Atrius Health Reacts to Meaningful Use Final Rule

Meaningful Use, a program launched by the Centers for Medicare & Medicaid Services (CMS) in 2011, was first created as part of the Electronic Health Record Incentive Program, to provide financial incentives to encourage physician and hospitals to use electronic health records (EHR) to improve patient care. Meaningful Use is made up of three stages of performance for use of electronic health records: Stage 1 focuses on data capturing and sharing; Stage 2 focuses on advanced clinical processes; and Stage 3 centers on improving outcomes. Each stage has progressively more complex objectives and quality measures, and the bar is raised higher and higher as providers and healthcare organizations move from one stage to the next. Financial incentives are linked to demonstrating ability to achieve the different stages.

In late August, the Centers for Medicare & Medicaid Services (CMS) finalized a rule for Meaningful Use granting hospitals and health care providers more flexibility in how they meet requirements. We applaud CMS for understanding the complexity around health information exchange and for recognizing that not all in the medical community are at the same level. This ruling will likely have a positive effect for providers who have struggled to meet the strict EHR deadlines set by CMS.

There are a few specific changes CMS addressed in the Final Rule that we’re particularly glad to see:

• Many providers have expressed concern over attesting to Stage 2 because of a measure requiring providers to transmit an electronic summary of care document for more than 10 percent of transitions or referrals. Providers expressed concern that the sending provider may experience difficulty meeting the 10 percent requirement, despite their ability to send the electronic document because not all recipients have the ability to receive the document. CMS recognized that this hurdle may inhibit referring providers from being able to meet the summary of care measure in 2014, so they allowed for a limited exception for providers who could not meet the threshold because of this obstacle.

• Eligible providers attest for Meaningful Use individually, so if a clinician practices in multiple places, it can be difficult because they have to merge data from a number of different sources. The Final Rule added clarification to help people in this circumstance understand how to attest.

• To meet 2014 EHR certification, EHRs had to meet certain criteria meant to enhance care coordination, patient and family engagement, interoperability, and security and safety. EHR vendors indicated that they weren’t given enough time to make the required coding changes, while providers did not have enough time to make the necessary patient safety, staff training, system testing and workflow revisions to be prepared to demonstrate meaningful use in 2014. The final rule allows eligible providers to use 2011-certified EHRs or a combination of 2011 and 2014-certified EHR technology for a reporting period this year.

• The rule also extends Stage 2 through 2016. Stage 3 will begin in 2017 for those who first joined the program in 2011 or 2012. CMS noted that this change was made to allow CMS to use data and information from Stage 2 to inform policy decisions for Stage 3.

Here at Atrius Health, we’ve been working to improve patient care through the use of EHRs for years. Harvard Vanguard Medical Associates, our largest medical group, has used an EHR from Epic for more than 20 years, and the remaining Atrius Health groups fully transitioned to the Epic system by 2008. More than 80 percent of our physicians have demonstrated Meaningful Use Stage 1 and will move into Stage 2. We’re glad to see other doctors and medical groups being incentivized to adopt similar technologies to improve care.

What the future holds for Meaningful Use remains unclear. Enthusiasm for the program has certainly started to wane throughout the medical community. The deadlines are difficult to meet; the requirements are cumbersome. While we strongly support the intent of Meaningful Use, there are certainly changes that could make the program even stronger. Simply raising the bar on technology rather than measuring and demonstrating how it improves patient outcomes may actually reduce the success of Meaningful Use.

We will continue to work with the Congress and CMS to voice our concerns and recommend changes to ensure the program’s sustainability. As with all good policy, the Meaningful Use program will require changes as we learn what works and what does not. We encourage the federal government to continue to improve the program so that medical providers are utilizing electronic medical records in a way that truly improves patient care.

About Dr. Michael Lee

Michael A. Lee MD, MBA is the Director of Clinical Informatics at Atrius Health and a pediatrician at Dedham Medical Associates, an affiliate of Atrius Health, where he has practiced since 1991. He was President of the Board of Directors of Dedham Medical Associates from 1996-2000. He was Chairman of the Board of Atrius Health at its inception from 2004-2006. Atrius Health is a national leader in clinical quality and electronic patient record use, and cares for about 1,000,000 ambulatory patients. Dr. Lee led the installation of the electronic record at Dedham Medical Associates and since 2007 has been the clinical leader of the platform for Atrius Health. He also directs a vibrantly growing patient portal with over 250,000 active members. He serves on the Advisory Council of the Massachusetts Health Information Exchange. Dr. Lee received his medical degree from McGill University and completed his internship and residency in pediatrics at Tufts Medical Center. He has a BA-Engineering Sciences from Yale and an MBA from the University of Massachusetts.

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