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Congress Debates Healthcare
Barnes testifies before the U.S. House on Healthcare innovation and interoperability
On The Issues
July 27th, 2010
U.S. House Energy & Commerce EHR Meaningful Use Testimony
Barnes and EHR Association Testimony on EHR Meaningful Use Final Rule
House Energy and Commerce Committee, Health Subcommittee
“Implementation of the Health Information Technology for Economic and
Clinical Health Act of 2009 (HITECH)”
July 27, 2010
Introduction
Thank you very much, Chairman Pallone, Ranking Member John Shimkus, and distinguished members of the Committee for organizing and attending this hearing. The Electronic Health Records Association applauds Congress for passing HITECH and for recognizing the vital contribution that electronic health records and health IT systems can have to improving the health care delivery system. . The EHR Association is comprised of 45 companies that employ industry experts in the field of HIT with a broad scope of expertise such as medical and clinical informaticists, physicians, nurses, pharmacists, and technology and policy experts. These individuals not only represent the EHR software industry, but also interact with and reflect the breadth of the entire healthcare community. The EHR Association offers unmatched experience and expertise, and provides a forum and structure for EHR leaders to work toward standards development, interoperability, EHR certification, performance and quality measures, HIT legislation and regulation, and other EHR and HIT issues. The Association is a partner in HIMSS and operates as an independent organizational unit within HIMSS for companies who are EHR software solution providers.
General Comments
We congratulate the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Healthcare IT (ONC) on their outstanding work in carrying out the regulatory requirements of the HITECH Act (Health Information Technology for Economic and Clinical Health Act) of ARRA (American Recovery and Reinvestment Act of 2009. We also want to emphasize that EHRA members understand our responsibility to ensure that the taxpayer funds allocated to the program are used prudently and effectively. We are committed to getting this right, working with our clients to identify opportunities to achieve the desired improvements in healthcare quality and efficiency.
We are also pleased that, from our interpretation of the regulation, CMS took very seriously the more than 2000 comments that were offered to strengthen the EHR incentive program and provide strong incentives for hospitals and individual healthcare professionals to adopt certified EHR technology, qualify as meaningful users, and participate in Stage 1 of the EHR incentive program. Overall, we feel, as do many of our clients that, although ambitious in some regards, the final rule represents achievable goals and will definitely advance the nation on our road to improved efficiencies and outcomes though healthcare automation.
In our comments on the CMS Notice of Proposed Rulemaking (NPRM) on meaningful use, our highest priority request was to make the guidelines achievable in the first year while still moving the industry rapidly forward to achieve the goals that Congress established. We focused on three main areas: the complexity and “all or nothing” nature of the proposal; the fact that many of the qualifying levels, we believed, were too high given the complex realities of HIT adoption and measurement; and the large number of proposed quality measures, many of which did not have specifications for use with EHRs. In the final rule, we were, therefore, pleased to see that CMS was substantially responsive on each of these issues. For example, many thresholds were reduced, CMS added substantial flexibility in selection of criteria to achieve meaningful use while maintaining a solid core of criteria, and the number of quality measures was streamlined with all final measures having EHR specifications.
Having said this, the objective to become meaningful users of certified EHR technology remains very challenging for some providers. Members of our Association have been and will continue to work with our existing and new clients in the coming months to support their efforts to become meaningful users. We will address what our community is doing as far as education, outreach, and training a little later on.
Regarding the indicators, while some measures (e.g., e-prescribing) have been brought down to manageable levels (40%), other categories such as medication management and problem lists still remain at high thresholds (80%). Although we remain concerned about such high levels, and recognize that elements of the new program will be challenging for many providers given the many criteria to be met and such specific aspects as quality measurements and reporting, we do concur with the comment made by Dr. David Blumenthal that, while the program is ambitious, it is achievable.
Some in the healthcare community have publicly worried whether the vendor community is ready to meet the challenge of supporting clients in their quest to achieve meaningful use?” The EHR Association responds with an unqualified, but careful, “YES”. Ever since the HITECH legislation was signed in February 2009, we have been educating ourselves and our clients on the HITECH program. We have participated in every available forum to learn, offer comments and suggestions, and react to the development of the regulations – as they were initially released by the HIT Policy Committee, by CMS in a formal proposed rule, and now to the final regulations.
We take our role in this process very seriously. We appreciate the taxpayer investment in this program and we commit our full effort to making sure this money is invested wisely in our healthcare system. Early adopters of EHR technology have invested their own financial and people resources to improve patient safety. They implemented EHR technology to reduce dangerous medication errors in hospitals and to support quality improvement programs in primary care, including automated reminders for childhood immunizations and cancer screening. With the stimulus funding, these important safety and quality improvements can be extended to the majority of our nation’s health care providers.
As leaders in the health IT sector, we realize that we have a very important responsibility to provide high quality, effective, and usable software for the healthcare providers. Furthermore, we must educate our clients not only on how to make the best use of their EHR system, but also how to navigate the path to meaningful use. Our clients rely on us for information on next steps as their “go-to” resource for answers regarding the requirements for their systems. To help our clients prepare, many vendors have been providing educational webcasts and user group presentations over the past eighteen (18) months since the legislation was passed. In addition, thousands of implementation planning sessions have been held with individual provider organizations to align the meaningful use requirements with their strategic objectives and to develop operational roadmaps that include new functionality. Many vendors have also provided their clients with information through “help desks” as well as “ask the experts” panels on their web sites.
While we are confident that we have made the right investments in people to produce high quality products, and have developed effective communications with our clients, we know there is much more work to be done and we do not minimize the need for additional resources to address clients’ needs. We, therefore, strive to create partnerships among the provider community, the federal and state governments, and the health IT supplier community represented by our Association.
We appreciate CMS’ and ONC’s outreach to our community for feedback, and we look forward to additional partnership opportunities to ensure that a consistent explanation on all aspects of the
regulations is communicated to all healthcare providers, communicating a common and authoritative message on what is expected of them.
While we applaud CMS and ONC for creating certainty through the release of the final rules, the vendor community does face several practical challenges: the short time between final regulations and when providers are expected to be able to start meaningful use; the lack of a definitive roadmap for future meaningful use criteria (Stages 2 and 3); the associated certification criteria and standards for these stages, and the fact that the final rule does not – in our respectful opinion – fully leverage work that has already been done in the area of standards and interoperability.
Our customers have, candidly, expressed some skepticism in the market. Many of our clients continue to question whether the stimulus money is “real” and whether they can realistically achieve meaningful use. The release of the final regulations and the directness of the comments made at the HHS press conference last week will help to dispel some of this doubt, as will actual incentive payments early next year. However, we believe that only a concerted educational effort, and commitment of resources from all parties involved, will allay the remaining uncertainty as to the sustainability of this program as we move into implementation of the Patient Protection and Affordable Care Act.
Recommendation for Future Action
Below are several recommendations from lessons learned that we hope will be considered in the future by CMS and ONC; we welcome your support for these requests:
1. Provide HIT vendors and medical providers more time to react to the final Stage 2 regulations. The vendor community and our customers are all under tight schedules to meet Stage 1 deadlines for EHR adoption. Based on the initial schedule that we have seen for the release of Stage 2 regulations, we will be in an even more challenging situation for Stage 2. Our position, and the position of our provider customers, based on careful balancing of multiple factors, is that the final rules for meaningful use and certification criteria should be available eighteen (18) months before the next stage of meaningful use commences to ensure optimal software development, testing, and safe implementation by providers.
2. Depending on the degree of change between stages, the certification rules and process require all hospitals and medical practices to take a significant system upgrade every two years, regardless of whether they are moving to a new stage of meaningful use. When coupled with new requirements for electronic transaction standards and ICD-10 codes, and the need to respond to healthcare reform provisions, plus the normal upgrade requirements, such a schedule will be a challenge. As CMS and ONC prepare for Stage 2, we ask that they consider adjusting certification policies to address these concerns.
3. We encourage the new “temporary” certification process to move along as quickly as possible. The sooner a variety of EHR products receive ARRA certification, the more time we will all have to help hospitals and eligible professionals achieve Stage 1 meaningful use. This tangible progress will further reassure the market of the government’s commitment to the EHR incentive program.
4. The work on interoperability standards originally set in motion by ONC and carried on by many stakeholders (including physician associations, standards organizations, non-profit standards development organizations, federal agencies, and EHR software developers) has over the last five years resulted in a very well defined set of standards and implementation guides. While we appreciate that some of these are included in the final Stage 1 rule, there are still many others that are not yet included. We continue to encourage regulators to consider this work and specify vetted, proven standards in Stage 2 and beyond.
5. We strongly encourage the committee to review the multi-campus hospital situation and clarify intentions with CMS to support all of our nation’s hospitals in this important transition. A concern that we are hearing from our clients is that, similar to each physician practice needing assistance in making the transition to automation, each hospital – whether a stand-alone facility or one site that is part of a multi-facility organization – will also require software licenses, implementation services, and activation and ongoing support.
Concluding Comments
In conclusion, we reiterate that, yes, the vendor community is ready to support our clients – hospitals, physicians, and other healthcare professionals -in achieving meaningful use, building on solid progress in EHR adoption over the past few years. We look forward to continued collaboration with the Energy and Commerce Committee and stakeholders throughout the community to ensure the effective adoption of health IT to transform the way we deliver healthcare in America. We hope that our comments here today, on behalf of the Association, provide helpful feedback and will aid in the development of next steps for effective health IT adoption.
Sincerely,
HIMSS EHR Association Executive Committee
Carl Dvorak
Charles Jarvis
Justin Barnes
Rick W. Reeves
Jacob Reider, MD
Pamela Chapman
Michele McGlynn
Mark Segal
About HIMSS EHR Association
HIMSS EHR Association is a trade association of Electronic Health Record (EHR) companies that join together to lead the health information technology industry in the accelerated adoption of EHRs in hospital and ambulatory care settings in the US. Representing a substantial portion of the installed EHR systems in the US, the association provides a forum for the EHR community to speak with a unified voice relative to standards development, the EHR certification process, interoperability, performance and quality measures, and other EHR issues as they become subject to increasing government, insurance and provider driven initiatives and requests. Membership is open to HIMSS corporate members with legally formed companies designing, developing and marketing their own commercially available EHRs with installations in the US. The association, comprised of more than 40 member companies, is a partner of the Healthcare Information and Management Systems Society (HIMSS) and operates as an organizational unit within HIMSS. For more information, visit http://www.himssehra.org.
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