For a case of supply and demand not quite meeting in the middle, look no further than the meaningful use initiative.
The government's massive healthcare IT overhaul offers $27.3 billion in incentives to providers who demonstrate meaningful use of electronic health records. The overarching goal is to spur health IT adoption with an eye toward improving healthcare quality and cutting costs.
At press time, two sets of rules from the Department of Health & Human Services detailing meaningful use were pending. The Centers for Medicare and Medicaid Services' Notice of Proposed Rule-making (NPRM) spells out what providers must do to achieve meaningful use, while the Office of the National Coordinator's Interim Final Rule (IFR) sets certification criteria for the EHR systems providers must adopt.
The meaningful use program will rollout in phases, with providers asked to meet increasingly rigorous requirements at specific points in time. The first of those target dates occur in 2011.
The success of the government's health IT plan rests on vendors producing compliant products, and providers deploying them in a timely manner. But only one part of that equation appears to be in place. On the supply side, health IT vendors say they will have little trouble providing products that conform to the government's criteria.
But many providers have yet to investigate EHR and will likely miss the initial meaningful use deadlines.
"I don't think the vendors are the ones with the big challenge here," said Dr. Mark Leavitt, chairman of the Certification Commission for Health Information Technology, which so far is the only federally designated group to certify EHRs.
"It is going to be the EHR users with the big challenge. Providers who have not started the process of purchasing an EHR will not be able to meet meaningful use in 2011, and will have a hard time meeting it in 2012."
Providers who fail to hit the meaningful use benchmark in those two years will not be able to take full advantage of incentive dollars, which ramp down over the meaningful use program's six-year span.
Doctors, for example, can quality for the maximum benefit"$44,000 for Medicare providers"if they reach the initial compliance stage in 2011 or 2012. After that, the incentives drop off. A provider who first meets meaningful use objectives in 2014 would have his or her incentive ceiling lowered to $24,000. There are no payments for providers who qualify in 2015.
Hospitals face a similar incentive draw-down over time. Healthcare executives suggested hospitals, as well as doctors, will also have trouble meeting the meaningful use timeframe.
Linda Simmons, vice president of operations and chief nursing officer for Memorial Hospital of Sweetwater County, Wy., said her hospital has already installed an EHR, Medsphere Systems' OpenVista. But smaller practices in particular may lack the money and access to highly trained IT personnel needed to field a system.
"I'm not sure they are going to meet the timeline"to really get on board and be compliant," she said.
Dr. Steven Waldren, director of the Center for Health IT at the American Academy of Family Physicians, agrees. If individual physicians and small practices are not already negotiating with vendors about purchasing and deploying an electronic health record system, he said, it will be tough for them to qualify for incentives in 2011.
Typically, small providers take six months to do the due diligence to find the right product, a month or two to sign the contract and become operational and a couple more months to get up to speed, roughly a year-long process, Waldren estimates.
"So, I think if practices haven't started the process of at least looking and doing the due diligence part, they're going to be hard pressed to meet the deadline for 2011," he said.
What providers who are late to act have going for them is that the reporting period for the first year is for just 90 days, giving them more time to get to the point where they can meaningfully use the EHR product and report quality measure.
And small practices can be fast on their feet. A two-doctor practice can decide quickly if they want an application service provider to deliver electronic health record services, while a large provider may have to obtain multiple departmental signatures on a technology decision.
"If you're a small practice, you're going to be more nimble than a larger practice, said AAFP's Waldren, "but you're also not going to have as many resources."
Vendors ready
ONC's interim final rule confronts technology providers with a 136-page to-do list. But vendors say a careful tracking of meaningful use has helped them readily close up any holes in their products.
Ryan Howard, chairman and chief executive officer at Practice Fusion, which provides a hosted EHR, said he hired a team to focus on meaningful use right after ARRA was passed last February.
"We have a team of doctors who have been working around the clock since last year," Howard said.
The team, he said, started "very aggressively" tracking the deliberations on meaningful use. When ONC's Health IT Policy Committee made initial recommendations last June, the firm moved into development mode, pursuing features that its team anticipated would emerge as government requirements.
As a consequence, Practice Fusion was able in January to release an e-prescribing offering to customers and follow-up a month later with clinical decision support, weeks after ONC confirmed those features in the interim final regulation.
Other vendors paint a similar picture. Glen Tullman, chief executive officer at Allscripts, a software and services company that provides ambulatory EHR solutions, said his company is close to meeting or exceeding IFR standards across its product lines.
Once the government makes its regulations final, Allscripts will "make modifications and very quickly be ready for certification," he said.
Consultants and organizations following EHR back up their stories.
"The EHR vendors, in general, are 80 to 90 percent there in meeting stage 1 compliance requirements," said Brenda Doles, president of HCRS, a company that consults with organizations on the EHR transition.
CCHIT recently completed a gap analysis comparing the IFR final regulation with EHR functionality of vendors certified under the organization's 2011 criteria. The certification criteria were based on the earlier work of the Health IT Policy and Standards committees.
"The big picture is there were no big surprises and the gaps were modest," Leavitt said of the analysis. "There will be a good and adequate supply of products."
That said, vendors do have some work ahead of them to meet all the criteria contained in the interim final rule. Leavitt cited two new functions as examples of features EHRs may lack: the ability to submit data to an immunization registry and the ability to transmit biosurveillance data to public health agencies.
However, he noted, vendors need only to test the capabilities and show they can submit data in the required format"as opposed to demonstrating a day-to-day link.
The provider challenge
While vendors think they have meaningful use under control, providers find themselves in a different spot.
Joe Gaetano, vice president at Siemens Healthcare's ARRA program office, said his company, which develops inpatient EHR systems, plans to make product adjustments regarding immunization reporting and other items, such as the ability to display growth charts. But his primary concern is for customers.
"The bar is set very high for them and the timeframe for them to assimilate some of this technology is hard for them," he said.
He said a third of Siemens' health IT customers are still grappling wi
