Three months ago, the Office of the National Coordinator for Health Information Technology (ONC) designated Vermont Information Technology Leaders, Inc. (VITL) as a Regional Extension Center. The designation came with a $6.8 million grant and a charge to help the state’s health care providers improve care by implementing electronic health records.
VITL was one of 60 Regional Extension Centers that received nearly $1 billion of US taxpayer money for this purpose. The funds were mandated by HITECH provisions within the American Recovery and Reinvestment Act of 2009 (ARRA).
In announcing the award, VITL said it would “assist physician practices in improving patient care and meet the criteria to receive the ARRA funds (italics are mine).”
The criteria mentioned by VITL are stipulated in federal rules now being finalized by ONC and the Centers for Medicare and Medicaid Services (CMS). According to these rules, eligible providers who demonstrate “Meaningful Use” of an EHR that has been “certified by HHS or its designees” can qualify for up to $44,000 in incentive payments from CMS.
Congress mandated that the HITECH incentive program should begin in 2011, which is a scant 7 months from now. ONC and CMS have worked diligently to finalize a definition for Meaningful Use and specify the process by which EHRs will be certified, but their work is not complete. It seems unlikely that any EHR will be certified until mid-to-late summer at the earliest.
VITL’s Dilemma
The situation creates a dilemma for VITL and indeed, all Regional Extension Centers (RECs). There are 300 or so electronic health records on the market today. VITL doesn’t have the resources to work with all of them, so which ones should it recommend?
Surely all RECs know it would be disastrous if providers adopted an EHR that they recommend, only to find out later that the EHR does not achieve certification by HHS: the provider will have spent tens of thousands of dollars on the EHR, and yet be ineligible for HITECH incentive payments.
To eliminate this risk, VITL can wait a few months for HHS to certify a cohort of EHRs and simply recommend those. But VITL and other RECs are apparently worried that implementing legacy EHR systems takes months, and even a short delay in the implementation process might jeopardize its constituents’ chances of cashing-in on 2011 HITECH incentive payments.
VITL’s alternative is to begin recommending EHRs now, before any EHRs have been certified by HHS. This amounts to betting taxpayer money that the EHRs it recommends will achieve HHS certification, and that the “preferred” vendors can distribute updated versions of their EHR (which can support Meaningful Use) to thousands of clients’ servers in time for the 2011 payout.
VITL’s Choice
VITL and many other RECs chose the latter option. Using CCHIT certification status as a proxy for future HHS certification, VITL selected a cohort of preferred EHR vendors. It organized online demonstrations for these vendors, and made these presentations available on its web site.
Of note, the CCHIT web site reveals there are only seven “2011 CCHIT Fully Certified Ambulatory EHR products (click on the 2011 filter).” Remarkably, only 2 of these, Epic and NextGen, are among the 7 most widely used EHRs in the ambulatory setting, according to a study released last week by Software Advice. This means that 5 of the most widely used Ambulatory EHRs are not 2011 CCHIT Fully Certified: Allscripts, eClinicalWorks, SOAPWare, GE Centricity and Practice Fusion.
2011, of course, would be the only year in which CCHIT could have tried (to the extent possible) to map its Ambulatory EHR criteria onto the evolving, still-to-be-finalized ONC criteria.
The real irony of course, is that VITL–an organization whose mission is largely supported by a $6.8 million grant from HHS– is using CCHIT criteria at all! HHS no longer recognizes CCHIT criteria as valid.
The irony aside, VITL’s decision is risky. There is no guarantee CCHIT-certified EHRs will achieve certification from HHS. The disastrous outcome mentioned above, in which a provider pays to acquire an EHR that can’t support Meaningful Use, becomes a real possibility.
Last week, VITL increased the risk inherent to its strategy by hosting a webinar titled, “Selecting an EHR System.” The slides for this webinar, available here, do not mention HITECH, barely mention Meaningful Use, and do not highlight the federal requirement that providers who wish to qualify for incentive payments under HITECH must Meaningfully Use an HHS-certified EHR. In essence, VITL’s webinar fails to alert providers that they are assuming financial risk by purchasing an EHR that has not been certified by HHS.
Our Take
Practice Fusion understands that VITL and other RECs want to begin helping providers implement EHRs as soon as possible. But we disagree with VITL’s approach for many reasons.
To begin, providers who practice in small groups do not require many months to implement our EHR. By taking advantage of our online video tutorials, live chat and unlimited direct contact with customer support representatives (all of which we offer for free), they can fully implement our EHR more quickly than that.
Beyond this, HITECH provisions require that providers demonstrate “Meaningful Use” for only a 90-day consecutive period in 2011 in order to qualify for 2011 incentive payments (not the whole year). Thus, providers don’t need to start demonstrating Meaningful Use for at least a year. The sense of urgency that is apparently perceived by VITL and other RECs simply isn’t real.
And as mentioned previously, CCHIT certification does not guarantee HHS certification. It isn’t going to be easy for legacy EHR vendors to come into compliance with HHS requirements. Even if it were easy, it is far from clear that even well-capitalized legacy EHR vendors have the resources to upgrade thousands of their clients’ servers with a version of their EHR that can support Meaningful Use in 2011.
In summary, ONC and CMS are developing rules that will, if properly implemented, reinvent health information technology in this country for the better. It would be a shame if unnecessary risk-taking by taxpayer-supported RECs interfered with their grand vision.
Glenn Laffel, MD, PhD
Sr. VP Clinical Affairs
Practice Fusion EMR
