Survey: "Meaningful Use" Too Strict

A workgroup of the Health IT Policy Committee has requested public comment on its proposals for Stage 2 and Stage 3 meaningful use objectives and measures. The committee advises the Office of the National Coordinator for Health IT, which oversees health IT modernization efforts. Health-care providers must meet meaningful use guidelines to receive federal financial incentives over the next several years.

The torrent of criticism about the next phase of "meaningful use" standards for electronic health records continued this week, most recently with vendors, health-care providers and other health IT "stakeholders" arguing that nine of the stated goals are too aggressive.

The latest criticism comes from the Certification Commission for Health Information Technology, a federally authorized health IT testing and certification body. In mid-February the commission conducted a survey that asked about the ease of implementing the objectives and measures of Stage 2 meaningful use. Respondents were to consider clinical workflow and potential technical challenges.

Of the 468 people who completed the survey, 36 percent were providers and 29 percent were EHR vendors. At least one-third of respondents indicated that nine goals were too aggressive, according to Dr. Karen Bell, the commission chair. In some cases, a majority of respondents raised red flags, she blogged on Thursday.

"We received numerous comments about the importance of assuring that finally adopted objectives and measures reflect those processes that are, in fact, in the providers' control," Bell notes. "... (P)utting individual providers financially at risk for results beyond their control is counterproductive to the overall goal of widespread provider adoption of HIT that is used in a meaningful manner."

Survey highlights include:

  • More than 50 percent of providers and 40 percent of vendors and others say the timetable for meeting a requirement for syndromic surveillance is too early, in part because cash-strapped public health agencies don't have the infrastructure to manage the data.
  • Requirements for drug formulary checks were considered too challenging for providers with patients on many different insurance plans with separate formularies, some of which are not available electronically.
  • Respondents say the second quarter of 2012 is too soon to guarantee patients access to their health information within four days. A "change of this magnitude at the national level could become a patient safety issue," Bell writes.
  • Ongoing submission of immunization data to state registries is "premature given the lack of transmission mechanisms and state systems that can accept these data," respondents say. The health information exchanges needed to facilitate the exchange likely won't be available nationwide until 2014.
  • Until infrastructure can be built, expanded requirements for clinical decision support are premature, the respondents say.