Meaningful use challenges
None of this answers the burning question of what physicians will be expected to do under the successor to the Meaningful Use program. But doctors do have some very clear ideas about what’s wrong with Meaningful Use, what they don’t want to do and what they can’t do.
For example, Filer notes, “One of our objections along the way has been that physicians are being penalized for something entirely out of their control.” In this category are the stage 2 and 3 requirements that a certain percentage of patients view, download, or transmit their health records electronically.
Edward Gold, MD, an internist in Emerson, New Jersey, notes that his 68-doctor group recently attested to stage 2, but wouldn’t have been able to do so if CMS hadn’t lowered the threshold for this objective from 5% of patients to a single patient. While some physicians were able to meet the original requirement, not all were.
“It wasn’t just signing up with the [patient] portal and going to the portal,” Gold points out. “The patients had to access the portal, they had to get their results, and they had to send a note back to us” to meet the view-download-transmit and other criteria for patient engagement.
If stage 3 were to go forward as planned, it would raise the threshold for view-download-transmit to 10% and for secure messaging to 25% of patients seen.
Another problem has been the lack of interoperability between EHRs, which has made it difficult for physicians to exchange care summaries at transitions of care, one of the requirements for attesting to stage 2 of Meaningful Use. Gold’s group has had trouble with this requirement, he says, partly because there are no functioning health information exchanges in its area. Direct secure messaging is also problematic, he explains, because not many other practices use the health information service provider (HISP) that his group does, and the local HISP cannot communicate with each other.