Atrius Health Exec to CMS: End MU Stages, Instead Gradually Add Criteria

On Tuesday, the Health IT Policy Committee's meaningful use workgroup hosted the first of two virtual listening sessions, inviting hospitals and physicians to share their meaningful use stories and struggles.

Michael Lee, MD, director of clinical informatics at Atrius Health in Newton, Mass., was one of the physician leaders who spoke during the session. His testimony, a condensed version of which appears below, advocates canceling stage 3 of meaningful use and instead adding a small number of features necessary for certification every three to five years that focus on outcomes. This more gradual approach will allow providers to use electronic medical records more meaningfully, he said.

Making Meaningful Use Meaningful
Dr. Michael Lee, Atrius Health

EMRs dramatically advance patient care. At Atrius Health, we fervently support the intent of meaningful use, a CMS program, started in 2011, that provides financial incentives to organizations that use EMRs to improve patient care and penalties for those who don't. We have watched with anticipation as this program has helped move the majority of U.S. physicians to electronic patient records. However, as the program progresses, we encourage Congress and CMS to re-assess the program's sustainability.  The current approach, with large scale changes from one stage to another, is proving to be a significant challenge and may in fact hinder rather than improve the adoption of EMRs.

Atrius Health has extensive experience with electronic patient records — our largest medical group, Harvard Vanguard Medical Associates, has used Epic for over 20 years and pioneered a home-grown electronic record before that. Following suit, our other medical groups fully transitioned to Epic from 2006-2008.

We were the first ambulatory only group to receive HIMSS Stage 7 designation for EMR adoption and over 80 percent of our physicians achieved meaningful use stage 1. Yet as we continue to prepare for stage 2 this year, we face unresolved challenges that may impede ease of use and efficiency. This should serve as a harbinger that many organizations nationally will not meet this hurdle.

So what do we recommend?

First, make stage 2 the final "stage" of meaningful use. Planning stage 3 right now will only hinder progress. Instead, move forward with a long-term plan that CMS will require EHR use and reporting for payment. Establishing a successful and ongoing standard for technology and reporting on outcomes supported by that technology will go a long way toward helping us achieve the triple aim. In addition, current transitions in the payer market will have a much stronger influence on the sensible adoption of technology and inform where we can find value. It is imperative that we remember that technology should be an enabling tool, and it is the use of that technology that spirits change, not changes in the technology itself.

Second, every three to five years, add a small number of features as a minimum base for certification and then measure outcomes — not just process — from clinician groups and hospitals so we can refine reporting and comparative metrics over time. The current steps between stages are too large to absorb and are harder to achieve than anyone imagined at the outset. Stage 1 of meaningful use created a significant set of challenges, such as the consistent review and acknowledgement of specific sections of the patient record or the provision requiring clinical summaries and after-visit printed summaries for patients.  While the intentions of these measures clearly support improved patient care and communication, we found significant difficulty in broad implementation.

Simply raising the bar on technology rather than measuring and demonstrating how it improves patient outcomes may in fact reduce the success of meaningful use. It is our view that it will take five years before we can fully assess the impact of this work. As with all good policy, the meaningful use program will require tweaks and changes as we learn what works and what does not. We encourage Congress and CMS to work together to improve the program to ensure that we are achieving measurable outcomes that improve patient care so that adoption of EMRs truly is meaningful.

Michael A. Lee MD, MBA is the Director of Clinical Informatics at Atrius Health, a not-for-profit alliance of six community-based medical groups and a home health care, private-duty nursing and hospice agency based in Newton, Massachusetts. Dr. Lee testified before the HIT Policy Committee: Meaningful Use Workgroup onMay 20, 2014 about Atrius Health's experience attesting for Stage 1 and 2 of Meaningful Use.

 

More Articles on Meaningful Use:

Stakeholders Welcome New MU Flexibility, But Worry About Timing
CMS: Providers Scheduled for MU2 Can Attest Again to MU1 in 2014
Dr. Karen DeSalvo: MU1 a Success

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