Webinar: Healthcare professionals weigh in on meaningful use

Healthcare professionals are strongly urged to review and comment on the proposed meaningful use definitions and EHR interim final rule from the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC), according to presenters of a Webinar, hosted by Washington D.C.-based eHealth Initiative on Jan. 8.

The Webinar featured health IT stakeholders’ initial reactions and thoughts on the CMS' meaningful use proposed rule, which was released on Dec. 30, 2009. While the presenters varied in terms of supportiveness for the rule, all presenters expressed enthusiastic endorsement for public comments.

Moderating by Raymond W. Scott, CEO of Axolotl, the Webinar included responses to the proposed meaningful use rules and regulations from Karen Bell, MD, senior vice president of health IT services at Masspro; Neil Calman, MD, president and CEO at the Institute for Family Health and Health IT Policy Committee member; Mickey Tripathi, PhD, president and CEO of Massachusetts eHealth Collaborative and Health IT Policy Committee Information Exchange Workgroup co-chair; and Glen Tullman, CEO of Allscripts.

Providers are expected to be enacting Stage 1 meaningful use of health IT by 2011 if they wish to receive incentive money from the government for the meaningful use of EHR systems. Providers can apply for meaningful use before 2011 and, to be certified, must employ 30 days of continuous meaningful use in the first year of certification. After a provider’s first year, the provider must enact continuous meaningful use throughout the entirety of the year.

Eligible health vendors can apply for either Medicare or Medicaid incentives--not both. According to Scott, healthcare professionals can switch from Medicare to Medicaid and vice versa once and only once. However, he remarked that the mechanisms for doing so are unclear at this point.

Scott estimated that 20 to 25 percent of eligible professionals will benefit from these incentives in a question and answer session. The board of presenters did not know if these incentives would be taxed.

Mandated by the Health IT for Economical and Clinical Health (HITECH) Act, the Health IT Policy Committee operates in an environment of a legislative framework where the entire rule-making process takes place, reminded Calman. “There is a box around this policies that specifies how many dollars there are. A lot of pieces are not subject to change by ONC or the HIT Policy Committee,” Calman said.

"There’s tens of billions of dollars of public money that contribute to supporting this healthcare transformation, so there’s a balance between how far we want to push this healthcare transformation and recognizing that IT adoption is low across the country," Calman said. One reality Calman acknowledged is that there is currently limited ability to employ health IT even though many professionals wish to freely exchange data across interoperable systems.

The subtle goal of the HITECH Act was to get professionals to shift focus from healthcare to health, stated Tullman. While most presenters applauded the committees overall for getting meaningful use definition proposals and discussion up and running, there were some concerns.

Small independent physician practices and group practices did not seem to be included in the rule-making process, stated Tullman, who suggested that the government find a way to create small advisory groups to include the voice of these practices. In addition, reporting requirements in the document were vague, concluded Tullman, because while it specified capturing what’s done on the computer, the document does not address what’s not done on the computer.

The Regional Extension Centers (RECs) are not operating, stated Bell. “I think one of the problems is that a lot of physicians have been waiting for the RECs….In 2011, there are going to be quite a few providers out of sync with what they will be able to do with REC support and the 2011 timeline. Many of those will probably bump over into 2012,” stated Bell.

Tripathi noted that the documents miss an opportunity to align laboratory results, which he sees as a significant weakness. “Laboratories are the most difficult component of interoperability,” said Tripathi, citing that there are no requirements placed on hospitals that are delivering labs to ambulatory practices. “It ultimately undermines the quality measurement capabilities that we hope to achieve.”

Public comment will be open until March 15. The final rule will not be released until late spring, according to a clarification from CMS during the Webinar.

The Webinar was sponsored by the San Jose, Calif.-based EHR provider Axolotl.