Health IT Stakeholders Find Meaningful Use Goals AggressiveHealth IT Stakeholders Find Meaningful Use Goals Aggressive

17 Leading EHR Vendors

A poll that gauged the views of 468 health IT stakeholders shows that they view the proposed Stage Two and Three meaningful use objectives and measures as too aggressive when considering the work to be done, the targets to be met, and the timelines in which to achieve the stated goals.

The survey was sponsored by the Certification Commission for Health Information Technology (CCHIT), and was conducted to coincide with the Meaningful Use Workgroup of the Health IT Policy Committee's request for public comment on their proposed Stage Two and Three meaningful use objectives and measures.

Survey participants were made up of providers (36%), electronic health record (EHR) vendors (29%), and others (29%), and the results were summarized in a blog post by CCHIT chair Karen Bell.

The survey findings reflect concerns expressed by several other organizations, including the College of Healthcare Information Management Executives (CHIME), the American Health Information Management Association (AHIMA), and the Healthcare Information and Management Systems Society (HIMSS) EHR Association. These organizations have complained that the meaningful use regulatory schedule doesn't allow vendors and providers sufficient time to perform adequate quality assurance, obtain Office of the National Coordinator for Health Information Technology Authorized Certification Body (ONC-ACB) certification, and implement new software releases as they prepare to meet meaningful use Stage Two and Three criteria.

Bell said respondents rated the objectives and measures with respect to the ease of implementation -- both from the clinical workflow perspective and technological challenges.

At least one-third of the survey respondents said they considered the nine measures and objectives listed below to be too aggressive. Several were considered too aggressive by most of the respondents. All nine procedures are enhancements of existing Stage One objectives and measures, and reflect current experience in the field.

-- Syndromic Surveillance: Over 50% of providers and 40% of vendors and others felt that this was not ready to be a core measure for Stage Two, since public health agencies do not have an infrastructure to accept and analyze data. Syndromic, or clinical, surveillance refers to the electronic collection, analysis, and interpretation of health data about a clinical syndrome that has an impact on public health.

-- Drug Formulary Checks: The target of having drug formulary checks, which compare whether prescribed medications comply with health plan preferences, on 80% of patients seen was not considered reasonable, even for providers who are using an e-prescribing network to retrieve formulary information.

-- Medication Reconciliation: Respondents said few providers in Stage One are assessing all of a patient's medications to avoid medical errors such as drug omissions, duplications, dosing errors, or interactions. Respondents recommended making it core in Stage Two, but not increasing the percent of patients to which it applies (from 50% to 80%) until Stage Three.

Health IT Boosts Patient Care, Safety

-- Patient Access to Health Information Within Four Days: Respondents said there is lack of clarity about what constitutes "relevant" information, this objective will require major workflow change at the provider level, and a change of this magnitude at the national level could become a patient safety issue. Respondents recommend staying at Stage One level until this can be further evaluated.

-- Submission of Immunization Data: Ongoing submission of immunization data to state registries is premature given the lack of transmission mechanisms and state systems that can accept the data, respondents said. They recommended no expansion beyond Stage One.

-- Capability to Exchange Key Clinical Information: Anything beyond using an EHR with the capability to submit data requires significant technological and policy work far beyond the scope of clinical practice and individual providers, said respondents. Most states have not yet addressed either the policy or technical challenges necessary to create the supporting infrastructure to meet these objectives in either Stage Two or Three, they said.

-- Clinical Decision Support: Respondents said this is another area where it is premature to go beyond Stage One because a supporting infrastructure is not yet built, beyond a few simple decision-support rules.

-- Submission of Reportable Lab Data (and reconciliation with orders): Respondents believe that this measure is not appropriate until there is more standardized lab results coding (beyond numerical values), transmission, and implementation guidance.

-- Drug Allergy Checks: Respondents registered minimal concern with this becoming a core requirement in Stage Two. There was, however, significant concern about the Stage Three proposal. Commentary identified that there is no consistent library of evidence-based interactions for more complex interactions and the field is more dynamic than existing technology can accommodate.

Bell said almost all respondents mentioned the need for "further maturation that would take longer than the implementation timeline necessary to have them included in EHR technology by 2014."

Bell also said providers want control over the implementation process, especially since the requirements necessary to achieve Stage Two and Stage Three of the meaningful use guidelines have an impact on costs.

"While many of the objectives, and measures proposed by the Workgroup are laudable in their own right, putting individual providers financially at risk for results beyond their control is counterproductive to the overall goal of widespread provider adoption of [health IT] that is used in a meaningful manner."