EHR vendors want clearer meaningful use guidelines

Non-certified electronic health record software has been such an issue within the Centers for Medicare and Medicaid Services' meaningful use program that the agency has issued, revised and extended a hardship exemption that would give organizations more time if they can prove that they were not able to receive the right software from their EHR vendors. The CMS determines which EHR systems will receive annual certification, and it is up to vendors to develop products that satisfy the CMS' requirements.

However, some vendors think these requirements are overly complicated and difficult for the reasonably prepared vendor to achieve. According to comments by industry experts and vendor representatives at a recent meeting between developers and the Office of the National Coordinator for Health Information Technology, vendors need clearer and more realistic timelines and guidelines if they are to produce viable products for stage 3 of meaningful use.

Working under greater scrutiny
Not many health care organizations were expected to utilize the CMS' hardship exemption for stage 1 of meaningful use. Stage 2 saw many more companies apply for an extension, and as the CMS continues to work on stage 3 guidelines behind closed doors, the increasingly complex requirements for EHR software are expected to push even more organizations to the hardship exemption.

However, from the perspective of vendors, the fault in failing to release certified software does not lie with them, but the CMS for issuing unclear and overly complex EHR requirements.

Leigh Burchell, vice chair of the Health Information Management Systems and Society's Health Record Association, told a gathered group of industry experts and federal officials that the CMS has continually failed to issue guidelines for vendors according to agency-set deadlines. With nothing to go on, Burchell wondered how vendors would develop software that could possibly achieve certification.

"It is essential that we take advantage of the opportunity that we have to avoid repeating the stage 1 and stage 2 timing challenges for providers and vendors," Burchell said in a prepared statement. "Keeping up with this accelerating flow of information has been costly and confusing for all stakeholders."

Catherine Britton, product manager at Siemens and fellow member of the HIMSS EHR Association, called for a timeline around 18 months that was more forgiving of EHR development schedules.

"The quality of the finalized [meaningful use] measures and [certified EHR technology] standards, including [clinical quality measures], protocol mandates and industry readiness … remain a considerable challenge even at this date," Britton said.

Burchell, Britton and a large number of their colleagues across the industry called for not only more timely issuance of EHR guidelines from the CMS, but that these requirements fall more into line with what developers are currently capable of. To fully comply with meaningful use, EHR software must satisfy 13 core objectives and five optional ones from a group of nine menu set requirements.

Moving EHR systems forward
While Burchell's and Britton's comments echo the majority's opinions on the current state of EHR development, not all want the CMS to publish more easily achieved requirements. In fact, John Halamka, chief information officer at Boston-based Beth Israel Deaconess Medical Center and co-chair of the ONC's Health IT Standards Committee, wrote in a blog post that the CMS is doing much-needed work to pull EHR systems into the modern age.

Much like the ICD-10 billing system, Halamka argued that continued delays and reductions in guideline complexities will only result in software of a lower standard. Though the current requirements may be difficult to achieve, that does not mean that they are impossible.