serving Minnesota and North Dakota, said in written testimony.

Providers shared their experiences with the ONC workgroup on meaningful use during a two-day informational hearing to identify possible criteria for Stage 3 of the meaningful use program.

According to Kleeberg, 27 percent of REACH providers in Minnesota and North Dakota will be attesting to meeting the criteria for the Medicaid incentive program, and approximately 43 percent will be attesting to meeting Medicare EHR incentive program criteria.

Citizens Memorial Healthcare, a rural health care network serving southwest Missouri, found most of the core measures to be "relatively easy to accomplish," Denni McColm, chief information officer, said in written testimony.

McColm warned, however, that its ease in reaching attestation will not be true for hospitals just beginning the process of adopting and implementing EHRs.

According to McColm, Citizens Memorial Healthcare implemented its EHR system over a period of years, but hospitals that are not considered "early adopters" will be expected to achieve the same levels of adoption in a much shorter time period to qualify for the incentives.

As part of the Medicare and Medicaid EHR incentive programs, providers have the option to progress through Stages 1 through 3 based on the payment year they begin meaningful use, rather than imposing the same meaningful use standards on all providers in a single year.

This allows for late adopters to not face more stringent criteria in the first year of adoption than early adopters. However, the phased approach requires that late adopters progress more quickly through the stages, so that all providers would be in Stage 3 by 2015.

Challenges Remain for Early Adopters.

Certain criteria for Stage 1 of the Medicare and Medicaid EHR incentive programs have proved challenging.

According to Kleeberg, providers have had problems attesting to criteria for electronically submitting immunization data to registries; performing surveillance of syndromes in communities and regions; providing patients with timely access to records; and providing educational material on diagnoses and treatments to patients.

The requirement that physicians provide patients with an electronic summary of their clinical care has also posed a challenge, particularly for sharing lab results that are available after the patient has departed the clinic, McColm said.

Eligible providers often have processes in place to ensure these results are communicated to patients via telephone or letter, McColm said, but reporting on this delivery of results in conjunction with handing a patient a standard clinical summary at the conclusion of a visit is very challenging.

For providers in Missouri, reporting lab results to public health agencies is also not yet possible. McColm said that local or state public health departments in Missouri are not currently accepting even a test of this functionality.

According to the providers' testimony, patients have responded in a mixed way to the use of electronic health records. Some patients have embraced the new technology and access available through EHRs, while others have remained resistant to the technology, Kelley Bridges, director of Application Support for the East Alabama Medical Center, said.

Patients gave positive responses about the use of health IT for electronic prescribing due to its convenience, Jennifer Bolduc, chief medical information officer at Walla Walla Clinic in Walla Walla, Wash., said.

According to Balduc, sharing medical records on a large flat screen TV is also a "huge win with patients," as they appreciate the transparency it provides in care.

The negative patient responses identified by Bolduc were predominately due to demographic requirements that collect patient data on race and ethnicity.

"Some patients are very resistant to those questions and feel that it is none of our business," Bolduc said in her testimony.

Vendor Readiness in Question.

For some providers, vendor issues have been a major impediment to attesting to meeting Stage 1 of meaningful use, Carol L. Steltenkamp, chief medical information officer at the University of Kentucky and director of the Kentucky Regional Extension Center, said.

For example, some vendors are unable to fully implement health IT systems into practices within an appropriate time to allow for attestation to meeting meaningful use criteria, while others include fees and charges for interfaces that can be exorbitant, Steltenkamp said.

In Kentucky, the regional extension center and the Kentucky health information exchange are working together to address vendor concerns, but vendor readiness for health information exchange requirements is "bigger than a state issue," she added.

Other regional extension centers have encountered vendor problems providing a "complete EHR," Kleeberg said.

Many EHRs can require additional modules, add-ons, or patches in order to meet meaningful use criteria, and in other instances, certified meaningful use versions of EHRs are not available to clients because the wait times on vendor installation of these systems is too long.

Additionally, health information exchange is a "major challenge" with some vendors, he said, because vendors have focused more on generating an encrypted data message than on the reception and unencryption of the data that providers send and receive. This can ultimately lead to providers being unable to unencrypt data to a human-readable document.

Kleeberg also said that statewide health information exchange is not yet ready in many states. This has added hurdles for providers trying to figure out long-term electronic exchange options with other care providers, he said.

Testimony from the hearing is available at by clicking on the Oct. 5 meeting entry on the ONC federal advisory committee calendar.

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