- LAS VEGAS - Healthcare is an industry made for challenges. From solving the most complex clinical cases and providing immediate care for critical patients to changing lives and curing rare diseases by pushing the boundaries of science, providers have never shied away from some of the toughest problems in the world.
A decade ago, few clinicians may have guessed that electronic health records would soon rank among their biggest foes. But for many providers, the EHR Incentive Programs have done just that.
Cumbersome reporting requirements, convoluted interfaces, confusing workflows, and the looming threat of financial penalties based on all-or-nothing attestations have stressed the industry to its breaking point, making enemies of the very health IT tools that are supposed to deliver better outcomes, smoother processes, and higher quality care.
CMS’ proposals for Stage 3 meaningful use were met with varying degrees of disgruntlement in October of 2015, with many industry observers feeling as if the program was still moving too quickly for providers to keep up.
So it’s no surprise that the collective sigh of relief after Acting CMS Administrator Andy Slavitt’s appearance at the JP Morgan Annual Health Care Conference in January was loud and clear.
“The meaningful use program as it has existed, will…be effectively over and replaced with something better” in 2016, Slavitt said at the time, prompting a flurry of celebration before he and National Coordinator Karen DeSalvo clarified the comments by reminding providers that the EHR Incentive Programs aren’t truly going away – they’re just changing.
That’s the message that Leslie Krigstein, Vice President of Congressional Affairs for CHIME, hopes the industry will remember.
Stage 3 meaningful use may look a little different when it finally comes to fruition, and the Merit-Based Incentive Payment System (MIPS) may change reporting and technology requirements even further, but the healthcare industry must stay the course when it comes to health data interoperability, the transition to alternative payment models, and the difficult process of navigating myriad policy changes.
“As folks think about meaningful use changing and evolving, there will be a big push from providers to ensure that any of those forthcoming changes really push the needle on interoperability, because that has been a major criticism of the EHR Incentive Programs,” Krigstein said to HealthITAnalytics.com during the 2016 HIMSS Conference and Exhibition.
“That’s a major opportunity as they work on what the final Stage 3 product will be and what MACRA will be for physicians.”
“CMS has a great opportunity to really reshape and reorient the program,” she added. “They raised hopes for a lot of folks – or created hope for some of them – who were not necessarily thrilled about how the program has progressed.”
“I think CMS is really going to look for opportunities to build a ‘create your own journey’ experience for providers that will fit what allows them to best treat their patients – and helps them be successful as they move towards value-based reimbursement.”
Since the beginning of the EHR Incentive Programs, stakeholders have urged CMS to take just such a flexible approach, but to no avail. The all-or-nothing attestation structure of meaningful use, along with overly long reporting periods and a requirement framework that does not meet the needs of many specialists or non-traditional providers, have been sore subjects for a large part of the community.
On top of the challenging mandates and strict reporting procedures, providers have been struggling with technologies that often seem as if they are doing more harm than good.
Information exchange can be difficult, workaround can cause unintentional negative consequences, and health data interoperability, a key aspect of the federal vision for the learning health system, has only progressed in fits and starts.
CMS and the ONC are staunch advocates of interoperability, but despite perceptions to the contrary, private industry initiatives may be one step ahead of the administration – and officials are perfectly happy to let innovators make as much progress as they can without a direct regulatory push.
“We’re seeing a lot of private sector initiatives to move the interoperability dialogue forward,” said Krigstein. “We’re going to start to see – especially as we start moving into alternative payment models – the necessity to start sharing data across providers as we move away from fee-for-service,” Krigstein said.
However, professional organizations, EHR vendors, and leading healthcare systems can only make so much progress. With a significant proportion of the industry still mired in fee-for-service reimbursement, the majority of providers are simply unable to devote the same level of resources to infrastructure development as the large academic medical centers and sprawling integrated delivery networks.
“Because we’re still in fee-for-service, and because some aspects of our industry are very archaic, it’s going to take a shift in mindset and it’s going to take leadership from the administration to recognize that they’re going to have to move the conversation along,” said Krigstein.
“Where there are technical barriers…we can knock those barriers down. It’s the policy barriers that will become more and more difficult.”
Formal policies like meaningful use and HIPAA may present challenges, but it’s the informal rules of doing business in the EHR space that are likely to be even more dangerous.
Information blocking became an infamous buzzword in 2015 after a series of high-profile hearings of the Senate Committee on Health, Education, Labor, and Pensions (HELP) and an April report by the ONC that made the industry sit up and take notice.
The hearings hinted at EHR vendor practices that may be purposely preventing providers from sending or receiving information across system lines. The EHR vendor community has denied the accusations, and asked for additional clarification about what, exactly, constitutes information blocking.
Krigstein has some of the same questions, but the industry has few of the answers. “Congress likes to talk about data blocking, but there’s a lot of misunderstanding,” she said. “There is just so much gray area that it’s going to take a lot more than just a stand-alone bill and strengthening certification.”
“The hearings did help to put a lot of focus on the issue of transparency,” she continued. “Any time you can bring transparency into the process, that’s a good thing, especially for small physicians who are purchasing with very little buying power.”
“But we’re going to have to think very carefully about exactly what data blocking is. What’s technical? What’s political? What’s business? What is malicious? We haven’t ironed all of that out yet.”
Understanding the true definition of information blocking – and developing a system to determine when it is malevolent and when it’s just circumstantial – will be crucial, especially if penalties will eventually be involved. Without a clear way to tease out the intent behind a certain action, providers may be unfairly punished for actions that may not originate from a negative place.
“APIs are supposed to be the answer to this, but are you opening up to all APIs or just preferred APIs? Is that data blocking if you don’t trust the security of one or the functionality of another?” Krigstein asked.
“Or what if your patients want one type of interface, but you don’t want to build it that way? Is that information blocking? There are so many layers of the onion to peel back. I don’t think any of us know what data blocking is at this point.”
Congress, the vendor community, and providers will need to open up an honest dialogue about these issues if they are to see long-term success with interoperability and whatever regulatory program comes after the end of meaningful use.
It is important to remember, however, that CMS has not decreed an official end to the EHR Incentive Programs, and the agency is still actively working on crafting a Stage 3 framework that will hold the industry to high technical standards.
“We have had CHIME members reaching out to us asking if they should stop acquisitions that they were planning for Stage 3, and we said absolutely not,” said Krigstein. “Don’t make any significant changes at this point.”
“Don’t forget that we’re in a 365-day reporting period. It’s still all or nothing. There’s growing interest on Capital Hill to look at opportunities to add more flexibility on those fronts, but we are still living in a meaningful use world.”