By John Reichard
July 24, 2013 -- The current federal deadlines that providers face for adopting health information technology (IT) are too tight and could stop adoption of the electronic system in its tracks, even leading to safety problems, representatives of hospitals and vendors told the Senate Finance Committee last week.
Without easing deadlines "many providers may opt out of further participation," said John P. Glaser, who heads a unit at Siemens Medical Solutions that sells health IT and medical imaging and laboratory equipment.
Glaser was formerly an aide to David Blumenthal when Blumenthal was the National Coordinator for Health Information Technology. Blumenthal was the architect of the "meaningful use" program that temporarily pays doctors and hospitals higher Medicare and Medicaid rates if they make effective use of health IT—and eventually lowers their payments if they don't.
Committee Chairman Max Baucus, D-Mont., listened attentively to Glaser and other witnesses who urged a slowdown. Baucus noted that rural health clinics "can't get funding for installing the technology," and said "we must correct this error."
But after giving critics a lot of time to air their views, Baucus gave no indication that he favors letting the deadlines slip. Obama administration officials told the committee at a hearing last week that changing the deadlines would be a mistake. The officials said they instead favored giving more help to providers that are lagging behind, particularly those in rural areas.
Glaser testified that the deadlines for the three-stage program could either cause the current adoption rate to "plateau" without showing further growth, or "rush the implementation" among the many doctors and hospitals—particularly smaller practices and facilities in rural areas—that haven't installed electronic medical record systems.
The technology requires an intensive effort by doctors and nurses to redesign the way they work, he noted. Moving too fast will keep that from happening and could cause unsafe care, he said.
The chief executive of a 20-bed hospital in Auburn, Nebraska, echoed that point. "These systems, especially when they are upgraded under severe time constraints, can, and unfortunately do, introduce risk when things go wrong," said Marty Fattig, who runs Nemaha County Hospital.
"We installed a software upgrade some time ago and all of the allergies listed in the patient record disappeared," he said. "We were able to catch this problem before patients were harmed, and restored the allergies to the record, but this is the kind of thing that can happen."
Fattig added that "most rural hospitals have yet to meet the exceedingly complex requirements for Stage 1 of meaningful use. And they worry that time is running out, as the positive incentives quickly turn to penalties."
Meanwhile, Stage 2 requirements that aim to begin the process of "interoperability," the exchange of patient data with other providers, are fast approaching. Stage 2 requires all doctors and hospitals to adopt a "2014 Edition" certified electronic health record in fiscal 2014.
"This means that vendors will need to support over 500,000 physicians and hospitals in a single year," Fattig said. Executives of rural facilities, which are lower on the priority list for vendors, "have significant concerns about whether the vendor community has the ability to support all of those upgrades in such a short period of time," he added.
In a statement submitted for the record, the Federation of American Hospitals suggested that deadlines for Stage 2 implementation should perhaps be tied to the timing of availability of certified 2014 electronic medical records.
In a position that appeared to be supported by other witnesses who favored delay, Glaser of Siemens urged moving the deadline for Stage 2 implementation from Oct. 1, 2014 to Oct. 1, 2015. Those who are ready to go to Stage 2 could do so as currently scheduled, he said. But moving the deadline would give others more time. But they should be given no more than one added year, he said.
Glaser also called for changing the timing of deadlines so that "each stage is separated by three to years." In a joint letter to Health and Human Services, the American Hospital Association and the American Medical Association also urged such a step.
But Janet Marchibroda of the Bipartisan Policy Center told Finance members that current deadlines should stick.
The National Partnership for Women and Families also urged no change in a statement submitted for the record that faulted the committee for not including patients and family caregivers among the witnesses at the hearings. Their perspective "is an essential voice because patients' health and health care at stake," the statement said. Implementation is difficult "yet often the difficulties have less to do with technology and more to do with culture change," the group said.
Baucus said in response to a reporter's question after the hearing that he does not favor stretching out the deadlines. "Not yet," he said. Asked how he would address industry concerns if there is no delay, he said "they just gotta do it." But "clearly everybody raised that question," he added referring to testimony about the need for more time. "So who knows." The committee "has a responsibility to see the degree to which they're right.
"I've got to go back and dig into it with my staff, and say, 'What do you figure; what makes sense here?' But so far, no."
