Should Stage 2 of EHR “Meaningful Use” Implementation Be Delayed?

The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, Title XIII of the American Recovery and Reinvestment Act (AARA) (P.L. 111-5), requires the implementation of “meaningful use” of certfied electronic health records (EHRs) to improve efficiency and quality of care.  For hospitals, Stage 2 began on October 1, 2013, the start of fiscal year 2014. For physicians, the start date is January 1, 2014. Failure of hospitals and providers to comply with meaningful use requirements will result in reduced Medicare and Medicaid payments by 2015.

While hospitals and providers surely appreciated HHS’ decision to extend Stage 1 implementation through 2013, the American Medical Association (AMA), the American Academy of Family Physicians (AAFP), and the American Hospital Association (AHA) have called for a delay in the implementation of Stage 2, which requires that EHR platforms be interoperable, i.e., have the ability to communicate with each other and with patients.

 In support of this delay, on September 24, 2013, a group of U.S. Senators wrote HHS Secretary Kathleen Sebelius requesting a one-year extension to medical professionals currently working to meet Stage 2 meaningful use requirements but who are not yet ready to take the next step to Stage 2. The AMA applauded the Senators efforts, stating “we join these Senators in expressing our concern that the overly aggressive deadlines may widen the digital divide for small and rural practices and may have serious unintended consequences including stifling innovation and increasing medical errors.”

In the letter, the Senators identified three key problems with the current Stage 2 timeline:

  • The regulatory structure has created significant time pressure in 2014. By the end of 2014, over 500,000 hospitals and physicians must upgrade their technology to demonstrate new standards of meaningful use in order to be eligible for incentive payments. In addition, EHR vendors must ensure that their products are certified under the 2014 Edition criteria and have time to upgrade their products for each hospital and physician using their product.
  • The aggressive onset of Stage 2 may further widen the digital divide between small and rural providers and large and urban practices who are of top priority to vendors. Even if certified products are available to small and rural providers, they will also need training and time to address how they will use the technology to achieve the Stage 2 standards.
  • The artificially aggressive Stage 2 timeline could stiffle innovation since vendors may not have enough time to introduce administrative flexibility into their EHRs to best serve diverse practices. In addition, vendors rushing through upgrades could cause new risks in the technology that could cause an increase in medical errors or patient safety problems.

The Senators did not suggest a wholesale delay of Stage 2.  Instead they recommended that providers who are ready to move to Stage 2 do so. They suggested, however, that providers who are not ready to transition to Stage 2 receive a one-year extension before they must show Stage 2 meaningful use. The Senators requested a response from the Secretary by October 8, 2013. Secretary Sebelius has not yet responded.

The AHA and the AMA previously wrote to Secretary Sebelius sharing their concerns that the start date for Stage 2 “will not provide enough time or adequate flexibility for a safe and orderly transition unless certain changes are made.” In their letter, they expressed their concern that the “compressed timeline put providers in a position of rushing to implement, creating conditions that prevent them from optimizing use of the systems and possibly introducing risks to patient safety.” In their letter they also told Sebelius that some providers have already reported usability issues with their current EHRs, which may be exacerbated as vendors manage the transition to the 2014 Edition.  They also agreed with the Senators that the current timelines could increase the digital divide between small and rural providers and larger urban providers due to a lack of economic resources available in the small and rural market.

The AHA and AMA recommended the following program changes to the Secretary: (1) allow providers at Stage 1 to meet the requirements using either the 2011 certified Edition EHR, or the 2014 certified Edition EHR; (2) establish a 90-day reporting period for the first year of each new stage of meaningful use for all providers, similar to what was done for Stage 1;  (3) offer greater flexibility to providers in meeting Stage 2 to ameliorate the “all or nothing” approach, and recognize that the level of change in Stage 2 will take time to accomplish; and (4) extend each stage of meaningful use to no fewer than three years for all providers.