A survey sponsored by the Certification Commission for Health Information Technology (CCHIT) has revealed significant concerns about the measures put forth in the preliminary Stages 2 and 3 meaningful use criteria.
The findings are in keeping with the sentiments of a growing list of professional organizations expressing misgivings about the objectives, timeline and terminologies proposed for Stage 2 by the Health IT Policy Committee.
These include CHIME, AHIMA, and, most recently, the HIMSS EHR Association, which has voiced its desire that the meaningful use regulatory schedule allow sufficient time for vendors and providers to develop and implement new software releases, and that the ONC focus more on increasing Stage 1 percentages than adding new criteria.
[See also HIMSS EHR Association airs Stage 2 concerns, launches new collaborative.]
CCHIT surveyed 468 healthcare professionals, including providers (36 percent of respondents), EHR vendors (29 percent), and others, explains Karen Bell, MD, the commission's chair, on the blog EHR Decisions.
A number of Stage 2 measures and objectives "were considered to be too aggressive by at least one third of the respondents," writes Bell. "Several were considered too aggressive by most of the respondents."
These included:
- Syndromic Surveillance. More than half of providers and 40 percent of vendors thought it was too soon for this to be a core measure for Stage 2, the CCHIT survey found.
- Drug Formulary Checks. "A target of 80 percent was not considered reasonable, even for providers who are using an e-prescribing network to retrieve formulary information," wrote Bell.
- Medication Reconciliation. The survey found that few settings are actually doing this as part of Stage 1; responders recommended making it core in Stage 2, but not increasing the percent of patients to which it applies – from 50 percent to 80 percent until Stage 3.
- Clinical Decision Support. Respondents to the CCHIT survey felt that it was premature to go beyond Stage 1 in this area at this point because a supporting infrastructure is not yet built beyond a few simple decision support rules.
- Submission of Reportable Lab Data. "Respondents believe that this measure is not appropriate until we have more standardized lab results coding (beyond numerical values), transmission and implementation guidance," wrote Bell.
- Drug Allergy/Etc. Checks. Respondents showed "minimal concern" with this becoming a core requirement in Stage 2, she reported. But there was "significant concern" about the Stage 3 proposal, with "no consistent library of evidence-based interactions for more complex interactions," Bell wrote, "the field is more dynamic than existing technology can accommodate."
Bell did stress that, in general, respondents indicated they believed the proposed Stage 2 objectives and measures "could be accomplished by 2012. Many of the features necessary to meet some of these new objectives and measures were already included in EHRs as part of the pre- HITECH EHR certification process."
[See also: AHIMA presses ONC to deal with vocabularies in Stage 2 MU.]
That said, she wrote, "concerns were registered … with respect to one of the Stage Three enhancements of these measures and objectives: providing educational materials in a common primary language. These could be made available in multiple other ways than through the physician of record and have the potential for errors using current translational technologies."
[See also: CIOs call for delaying move to Stage 2 meaningful use.]
Moreover, Bell reported that CCHIT received numerous comments about Stage 3 measures for which Stage 2 had not yet been determined: "Virtually all reflected the need for further maturation that would take longer than the implementation timeline necessary to have them included in EHR technology by 2014."
