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Some of the Thinking Behind Meaningful Use Stage 2 – Meaningful Use Monday

Posted on August 29, 2011 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

A great deal of work, discussion, and debate by the HIT Policy Committee and its Workgroup members went into developing the recommendations for meaningful use Stage 2 (discussed in the last two Meaningful Use Monday posts). Meetings were frequent and lengthy, but I tried to listen in on most of them to gain some insights into the thinking behind the decisions being made and the future direction of meaningful use. 

Committee members struggled with striking the right balance between aggressively pressuring providers so that adoption would be accelerated, on the one hand, and maintaining a realistic and practical view of their capabilities, on the other. Some committee members were adamant about staying on track to reach the Stage 3 end goals within the predetermined 2015 time frame, (i.e. remaining on the escalator, as the progression is often referred to), while others recognized that overburdening providers could lead to program failure, i.e., discouraging adoption by imposing unreasonable expectations that would cause providers to doubt their ability to earn the incentives and abandon the effort altogether. The debate led to an open question: does everything have to be accomplished under the umbrella of meaningful use?

 An issue that I think could have used more discussion is how to make meaningful use relevant for specialists—a subject raised frequently by Committee member Gayle Harrell. There was general agreement about the importance of having all types of physicians participate in the incentive program, and testimony from a variety of specialists was solicited. Other than suggesting a large number of new clinical quality measures, however, the basic recommendations are still predominantly primary-care focused. 

Lastly, there was a prevailing sense of frustration over the fact that the calendar did not allow time for an analysis of the experience of Stage 1 before requiring the definition of Stage 2.

Question and Answer with Lynn Scheps, Government Affairs VP for SRSsoft EMR

Posted on November 12, 2009 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I as many of you have been trying to closely follow what’s been happening in Washington in regards to the HITECH act. There are a lot of moving parts and it’s hard to keep up. One of the most recent topics the committees have begun discussing is how the ARRA EHR stimulus money and “meaningful use” will apply to specialists.

Lynn Scheps, Government Affairs VP for SRSsoft, has been attending the meetings and so I shot her a few questions about specialists and the EMR stimulus money.  The following are her answers:

Are ONC/Committees focusing too much on primary care and not enough on specialists?

It is clear that ONC intended to focus on primary care from the outset. Just look at the appointed membership on the HIT Policy and HIT Standards Committees. Of all of the physicians, only two are specialists—one a gastroenterologist and one a pathologist. And perhaps primary care is where the focus should be, since ideally that is where the management of care and coordination among treating physicians should take place. Twelve of the thirteen major medical problems that contribute overwhelmingly to the national cost of healthcare are treated by primary care physicians. These conditions are addressed in the currently proposed “meaningful use” matrix.

At the October HIT Policy Committee meeting, David Blumenthal stated that it was never intended that specialists would report on all of the measures in the matrix. However, it was not until very recently—in fact after SRS submitted the Voice of the Physician Petition in August—that specialists were even a part of the conversation. If you read the minutes from prior meetings, you will find not even a mention of specialists, except by members of the public during open comment periods.

If specialists are also expected to participate in a meaningful way, and will be subject to the penalties for non-participation in 2015, then the committees need to focus intently on making the requirements relevant—and meaningful—for them as well.

Do you see ONC moving in a direction to deal with specialists and “meaningful use”?

The HIT Policy Committee began to deal with specialists at its October 27th meeting. The issues raised by the invited panel members were complex—how to create relevant quality measures for 60 specialties and subspecialties, blurring of roles among specialists and primary care physicians, and how to encourage EHR adoption among physicians who, as a group, have adopted EHR technology to an even lesser extent than have their primary care colleagues.

What plan would you suggest for addressing specialists within “meaningful use”?

Widespread adoption by physicians—specialists in particular—will occur only if the “meaningful use” requirements are meaningful to the physicians and do not create onerous demands that negatively impact their productivity. As Albert Strunk, MD, (the representative of the American College of Obstetricians and Gynecologists on the specialists panel), testified, additional reporting requirements that do not benefit the physician will inhibit, not encourage, adoption. I agree with David Rath’s contention (presented in Healthcare Informatics) that micromanaging the myriad of measures that could be created for specialists is not the answer.

“Meaningful use” for specialists should focus on the following: closing the referral loop by communicating meaningful information to primary care physicians, ePrescribing to eliminate duplicate costs and increase patient safety, and making lab and diagnostic imaging results available to eliminate test duplication and accelerate the provision of care.

What are the best ways for people to share their opinions with Washington from what you’ve seen?

Currently, (through mid-November), there is a golden opportunity for providers to share their opinions and concerns with the decision-makers by posting comments on the government’s FACA blog. The HIT standards committee has asked for documentation of real-life EHR stories—both implementation successes and failures—and comments on the EHR standards being established.

There are also public comment periods at the end of every committee meeting, and people can access these opportunities by telephone, as well as in person. The schedule of these meetings can be found on the SRS website in the Government Affairs section. Once the CMS Notice of Proposed Rulemaking is issued at the end of December, there will also be a 60-day public comment period specifically on “meaningful use,” but it seems unlikely that significant changes would be made so far into the process.

– Lynn Scheps, Vice President, Government Affairs