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Health IT official coordinator says bad habits hard to break

Some critics of the Meaningful Use incentive program to get hospitals and doctors to adopt electronic health records (EHRs) have complained that the federal government has set the bar too low to qualify for bonus payments and spent too much money — $14.6 billion through the end of April — for minimal progress toward a safer, more efficient health system. Others, particularly healthcare providers, want to mature into the tougher standards.

Judy Murphy
The latter group seems more likely to get its way, based on comments made by Judy Murphy, deputy national coordinator for programs and policy in the federal Office of the National Coordinator for Health Information Technology (ONC), at the WTN Media Digital Health Conference.

Murphy reiterated comments her boss, national health IT coordinator Dr. Farzad Mostashari, and Centers for Medicare and Medicare Services (CMS) Administrator Marilyn Tavenner made in March that there would be not much work done this year on Stage 3 of Meaningful Use. "The focus this year is on helping people understand the Stage 2 criteria," Murphy said.

Stage 2 begins no earlier than October — the beginning of the federal fiscal year — for hospitals and January 2014 for individual physicians and other "eligible providers," though the actual timing depends on when each provider first qualifies for Stage 1.

Stage 3 currently is scheduled to start two years after a provider reaches Stage 2, meaning fiscal year 2016 at the earliest. But Murphy noted that it takes a good year to develop a major set of regulations like the Meaningful Use rules, plus more time for EHR vendors to update their products to new certification standards and then for customers to install upgrades and actually meet the Meaningful Use criteria, which will be more stringent than in the two previous stages.
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Murphy noted that more than half of the estimated 521,000 eligible providers nationwide have been paid either for meeting Stage 1 Meaningful Use standards through Medicare or qualified through the less-stringent "adopt, implement or upgrade" Medicaid requirements.

But Mostashari said recently that the nation's doctors are perhaps only 5 percent the way through the workflow transformation necessary to accomplish the "Triple Aim" of increasing patient satisfaction, improving population health and lowering costs.

Murphy said Mostashari made that number up, "but he's probably not far off," she added. "Getting [the EHR] in is kind of the easy part."

A big reason why health IT hasn't realized its promise yet is culture, according to Murphy. "We haven't changed the people. We haven't changed the processes," Murphy said. The public also has been too accepting of the status quo, which means a lot of bad habits. "They're ingrained, they've been around for a long time and quite frankly, they're very difficult to change."

She did note that health information exchange has begun on a fairly small scale, such as with the electronic sharing of demographic and insurance information between healthcare entities. Clinical data exchange seems mostly confined within the walls of large organizations, Murphy noted. But interoperability soon will become an "imperative" because patients eventually will need care somewhere else eventually, in a long-term care facility or through a home health agency.

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