HHS Pushes Forward With Meaningful Use, Despite Senate Trepidation

On July 17, 2013, the Senate Committee on Finance held a hearing on Health Information Technology:  A Building Block to Quality Health Care, to discuss the progress of the meaningful use of health information technology (HIT).  Chairman Max Baucus (D-Mont.) noted the benefits of HIT, including the ability of physicians to electronically prescribe medication, eliminating handwriting errors.  He noted that nearly 80 percent of hospitals and half of physicians received incentive payments as a result of participation in electronic health record (EHR) incentive programs.  However, he raised concerns about disparities between rural and urban areas and the idea of interoperability, which would allow different computer systems to communicate information to each other.  Senator Orrin Hatch (R-UT) also noted the benefits of meaningful use technology, but suggested a more reasonable timeline might be appropriate to allow providers and vendors to achieve stated goals.  Farzad Mostashari, however, National Coordinator from HHS’ Office of the National Coordinator (ONC) for Health Information Technology, sang the praises of the program and cautioned that slowing the process down “would stall the progress that has been hard fought.”

Meaningful Use

The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 authorized the Medicare and Medicaid programs to grant financial incentives to providers who “meaningfully use” health information technology.  CMS developed meaningful use milestones that must be met in order for providers to continue participating in the program, dividing them into three stages.  All participating providers are currently engaged in Stage 1.  Beginning in 2014, some providers will move to Stage 2.  Providers will enter Stage 3 no earlier than 2016.

Adoption of HIT

Mostashari stated that the ONC has achieved significant progress in achieving the adoption of certified HIT, noting that the adoption of EHRs more than doubled in office practices and more than quadrupled in hospitals between 2008 and 2012.  Furthermore, EHR adoption has improved quality, safety, and efficiency.  According to Mostashari, the use of computerized provider order entry (CPOE) for medication orders, a meaningful use requirement, cut medication errors  nearly in half; its use among physicians increased by 35 percent between 2009 and 2012.  Other Stage 1 meaningful use requirements include drug interaction checks, advanced directives, and active medication lists.

Interoperability

However, the ONC still needs to work on its goal of making systems interoperable.  Mostashari defined interoperability, a Stage 2 requirement, as the ability of two or more systems to both exchange and use information.  In order to meet the Stage 2 interoperability requirement, after a transition in care, providers will need to electronically send a summary of a patient’s record to the next provider or care setting and communicate with patients through secure messaging via, e.g., encrypted email, and make patients’ records available to them electronically.  Such health information exchanges (HIEs) are not frequently achieved.  Fewer than one in four physicians are notified when their patients visit an emergency room, fewer than half receive information needed to manage care within 48 hours of a hospital discharge, and only 16 percent receive information from specialists regarding changes to patient’s medications or care plans.  Mostashari noted that the average cancer patient has 32 providers, emphasizing the crucial nature of the exchange of health information.

Other Advancements

In addition to discussing meaningful use stage requirements, Mostashari discussed HHS’ recent decision to expand the HIPAA Privacy and Security Rule requirements to include contractors of HIPAA-covered health care providers and health plans, as well as additional ONC initiatives to increase security.  He also referred to consumers as “the most underutilized resource in healthcare” and described programs intended to increase patients’ ability to access their own health care data and to empower them by increasing the use of these data using mobile technology.  In fact, Stage 2 will require providers to allow patients to view, export, and share their health data with others.

Senator Baucus was receptive to Mostashari’s testimony, but cautioned him not to “blindside” the committee and to “let us know if there are areas we can help in one way because clearly I don’t know a senator who doesn’t believe health IT is a critical component.”