EHR: Status Update

By Michael Paquin, FHIMSS

Meaningful Use? Interoperability? Here are some things to know

Editor’s note: In January, Acting Centers for Medicare & Medicaid Services Administrator Andy Slavitt dropped a bomb when he tweeted that Meaningful Use – the criteria that physician practices must meet in order to be reimbursed for installing electronic medical records systems – will be “effectively over and replaced with something new.”

At the same time, the Senate Health, Education, Labor and Pensions (HELP) Committee was deliberating over a bill that would hold EHR vendors responsible for providing systems that are truly interoperable, that is, that would allow for the free flow of a patient’s medical information from one healthcare setting to another.

JHC asked EHR consultant and expert Michael Paquin to spell out the bottom line of these developments.

Meaningful Use: Is it really dead?

JHC-May16-iStock_000015427753_LargeTurns out that Meaningful Use isn’t dead after all. Several weeks after Acting CMS Administrator Andy Slavitt dropped the Meaningful Use bomb, he and National Coordinator for Health Information Technology Karen DeSalvo, M.D., posted a blog to CMS’ website titled “EHR Incentive Programs: Where We Go Next” to clarify the earlier post.

In the blog post, Slavitt and DeSalvo clarified that the Meaningful Use (MU) program is not ending. Rather, as a result of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, the financial penalties tied to performance in the MU program are being rolled into the new Merit-Based Incentive Payment System (MIPS). Meaningful Use will be one of four factors that will contribute to a performance score for providers, which will then be used to adjust payments to providers.

The blog specifically stated: “The current law requires that we continue to measure the meaningful use of ONC Certified Health Information Technology under the existing set of standards. While MACRA provides an opportunity to adjust payment incentives associated with EHR incentives in concert with the principles we outlined here, it does not eliminate it, nor will it instantly eliminate all the tensions of the current system….I encourage you to look for the MACRA regulations this year; in the meantime, our existing regulations – including Meaningful Use Stage 3 – are still in effect.”

CMS is currently writing regulations to implement the new MIPS system, and those regulations are likely to include changes to the future reporting requirements for Meaningful Use. CMS is expected to release the regulations in late spring/early summer, and although the exact implementation dates have not been finalized, the MIPS program and any associated MU changes will probably impact providers starting Jan. 1, 2017.

Bottom line: Meaningful Use isn’t ending. The financial penalties associated with MU performance for Medicare physicians are being rolled into the MIPS program from the MACRA law. When the MACRA regulation comes out this spring, CMS may make some changes to the requirements for MU Stage 3 that were published last fall.

The interoperability issue
Recently, the Senate HELP (Health, Education, Labor, & Pensions) Committee, which has jurisdiction over healthcare, “marked-up” and then voted to approve its bipartisan health information technology bill, “The Improving Health Information Technology Act” (S.2511). The 51-page bill targets improvements to the interoperability and usability of electronic health records.

Specifically, the bill:

  • Defines interoperability and information-blocking.
  • As a condition of certification, would require vendors to attest to being interoperable and not blocking information.
  • Authorizes the U.S. Department of Health and Human Services to investigate claims of information-blocking and assess civil monetary penalties on violators.
  • Establishes a Health IT Rating System, to be published on the website of the Department of Health and Human Services Office of the National Coordinator for Health Information Technology (ONC), which would allow providers to compare certified health IT products on the basis of transparency, interoperability and usability. The rating system would designate each certified EHR a star rating (likely one, two, or three stars) based on a biannual report on each vendor’s performance in the marketplace. EHRs deemed “one-star” (the lowest rating) would be forced to take action to improve their rating or face decertification.

Having cleared the committee with unanimous, bipartisan support, the bill at press time was headed to the Senate floor, where its ultimate fate was unclear. The Senate would prefer to pass it as part of a broader package of legislation targeting “healthcare innovation” through U.S. Food and Drug Administration and National Institutes of Health reforms in order to produce a companion to the 21st Century Cures Act, which the House passed last summer (which included sections on EHR interoperability and regulatory oversight of health information technology.) At press time, committee members lacked the consensus needed to move forward with the FDA and NIH bills (due to funding issues), but had plans to debate those issues this spring.

Bottom line: If passed into law, this bill would impose burdensome new certification requirements on vendors that produce EHR products, and would subject their certified EHR products to the proposed star rating system. It would also define “information-blocking” and give the Department of Health and Human Services the authority to prosecute offenders with fines. While different than the interoperability legislation that passed the House last July as part of the 21st Century Cures Act, this legislation does have similar elements to that bill. It could act as a companion bill to the House version that, if passed by the Senate, could be reconciled with the House bill and signed into law. However, until partisan differences over FDA and NIH funding issues are resolved (unknown, at press time), it appears unlikely that this bill will move any further in the Senate. EHR vendors are working closely with Electronic Health Record Association (EHRA) colleagues to meet with committee staff and track this legislation.

Editor’s note: Michael Paquin is founder of MDP Group, Paso Robles, Calif., a healthcare consulting group with clients in the medical device, medical/surgical supply and EMR vendor market segments. Prior to founding MDP Group, he was president of Midmark Diagnostics Group. He may be reached at 818-519-4779 or

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