Healthcare IT: The Battle to Change Meaningful Use Stage 3

If you’ve been following our blog during the latter half of this year (or any Health IT blog, for that matter), you are already well aware of the fact that the chaos of Meaningful Use Stage 3 (MU3) has been causing panic attacks for many folks in the healthcare industry.  If you find yourself breaking out in hives at just the thought of MU3, you can at least take comfort in the knowledge that you are definitely not alone.  Many groups are calling for it to be reformed.

Unfortunately, this also seems to be the only thing they agree on.

You see, the American Medical Association (AMA) began by rallying a group of 111 national and state medical societies earlier this year, drumming up support for their fight to delay MU3.  They (along with HELP Committee Chair Lamar Alexander) drafted a letter to ONC/HHS calling for MU3 to be postponed until a number of reforms can be made.  However, their call for a delay has not come with any specific reformation suggestions.   More or less, they just want MU3 to be stopped until it’s fixed.  But they’re not saying how it needs to be fixed,

On the other side of the argument is a new coalition—let’s call them the “Health IT Nine” (mainly because I think that name sounds kind of cool)—made up of nine organizations, mostly Health IT vendors and other tech firms with interest in the EMR industry… as well as a few healthcare special interest groups thrown in for good measure:

• Health IT Now (coalition founder/leader)
• Apervita
• Athena Health
• Intel
• The National Alliance on Mental Illness
• New Directions Technology Consulting
• Oracle
• The United Spinal Association
• Verizon

This second coalition disagrees with the AMA’s group, and insists that MU3 must continue as planned.  In a letter to Congress [addressed to Nancy Pelosi (Dem. Leader of the House), Paul Ryan (Speaker of the House), Senate Minority Leader Harry Reid, and Senate Majority Leader Mitch McConnell], the Health IT Now group urged them to “oppose any legislative changes to the Meaningful Use program, including delays in timing of Stage 3.”  However, they are in agreement with the AMA that reform is necessary.  They just disagree that doing so requires a delay to MU3, stating “Delay without reform would rob taxpayers and patients of cost savings while doing absolutely nothing to make the program work well for overburdened doctors and hospitals.”

In the Health It Now coalition’s letter, instead of delaying MU3, they offered Congress a list of ten items that they feel can pave the way to the much needed and long awaited interoperability that the ONC and HHS claim as the main goal:

1. Define Interoperability: Establish a common definition of interoperability in the statute
2. Information Blocking: Put an end end to information blocking in any taxpayer-funded programs intended to support information exchange
3. Industry Standards: Set industry-developed standards by promoting open APIs, referencing implementation models, and making thorough interoperability testing a condition for certification
4. Certification: Provide incentives to vendors who continuously improve their products and base full certification of products on set measures related to interoperability and usability/functionality
5. Testing: Task the National Institute of Standards and Technology (NIST) with testing the interoperability of products, and make it the job of the ONC’s Authorized Certification Body (ONC-ACB) to conduct field surveillance/research to determine whether products adhere to established standards
6. EHR Marketplaces: Ensure physicians must be given access to all relevant data about an EHR before choosing one, including data on certification, decertification, penalties, and information blocking incidents
7. Reporting Problems: HHS should be required (by Congressional order) to establish a process (as well as an online tool) that providers and patients can use to report EHR providers/vendors who fail to transmit/receive patient information with other providers, or if patients are not given the ability to transmit/receive information from providers
8. Enforcement: Implement civil monetary penalties, decertification, and/or program exclusion to punish bad actors and information blockers. However, they also want CMS to be required (by Congressional order) to offer hardship exclusion for providers whose products have been decertified and to create a hardship fund (see item #9) to help these providers transition to certified products
9. Penalty Structure: Allow HHS to charge penalties against vendors for not adhering to interoperability standards or participating I information blocking, and use penalties funds to assist providers whose EHR systems have been decertified
10. Operational Efficiencies: The ONC should no longer manage grant programs, as this is not in their core set of competencies and detracts from their primary focus—achieving interoperability across systems and providers.  Grant authority should be transferred to an alternative agency with experience and dedicated staff capable of administering funding programs

Now it’s important to remember that the above is just a list of recommendations.  None of this has been introduced as legislation, and it is possible that none of it ever will.  For now, neither a delay nor any concrete reforms have been approved by Congress, the ONC, or any other leadership entities.

Seeing as how Congress adjourns for the year next Friday (December 18) and is not scheduled to reconvene until January 5^th (with votes postponed until 6:30pm) of next year… well… it’s not likely that anything is going to be done about it in 2015. 

So for now, it looks like we’ll just have to wait until 2016 to see what happens with MU3…

But that’s nothing new, is it?