Dr. John Halamka: 7 thoughts on how to fix MU

CMS released final rules for stage 3 of meaningful use in October amid criticism and concerns regarding the program. John Halamka, MD, CIO of Beth Israel Deaconess Medical Center in Boston, has been a vocal critic of meaningful use, saying on various platforms the rules are burdensome and restrictive. Now, Dr. Halamka has outlined on his blog "Life of a Healthcare CIO" what he believes to be next steps regarding meaningful use and how to best move forward.

Here are seven of Dr. Halamka's thoughts on the future of meaningful use.

1. Meaningful use has served its purpose, and the program should end. Dr. Halamka writes stage 1 created a foundation for everybody, which was good. Stage 2 came along and pushed providers too quickly to do too much, and stage 3 repeats many of stage 2's mistakes. "Clinicians cannot get through a 12 minute visit, enter the necessary stage 3 data elements, reconcile problems/allergies/medications from multiple institutions, meet the demands of the stage 3 clinical quality measures, make eye contact with patients and deliver safe medical care," he writes. "There needs to be a new approach."

Similarly, certification of IT products is outdated and doesn't support maturity in the market, he writes. Again, the early stage certification was useful in setting a baseline for EHR capability, but as systems progress and advance, certification will stifle innovation and growth. "Certification is NOT [sic] good for the next stage of maturity, which will be driven by heterogeneous use cases and dynamic technology evolution," Dr. Halamka writes.

2. Information blocking does not exist. "There may be incompetence that feels like blocking, but I've never encountered a competent organization with a business need blocking the secure exchange of information," Dr. Halamka writes. Any blocks to information sharing, he says, are due to a lack of enabling infrastructure, data governance, uniform policies, standards and economic incentives.

3. Not every problem can or should be solved through regulation. The complexities and requirements of government regulations aren't just confusing for providers, Dr. Halamka writes, the government itself can get lost in the details.

4. Instead of meaningful use, the government should use alternative payment models and merit-based incentive payments as part of the Medicare Access & CHIP Reauthorization Act of 2015. "If alternative payment models offer compelling reimbursement for health and wellness, then clinicians and hospitals will adopt products and change behavior to achieve that goal," Dr. Halamka writes.

5. Similarly, instead of certification, the industry should have access to "enabling infrastructure." This means a service, a national provider directory that provides test beds for developers to test out their offerings. Certification, Dr. Halamka believes, is not the key to achieving interoperability.

6. Change the ONC's focus to policy-based. Dr. Halamka writes the scope of ONC has become too large and has strayed too far from its purpose. "ONC has become distracted by grant making, political agendas and expansive certification ambition. It's time to narrow the scope and enhance the effectiveness of this important agency."

7. Focus on what matters. The ONC's interoperability roadmap tries to do too much, according to Dr. Halamka. He points out it has 117 goals, but honing in on just a handful of goals could help the roadmap be much more effective.

"I'm really trying to be helpful here and incorporate overwhelming feedback I've heard from stakeholders," Dr. Halamka concludes. "More meaningful use and certification criteria are not the answer. Paying for outcomes that encourage government, payers, providers, patients and health IT developers to work together, instead of being adversaries, is the path forward."

More articles on meaningful use:

Small, rural hospitals still lagging significantly on EHR adoption
Webinar: Meaningful Use Regulations for Stage 3 Released - Updated for Stage 1 and 2
AMA to Congress: EHR Meaningful use is doomed without intervention

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