Meaningful Use Stage 3 Concerns Abound

Physician requirements, including a new requirement for patient-generated health information, called cumbersome by industry.

While industry groups are thrilled with the government’s goal of promoting EHRs, their concerns about the forthcoming Stage 3 requirements for meaningful use speak to the challenges physicians face on a day-to-day basis.

Everyone from the American Medical Association (AMA) to state associations and physicians has weighed in on Stage 3, and called for the Office of the National Coordinator for Health Information Technology at HHS to pare down the objectives proposed in its 44-page document.

Earlier this month, the AMA submitted formal comments to ONC, generally calling for the government to ease up on the requirements.

“A full evaluation of past stages and more flexible program requirements will help physicians in different specialties and practice arrangements successfully adopt and use EHRs,” said physician and AMA Board Chair Steven J. Stack in a statement.

In its letter, AMA asked the ONC to address a number of things, including the usability of certified EHRs, and create a “reasonable and achievable” pass rate. “Failing to meet just one measure by one percent would make a physician ineligible for incentive and subject to financial penalties,” the agency stated.

At about the same time, the American College of Physicians also presented its comments in a letter to Farzad Mostashari, head of the Office of the National Coordinator for Health Information Technology at HHS, from Michael Zaroukian, a physician and chairman of the ACP's Medical Informatics Committee, Modern Healthcare reported.

“As a general rule, [physicians and other EPs] should not be expected to demonstrate use of new functions until those functions have been implemented in systems and successfully tested in real-world settings,” Zaroukian wrote. Instead, EHR functions should be tested and certified through the ONC process “at least two years ahead of CMS incorporating them into 'core' measures for meaningful use,” he said.

Industry experts seem to agree the new measures are a bit cumbersome for various reasons.

"The Stage 3 proposal is a lot about coordination between different provider organizations, whether practices or hospitals," Michelle Holmes, a senior manager with ECG Management Consultants in Seattle, told Information Week. "It's about more extensive use of decision support at the point of care, and more patient engagement. There isn't anything new in those three areas; they've just taken them further."

One of the objectives Holmes took issue with: a new item that would require providers to give 10 percent of patients the ability to submit patient-generated health information to improve performance on high-priority health conditions; to increase patient engagement in care; or both.

The HIT Policy Committee suggests one way healthcare providers could electronically accept such information would be to develop "semi-structured questions" and choose information "that is most relevant for their patients and/or related to high-priority health conditions they elect to focus on,” iHealthBeat reported.

Holmes told Information Week physicians are likely to push back against this requirement because they don't have control over patient behavior. For example, she noted, a geriatrician might have difficulty finding 10 percent of elderly patients willing to fill out a Web-based questionnaire.

Stage 3 is expected to take effect in 2016.