The healthcare industry is laboring under a massive operational transformation which requires the move to electronic records, digital patient engagement methods such as online portals, technology interoperability, significant security overlays and the use of technology to improve clinical processes across the board.
The goals form a Valhalla-like picture of perfectly optimized and efficient healthcare delivery — but the problem is that many providers are still battling with the data management strategies and tech required to get there. Taking a ride on the federal Valkyries is easier said than done.
The Centers for Medicare & Medicaid Services (CMS) have issued a proposed Stage 3 rule for an incentive program that has distributed about $28 billion to healthcare providers so far, aimed at encouraging the adoption of digital systems. Eligible professionals and hospitals must attain Stage 3 objectives by 2018 in order to qualify for critical funding.
The goal for this stage is, broadly, to improve health outcomes by implementing electronic reporting, information exchange and patient communication, rather than using paper to attain objectives. It follows Stage 1, which concerned data capture and sharing, and Stage 2, aimed at improving clinical processes.
Stage 3 has eight objectives: covering data security, electronic prescribing, clinical decision support, CPOE, patient access to information, coordination of care, health information exchange, data reporting and patient portals/APIs. Each of those has several measures beneath them.
The proposed rule for Stage 3 "encapsulates where CMS wants healthcare to be. The future that CMS envisions is almost all digital," said Jeff Smith (News - Alert), senior strategy advisor for public policy for the College of Healthcare Information Management Executives (CHIME), speaking to an industry publication. "When you read through the regulation, there's a continued emphasis on raising the bar, even in small ways, to reach the complete digitization of healthcare."
Rachel Britt-McGraw, CIO at Tennessee Orthopaedic Alliance, says that the requirements are too onerous, meaning that her 54-physician practice will be unlikely to snag any funding.
"For us, the news is not great. I'm not a terribly popular person here," she told Health Data Management. "I don't believe we will meet…Stage 3 unless we see adoption of proposals that reduce some of the percentages and relax the timing."
Others echo the concerns, adding that beyond Stage 3, there are multiple other layers of complexity in the to-do list. And that means knowing where to put investment into the effort becomes a moving target.
"In short order, [our industry] faces Stage 3 proposals, modifications to Stages 1 and 2 after that, an SGR [sustainable growth rate] fix, and two or three other bills related to interoperability," said Charles Christian, until recently vice president and CIO at St. Francis Hospital in Columbus, Ga. and board chair for CHIME. "I think I'm pretty adept at studying these, and I'm struggling to reconcile how it's all going to fit together. All of it is coming at one time, and some of them do contradict each other.”
As for CMS, it has pledged to work with providers. "We need to adjust and make things easier for you," said Andy Slavitt, acting administrator of CMS. Offices and hospitals will "know where to invest based on how we will reimburse."