Last week we discussed the Meaningful Use criteria of the federal incentive program for electronic health records (EHRs), created through the Health Information Technology for Economic and Clinical Health Act (HITECH) in the 2009 stimulus package. The standards have proved to be much harder for hospitals and eligible professionals to meet than expected.

A Slow Start

In May, the Centers for Medicare and Medicaid Services (CMS) reported that just four hospitals had attested to Meaningful Use Stage 2 (MU2) of an estimated 750 that had intended to attest by that time; 50 independent professionals had also attested. Those numbers have increased; as of August, 78 hospitals and 1,898 professionals had attested to MU2. However, MU2 enrollment is still far below MU1 numbers of previous years: 59% of the country’s 392,800 eligible providers attested last year, according to government stats.

Why has Stage 2 seen such low attestation rates?

EHR Software Certification and Capabilities

A major unforeseen challenge has come from the government’s approval process for the software itself; EHR software must be certified to meet MU. 1,932 EHR products were certified under the 2011 standard, which was used until this year. By May of this year, only 220 products had been certified under the 2014 standard, according to Medical Economics, providing an enormous barrier to hospitals and professionals using software that has yet to achieve upgraded certification.

In response to this low rate, the government temporarily loosened the requirement to allow continued use of 2011 software through the end of this year in a Final Rule issued on September 4th.

In addition, not all certified software is capable of supporting all of the variations of MU. While the MU2 requirements maintain some of the flexibility of MU1, the requirements that are attainable for a professional may not fully coincide with the capabilities of their system. Changing software, however, often requires too much further investment of time and money.

Outside of Professionals’ Control

The requirements of MU2 are stricter than those of MU1, and several are giving would-be attesters enormous difficulty, especially when compliance requires cooperation from third parties like patients or others in the healthcare industry.

Two of the requirements specify that patients must use the system, one to view records and the other to message their doctors. While not all patients must participate, even getting the required portion to do so can be tough. “People just don’t want to interact that way,” Jennifer Brull, a family physician in Kansas, told Medical Economics. “I don’t understand it. I love the portal. [As of March] when I ran my reports, I am at 38%, and I need 50%.”

Another requirement involving interaction with other healthcare providers is even more troublesome. When transferring patients to another provider, records in at least 10% of cases must be exchanged electronically. As discussed in a blog post from HealthFusion, this assumes that EHR systems from different vendors can communicate securely, which is not always the case. This requirement is not within the provider’s control.

While these are some of the most significant barriers to meeting Meaningful Use 2, they are not the only challenges. Overhauling an age-old system in an enormous, fractured industry is simply difficult. MU1 was easier to meet because it was more flexible, designed to ease into the program. It may be that a painless route to universal EHR adoption was never possible, but the deadlines and penalties intended to drive the process forward seem largely to increase distress.

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