Welcome to Meaningful Use March Madness, a series of blog posts refuting frequently-heard arguments about the criteria proposed for the Electronic Health Record “Meaningful Use” Incentive Program.
Background: Recently at the Energy & Commerce Health Subcommittee hearing on health IT, members debated the Electronic Health Record (EHR) Incentive Program. Christine Bechtel's testimony highlighted the astounding progress that has been made in two short years, and encouraged Congress to keep up the pace on EHR adoption.
The Claim: Meaningful use is too difficult.
The Reality: There are already hundreds of thousands of providers who have succeeded at meaningful use.
Just a few years ago, we were worried about this program’s success. Many wondered if incentive payments would be even effective drivers of EHR adoption. They doubted whether Eligible Professionals (EPs) — particularly specialists — would be able to achieve meaningful use. CMS officials projected that between 21 and 53 percent of ambulatory care providers would adopt EHRs by 2015.
But as of February of this year — two years before 2015 — CMS data tell us that over 70% of Eligible Professionals have already registered for the program, and nearly 40% have already successfully completed the first phase of either the Medicare or Medicaid incentive program. Hospitals have been even more successful. Almost 85% of Eligible Hospitals have registered for the program and over 70% are meaningful users today.
At the program’s outset, there was concern that specialists would be excluded from what many considered to be the primary-care focused program. To date, providers have had flexibility in choosing among measures best suited to their patient population. This flexibility appears to be working; more than half — 58% — of Medicare EPs receiving payments are specialists.
Furthermore, providers are not alone on this journey. Congress included funds for Regional Extension Centers (RECs) to provide on the ground assistance to doctors adopting and using EHRs. Currently, more than 40 percent of all U.S. primary care doctors are working with 62 RECs to achieve meaningful use. That includes over 60 percent of rural primary care physicians and over 80 percent of federally-qualified health centers and so-called “look-alike organizations.” In fact, a recent GAO report found that eligible professionals receiving assistance from an REC were more likely to achieve meaningful use and receive an incentive payment.
As providers become more comfortable with their EHR systems, these seemingly difficult tasks become easier to achieve. Just look at CMS performance data comparing provider reporting periods of 90 days to a full calendar year. As providers move into having to demonstrate meaningful use for 12 months straight, their workflows become more routine and they perform at a slightly higher level. By the time Stage 3 is in effect, providers will have been using EHRs for at least four years. The enhanced data capture and functionality being considered for the final stage of incentive payments continues a natural evolution of these powerful tools.
Demonstrating meaningful use is challenging — it’s supposed to be. Many of the criteria proposed for the incentive program are ambitious; some may even seem like a real stretch. But that’s the point — to move us beyond the status quo.
Now is not the time to second-guess the potential of this transformational program. Now is the time to push the envelope even further, to capitalize on existing progress towards a patient- and family-centered healthcare system that consumers want and deserve.
 Centers for Medicare and Medicaid, Medicare & Medicaid EHR Incentive Programs, HIT Policy Committee, 3/14/13.
 HealthIT.gov, Healthcare Providers and Health Information Technology Infographic.
 United States Government Accountability Office, Electronic Health Records: Number and Characteristics of Providers Awarded Medicare Incentive Payments for 2011.