Docs talk challenges of 'meaningful use'

Physicians from group practices with extensive experience adopting and using electronic health-record systems testified before a federally chartered advisory group Tuesday.

The elite EHR users—who self-defined their groups in terms of EHR implementation to be in the upper 25% of all EHR users nationwide—said that meeting the Stage 1 meaningful-use criteria to receive federal EHR incentive payments presents multiple challenges to their practices.

They also warned federal rulemakers against setting the bar too high when second and third stages of the meaningful-use requirements are set for 2013 and 2015.

Dr. Careen Whitley of Hill Physicians Group in San Francisco said her group's EHR vendor, NextGen Healthcare Information Systems, has certified its system for eligibility under the federal incentive program but that Hill Physicians has not yet installed the upgraded system and will still need time to train physicians on it.

"We're feeling the time crunch right now," Whitley said. "Meeting all measures to receive payment is a very hard goal."

Whitley's testimony came during a day and a half of hearings Monday and Tuesday before the implementation work group of the federally chartered Health IT Standards Committee. The committee is an advisory panel to the Office of the National Coordinator for Health Information Technology at HHS.

Dr. Robert Murry is the physician leader for implementing an EHR system at Hunterdon Healthcare, Flemington, N.J. Murry said that the group is three years into a planned four-year rollout of an EHR system and that three-fourths of the group's 170 providers are now using the system.

For those users, Murry said the plan is to attest to the government in May that they've met meaningful-use requirements. But getting to that level of readiness has necessitated two upgrades to their EHR system, he said. Murry complained that the complete descriptions of the measures he needed to make the system fully operational to meet meaningful-use targets weren't available from the government until Nov. 7. He likened the quick changes to "upgrading an engine on an airplane while it's flying."

Dr. Lyle Berkowitz, medical director of clinical information systems at Northwestern Memorial Physicians Group in Chicago, said that his group of about 100 providers has been using an EHR system since 2003 and that several hope to qualify as meaningful users this year. But 10 pediatricians in the group won't qualify because they don't see a high enough percentage of Medicaid patients as part of their patient panels, he said. Berkowitz said his group has an advantage in that its affiliation with a hospital affords it technology resources independent groups don't have.

"If not for our hospital, we'd be hard-pressed to do the work that it takes," Berkowitz said. "We have a plan. Talking to other folks (in other groups), their heads are spinning right now.”

That said, even with the hospital affiliation, "What scares us, or at least challenges us, are resource limitations," Berkowitz said, adding that putting time into meeting meaningful use is drawing resources from other IT projects the group had planned.