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Medicare Gives Doctors Good News and Bad on Electronic Health Records

'Ridiculously complex' reporting requirements for 2015 follow more flexible rules for 2014

A flexible new Medicare rule on electronic health records will help physicians meet reporting requirements for 2014, but the rule also sets standards so high for 2015 that it may prompt physicians to simply throw up their hands, say experts for the American College of Physicians.

The new rule, released in September by the Centers for Medicare and Medicaid Services, gives physicians several options for meeting reporting requirements of the Meaningful Use Program, said Dr. Peter Basch, who chairs ACP's Medical Informatics Committee. That's especially important, he said, because many vendors were late in releasing the 2014 certified version of EHR software.

Doctors can use a combination of the old and new software versions, or opt between CMS Stage 1 and Stage 2 meaningful use standards, to meet 2014 requirements for the Meaningful Use Program, Basch said.

"Docs who are having trouble no longer have to do what many in the IT field consider one of the most dangerous times in using EHR, which is a hasty implementation without testing for bugs," he said.

However, the new rule also contains less-desirable news.

To meet reporting requirements for 2015, physicians will have to use the 2014 certified version of EHR software for the entire calendar year, said Thom Kuhn, ACP's senior systems architect.

"That is just not going to be possible," Kuhn said. "If doctors aren't ready now, they aren't going to be ready in two or three months. It makes a shambles of the options that have been provided for 2014."

It can take months for practices to adopt and implement new EHR systems, Kuhn and Basch said.

"It's ridiculously complex, and obviously a small practice is not going to have an IT staff to figure out the glitches," Kuhn said.

On top of that, EHR systems continue to have trouble swapping and sharing information -- one of the key requirements of meaningful use.

"You can pretty much predict you're going to have issues in 2015, thus meaning you cannot give your full attention to what you should be giving it to in phase 2, which is training on workflows and using EHRs to improve medicine," Basch said.

By requiring a full year's use of EHRs, CMS also will block doctors' ability to dump a system that they feel isn't working for them.

"A lot of members have said they want to switch technologies, but how can they do it without having a period where they don't have to report?" Kuhn said. "They can't report while they are switching systems."

ACP and other medical societies had asked CMS to reconsider its 2015 reporting requirements, but the agency decided that it needed to keep up the pressure on doctors to adopt EHRs, the two ACP experts said.

But, Basch said he's worried that this tactic might backfire: Doctors could bail out of the Meaningful Use Program in droves if they feel they won't be able to meet standards, particularly because the program's financial incentives are winding down.

"With a negative tone and a lack of incentives ... if people feel this is too difficult to do .. and CMS does not relent, there's probably a 50-50 chance we will see a mass exodus from the program," Basch said.

Frustration with EHRs already is mounting. About 75 percent of physicians believe that EHRs waste time and money, according to a Deliotte survey reported by Politico, and an ACP survey published in JAMA Internal Medicine found that EHRs cost doctors 48 minutes, on average, daily.

ACP and other medical societies are hoping that either CMS will relent or Congress will intercede. Kuhn noted that a bill has been introduced in Congress that would require a 90-day reporting period in 2015 instead of a full year.

"We really want this to work," Basch said. "But if you force it not to work, is it really politically wise to say we will not reconsider our position and will penalize a large number of the nation's doctors?"

"I'm hopeful that a thoughtful compromise can occur, as well as some course-correcting for the things that are driving docs crazy about meaningful use," he said.

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