WISCONSIN HOSPITAL ASSOCIATION, INC.

Transcription

1 WISCONSIN HOSPITAL ASSOCIATION, INC. February 24, 2011 Office of the National Coordinator for Health Information Technology Department of Health and Human Services Attention: Joshua Seidman Mary Switzer Building 330 C Street, SW, Suite 1200 Washington, DC Submitted electronically at Re: Health Information Technology Policy Committee Request for Comments Regarding Meaningful Use Stage 2 Dear Mr. Seidman: On behalf of our over 130 member hospitals, health systems and other health care organizations located in Wisconsin, the Wisconsin Hospital Association (WHA) appreciates the opportunity to comment on the Health Information Technology Policy Committee s (HITPC) preliminary set of recommendations for Stage 2 meaningful use (MU) regulations published on January 12, Congress established the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs in the American Recovery and Reinvestment Act (ARRA) to provide much-needed funds to support the transition to an e-enabled health care system. Wisconsin s hospitals are very appreciative of the opportunity presented by this program. They share the Administration s vision of a health care system where widespread use of interoperable EHRs supports improved clinical care, better coordination of care, fully informed and engaged patients, and improved public health. They also work every day to ensure adequate privacy and security for personal health information. However, WHA is concerned that HITPC s initial recommendations are overly aggressive for Stage 2 meaningful use and are counter to Congress s and the President s goal of using HITECH stimulus funds to enable widespread adoption of EHRs. In order to help ensure that the HITECH stimulus funds will enable widespread adoption of EHRs, WHA believes that HITPC should carefully consider the well-thought-out recommendations of the HITPC Adoption Certification Workgroup as HITPC develops its final Stage 2 meaningful use recommendations. As noted on Slide 15 of the Adoption Certification Workgroup s presentation of its Top Ten Recommendations to the HITPC during its February 2, 2011 meeting, those Top Ten Recommendations were: Research Drive, Post Office Box , Madison, WI P ( ) F ( ) wha.org

2 1. Provide adequate time. 2. Keep it simple. Don t let perfect be the enemy of good enough. 3. Keep the implementation cost as low as possible. 4. Design for the little guy. 5. Pick a standard(s) soon. 6. Address workforce issues. 7. Increase focus on usability. 8. Improve choreography between federal agencies impacting HIT. 9. Create a crosswalk between MU and certification requirements. 10. Provide adequate time (purposely listed again). Members of WHA s HIT Task Force, which includes Wisconsin hospital chief executive officers, chief information officers, quality improvement experts, and other experts leading Wisconsin hospitals EHR implementations, have echoed comments similar to the Adoption Certification Workgroup s Top Ten Recommendations in regards to HITPC s initial recommendations for Stage 2 meaningful use. A list of participants on WHA s HIT Task Force is attached as Appendix A to this comment letter. Building from the Adoption Certification Workgroup s recommendations, WHA s HIT Task Force recommends to HITPC that its final recommendations for Stage 2 meaningful use standards incorporate the following principles in order to help ensure that the HITECH stimulus funds will enable widespread adoption of EHRs: Ensure the Stage 2 MU standards are clearly defined and avoid ambiguity; Carefully consider Stage 2 MU standards impact on overall health care costs. HITPC should explicitly identify and take into account the expected capital and operational costs to implement its recommendations; Provide flexibility so that all providers, no matter where they are in their health IT adoption journeys, can take advantage of the opportunity presented by HITECH; Facilitate the flow of much-needed funding for adoption of core EHR functionalities; and thus Encourage the rapid adoption of EHR technologies by all providers that can lead to immediate improvements in patient care quality and coordination. WHA, with consultation from the WHA HIT Task Force, offers the following additional comments on HITPC s initial recommendations for Stage 2 meaningful use. Removing a menu set of MU objectives and returning to an inflexible all or nothing MU standard will impair Congress and the President s intent to use HITECH as a way to significantly enable the widespread adoption of electronic health records. It is unclear from HITPC s proposal whether it intends to retain a menu set of MU objectives. Like Stage 1 MU, WHA believes that Stage 2 MU should continue to include both core and menu objectives. In order to achieve HITECH s goal of encouraging widespread adoption of EHR technologies, the meaningful use rules must provide flexibility so that all providers, no matter where they are in their Research Drive, Post Office Box , Madison, WI P ( ) F ( ) wha.org

3 health IT adoption journeys, can take advantage of the opportunity presented by HITECH. HITECH s goal will not be met if HITPC s meaningful use standards are unachievable for many providers in the timeline set by HITPC. HITPC s Stage 2 MU recommendations must be implementable in the timelines and rules established in the July 2010 MU final rule and/or HITPC should work to adjust those timelines and rules. Without changes, many early participants will lose their FFY 2013 Medicare EHR incentive payment. Pursuant to the July 2010 MU final rule, hospitals that receive a Medicare EHR incentive payment in the first year of the program, Federal Fiscal Year (FFY) 2011, must show continuous achievement of Stage 2 MU beginning on October 1, 2012, or they will lose their third year of payment under that program. CMS in its final rule indicated that it expects to update the Stage 2 criteria by the end of If the Stage 2 final rule is not issued until the end of 2011, those hospitals that must show achievement of Stage 2 MU on October 1, 2012 will have only 9 months to implement the requirements. Given the numerous functionality additions and workflow changes that would be required under HITPC s proposed Stage 2 standards, WHA is very concerned that many early participants will be unable to meet such a short deadline and will not receive the full HITECH incentive payment. Conversely, in order to avoid the risk of losing a HITECH payment, many hospitals may choose to delay their participation in the Medicare EHR incentive program until FFY 2012 or FFY Bottom line, HITPC s proposed Stage 2 standards seem likely to have the effect of reducing the number of incentive payments paid to hospitals and/or delaying hospital participation in the HITECH incentive programs either of these outcomes run counter to HITECH s intent of encouraging rapid, widespread adoption of EHR technology to improve quality and efficiency. It is critical that Stage 2 meaningful use rules be as clear as possible. A number of HITPC s proposed Stage 2 standards and policies are unclear or not defined. Without better clarity, it is difficult or impossible for stakeholders to fully comment on HITPC s proposals. Further, HITPC s final recommendations for Stage 2 MU standards should be as clear and unambiguous as possible in order to reduce providers Stage 2 MU implementation costs. Ambiguity in the final Stage 1 MU rules has made implementation of Stage 1 MU more difficult for many providers and vendors, increasing the time, effort, and likely cost, of providers to implement the Stage 1 standards. Continue to evaluate an alternative way to achieve meaningful use based on clinical quality measures. WHA agrees that it would be advisable to provide an alternative way to achieve meaningful use based on demonstration of high performance on relevant quality measures. For many providers, improved quality may be achieved through more efficient and innovative approaches than a single, one-size-fits-all approach to EHR functionality and use Research Drive, Post Office Box , Madison, WI P ( ) F ( ) wha.org

4 Meaningfully evaluate actual experience under MU Stage 1 prior to further consideration of MU Stage 2. In CMS s discussion of a phased approach to meaningful use in its analysis of the Stage 1 meaningful use final rule, CMS states, One of the greatest benefits of the phased stage approach is the ability to consider the impact and lessons of the prior stage when formulating a new stage. 75 Fed. Reg (2010). WHA is concerned that it appears no assessment of actual experience under MU Stage 1 was undertaken by HITPC prior to the development of its proposed Stage 2 MU recommendations. WHA agrees with the College of Healthcare Information Management Executives that Absent such an assessment, we are greatly concerned that HITPC s proposals for Stage 2 may be unduly ambitious, even unattainable, for many eligible hospitals (EHs) and eligible professionals (EPs). At a minimum, in order to develop evidence-based final recommendations for Stage 2 meaningful use, WHA would propose that HITPC clearly identify actual experience and evidence from MU Stage 1 implementation that would support each of its final Stage 2 MU recommendations. The Policy Committee should work to align its recommendations for Stage 2 meaningful with other rapidly evolving changes to health care policy. Health care policy is currently undergoing rapid change in an effort to improve quality and efficiency. Implementation of meaningful use standards, ICD-10 standards, pay for performance and value based purchasing programs, the Patient Protection and Affordable Care Act and CMS s National Patient Safety Initiative are all being finalized and/or implemented over the next few years. There are significant overlapping goals and related EHR implementation issues that HITPC should consider as it develops its final Stage 2 MU recommendations. Working to align Stage 2 and future MU stages to these related policies and implementations should help avoid unnecessary disruption and cost to the health care system and result in a higher likelihood that programs policy goals are met. Adopting detailed, exacting standards across the full range of EHR functionality and use will likely discourage innovation in functionality and use of EHR technology. Health care providers and EHR vendors need to have the ability to innovate, find cost savings, improve quality, and improve patient satisfaction. However, HITPC runs a risk of slowing innovation in the development of new EHR technologies and ways to use and leverage EHR technology by adopting overly specific and comprehensive standards for EHR functionality and use. For example, providers in Wisconsin are increasingly offering patient portals to their EHR information, and those portals are being tailored to best meet providers and patients needs. If detailed patient portal standards are imposed for Stage 2 MU, it seems likely that many providers and vendors will be increasingly focused on tailoring their portals to the federal standards than the needs of patients and provider in their community. Analogous to concerns about teachers spending too much time being forced to teach to the test, overly comprehensive MU standards would likely result in EHR vendors and providers spending time and resources modifying their existing EHR systems and workflow processes to meet MU standards at the expense of work to innovate and expand their EHR functionality and use. Bottom line, to encourage Research Drive, Post Office Box , Madison, WI P ( ) F ( ) wha.org

5 innovation, HITPC s final Stage 2 recommendations should seek to avoid overly specific mandates on EHR functionality and use. WHA supports the comments on specific Stage 2 MU proposals by HITPC submitted by the experts at the College of Healthcare Information Management Executives (CHIME). CHIME s comments submitted to HITPC provide an outstanding analysis and identification of concerns with specific Stage 2 MU proposals made by HITPC. An excerpt of CHIME s comment letter is attached as Appendix B to this comment letter. Thank you for the opportunity to share our concerns and comments. If you have any questions, please contact Matthew Stanford, Vice President Policy & Regulatory Affairs, Associate Counsel, at (608) or mstanford@wha.org. Sincerely, Stephen F. Brenton President Research Drive, Post Office Box , Madison, WI P ( ) F ( ) wha.org

6 APPENDIX A Wisconsin Hospital Association HIT and State-Level Health Information Exchange Task Force Participants Sandy Anderson, President, St. Clare Hospital and Health Services Will Weider, CIO, Ministry Health Care & Affinity Health System Greg Smith, CIO, Wheaton Franciscan Healthcare Rod Dykehouse, CIO, ProHealth Care Louis Wenzlow, CIO, Rural Wisconsin Health Cooperative Cathy Hansen, Director Health Information Management, St. Croix Regional Medical Center David Lundal, CIO, SSM Health Care of Wisconsin Steve Nockerts, CEO, The Richland Hospital, Richland Center Bob Van Meeteren, President, Reedsburg Area Medical Center Dr. Steve Cardamone MD, CEO Wheaton Medical Group Dr. Jerry Halverson, Medical Director of Adult Services, Rogers Memorial Hospital David Fish, Senior Advisor, Hospital Sisters Health System Joy Tapper, Director, Milwaukee Healthcare Partnership Jackie Gish, Director, Care Management, Aurora Health Care Marie Wiesman, Manager of Quality/Integration, Fort Healthcare Sue Sanford-Ring, Director, Quality and Safety, UW Hospital Kelly Wilson, Vice President, Deputy General Counsel, UW Hospital Catherine Eastham, Senior Vice President, General Counsel, Froedtert & Community Health Michael Heifetz, Vice President, Government Affairs, Dean Health System & SSM Health Care of Wisconsin Paul Westrick, Vice President, Mission Integration & Advocacy, Columbia St. Mary s, Inc Research Drive, Post Office Box , Madison, WI P ( ) F ( ) wha.org

7 APPENDIX B EXCERPT FROM CHIME COMMENT LETTER TO HITPC Finally, since the HITPC s preliminary thinking about Stage 2 was provided in matrix form, we often found it difficult to understand what exactly was being proposed or why. In a number of cases, the brief entry in a cell describing the HITPC s proposal was vague, used terms with several possible meanings, did not make clear whether proposed criteria were intended for EHs or EPs only, or for both EHs and EPs, or did not offer much in the way of rationale or intentions. Below our comments identify these kinds of issues. We recognize, of course, that stakeholders will have another opportunity to comment on proposed Stage 2 MU objectives and criteria, as part of the formal rulemaking process, but we take this opportunity to encourage ONC and CMS to ensure that, when these proposed objectives and criteria are next presented for public comment, every effort has been made to provide specific, detailed explanations regarding each proposed objective and criterion. Absent this level of specificity and detail, stakeholders ability to provide meaningful comments can be severely hampered. Proposed Meaningful Use Objectives and Measures for Stage 2 7

8 8

9 9

10 10

11 11

12 12

13 13

14 14

15 15

16 16