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Hospitals Struggle to Meet CMS Goals for Electronic Health Records

By Kerry Young, CQ HealthBeat Associate Editor

August 7, 2014 -- Only about 5.8 percent of hospitals last year met all the requirements of a "stage 2" federal standard intended to more fully realize the potential of electronic health records, a troubling sign even amid the rising use of the technology, a new study found.

Medicare and Medicaid offer higher payments to providers if they make "meaningful use" of health IT, a definition that becomes increasingly difficult to meet over the three stages of a rulemaking program being put in place over a period of years.

Separately, data gathered by federal researchers and hospitals showed that most office-based doctors and most hospitals now have some form of electronic health record system.

The paper on stage 2 compliance, released last week by the journal Health Affairs, was prepared by authors who work or worked at key federal agencies including the Office of the National Coordinator for Health Information Technology (ONC). Still, a majority of hospitals met many of the requirements for stage 2 objectives for electronic health records (EHR), even if they couldn't reach the full standard, the authors said.

"For example, at least 90 percent of hospitals were able to use their EHR to record vital signs, smoking status, and patient demographic characteristics," they said. Those facilities also were able to "incorporate clinical lab test results as structured data; generate patient lists by specific conditions; provide patient-specific educational resources; and track medications using electronic medication administration records," the authors wrote.

The American Hospital Association (AHA) cited the study as proof of the need for some changes to the rules regarding Medicare payments and electronic health records. Hospitals that do not meet certain stage two requirements by Oct. 1 could face payment penalties under current rules, and also miss out on incentives meant to spur wider adoption of electronic health records.

There already has been notable progress in the field, said Linda E. Fishman, a senior vice president with the AHA. The share of hospitals using electronic health records has grown fourfold since 2010, to almost 60 percent, Fishman noted in a statement.

"Despite this remarkable increase, the article also suggests the federal 'meaningful use' program designed to support certified EHR adoption could go off the rails because the pace is too fast and the bar is too high," she said.

In Stage 2, hospitals face a demand to meet each of 16 core objectives and three of six menu-set objectives. They also need to report on 16 clinical quality measures. Gearing up to meet these demands has proven taxing.

The AHA has asked the Centers for Medicare and Medicaid Services (CMS) and the ONC to allow some flexibility with the payment rules regarding EHR to address these difficulties. But other organizations, such as consumer advocates and employers, have faulted CMS officials for moving too slowly on stage two.

In the paper that appeared in Health Affairs, the authors noted that some technical assistance may be needed, particularly for rural hospitals.

"The struggle of many hospitals to meet stage 2 meaningful use criteria suggests that the path forward remains challenging, and a particular focus on building data exchange infrastructure may be needed to support the nation's health and care improvement goals," the authors said.

An HHS press release on adoption levels said 78 percent of office-based doctors in 2013 reported they had installed some type of electronic health record system. About six in ten hospitals had electronic health records with certain advanced features, twice the adoption rate in 2009. The data, also reported in Health Affairs, showed the electronic exchange of medical data among doctors was relatively low in 2013 at 39 percent. Only 14 percent shared electronically medical data with ambulatory care providers or hospitals outside their organizations.

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