By Diana Manos
The fate of the federal government’s method of incentivizing healthcare professionals to “meaningfully use” electronic health records (EHRs) is now in question.
After five years, the expenditure of more than $32 billion in bonuses for meaningful use achievers and a drastic boost in EHR adoption, it appears that the federal government is altering its course.
A good indication as to the direness of the situation is reflected in the thoughts of one of the most noted leaders in the health IT field.
Harvard Medical School professor John Halamka, MD, CIO of Beth Israel Deaconess Medical Center, and co-chair of the federal HIT Standards Committee, has been intimately involved in developing the standards needed for meaningful use and health information exchange for more than ten years. On Jan. 14, Halamka, on behalf of Beth Israel Deaconess, along with 30 other organizations, wrote the federal government calling for a removal of the meaningful use program. In essence, a unified “uncle” voice was lifted.
Now, all eyes are on Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the legislation passed by Congress last March. A significant piece of healthcare reimbursement legislation, federal regulators will revamp not only the MU incentive program but how Medicare physicians will be reimbursed.
In his Jan. 20 blog, Halamka writes, “MACRA provides a path for eligible professionals to move from the highly prescriptive check boxing of Meaningful Use to alternative payment models based on outcomes.” He also cautioned that providing a path for hospitals would require new legislation beyond MACRA, because MACRA doesn’t cover what is needed for hospitals.
Providers struggled with meaningful use. The requirements between stages are each increasingly more difficult. Meaningful use stage 2 requires many elements that providers have no control over—especially with regard to patient engagement. For example, how can providers ensure that patients access their EHRs, if patients don’t choose to do so? The intentions of the meaningful use program are good, but the achievability has sometimes been elusive.
And likewise with interoperability—the kingpin of meaningful use. Digital healthcare data is only as good as its capacity to be shared. No one could have predicted how incredibly hard this achievement would be. Even though progress has been shown each year at various interoperability showcases, and the Nationwide Health Information Network (NHIN) has intently worked on its goals to achieve data exchange, all of this has only tantalized the industry. Interoperability is still out of grasp.
Now, in this jaded environment of the meaningful use program’s demise, rises a brand new hope from the ashes: APIs. Also known as application programming interfaces, APIs are a set of routines, protocols, and tools for building software and applications. In essence, it’s how apps talk to each other.
Recent comments from CMS Acting Administrator Andy Slavitt indicate that the government plans on being resoundingly intolerant in the future of the lack of interoperability. It also plans to promote APIs, which together with the use of apps and the cloud, might just get meaningful use to the kind of data exchange capabilities it requires.
“The stakes are high for this program,” Slavitt says of meaningful use, or its derivative under MACRA. “As any physician will tell you, physician burden and frustration levels are real.”
Slavitt said over the next several months, CMS will be rolling out details on the future of meaningful use.
Despite the uncertainty of how MACRA will take the place of the meaningful use program, one thing is certain. The fate of meaningful use is tied up in interoperability. Without the ability to exchange data, providers might as well be back in the age of the paper record.
Diana Manos is a healthcare policy journalist with more than two decades of experience in the trenches covering federal government agencies and Congress on healthcare and health IT issues. She can be reached at dnewsprovider@gmail.com.
