Several groups have submitted comments on CMS' proposed meaningful use modifications for 2015 through 2017, Clinical Innovation & Technology reports (Walsh, Clinical Innovation & Technology, 6/15).

Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments.

Details of Proposal

In April, CMS released a proposed rule that would shorten Medicare and Medicaid meaningful use attestation for eligible professionals and hospitals to a 90-day period in 2015.

Overall, the proposed rule would:

• Realign the reporting period starting in 2015 to allow hospitals to participate on the calendar year instead of the current fiscal year period;
• Reduce the number of meaningful use objectives to improve advanced use of EHRs; and
• Remove redundant measures and those that have become widely adopted.

In addition, the proposed rule would change Stage 2 meaningful use requirements related to patient engagement. Specifically, CMS proposed reducing the requirement for patients to use technology to electronically download, view and transmit their medical records from 5% of eligible providers' patients to just one patient (iHealthBeat, 4/13).

Comments on the proposed modifications were due June 15 (iHealthBeat, 5/28).

American Medical Group Association Comments

The American Medical Group Association in its comments praised CMS for easing the program's reporting requirements, as well as for proposing a shorter 90-day reporting period.

AMGA CEO Donald Fisher said, "This proposed rule reflects that CMS has been sensitive to the struggles that the health care industry has had with meaningful use by simplifying some of the reporting requirements through 2017."

The group also urged CMS to help strengthen the health IT infrastructure to support future data sharing requirements (AMGA release, 6/15).

College of Healthcare Information Management Executives Comments

Russell Branzell, president of the College of Healthcare Information Management Executives, in his comments called for a middle ground on patient engagement. He wrote that rather than requiring every specialist to demonstrate that patients can "view, download and transmit" their health information, those data should be aggregated into a single location for patients.

He added, "I definitely want patient data made accessible to patients or those taking care of them. But I don't want to get every note out of some subspecialty office" (Pittman et al., "Morning eHealth," Politico, 6/16).

Consumer Partnership for eHealth Comments

Meanwhile, a group of 50 advocacy groups organized by the Consumer Partnership for eHealth and the Consumer-Purchase Alliance in its comments expressed disappointment, saying CMS' proposal to reduce patient engagement requirements would undermine patient engagement efforts (Clinical Innovation & Technology, 6/15). Specifically, CPeH said, "CMS' proposed amendments constitute a dramatic retreat from essential efforts to make patients and family caregivers true and equal partners in improving health through shared information, understanding and decision making" ("Morning eHealth," Politico, 6/16).

Debra Ness -- president of the National Partnership for Women & Families, which was part of the coalition -- said the groups "urge CMS to keep the existing patient engagement thresholds."

Meanwhile, Bill Kramer, co-chair of the Consumer-Purchase Alliance, noted that maintaining efforts to give patients and caregivers "electronic access to and use of their health information" is key to achieving interoperability in the U.S. health care system (Clinical Innovation & Technology, 6/15).

Healthcare Information and Management Systems Society Comments

The Healthcare Information and Management Systems Society in a letter to CMS supported the agency's proposal to ease reporting requirements but urged CMS to be cautious moving forward with other proposals, Health Data Management reports.

Among other things, HIMSS recommended that CMS:

• Phase-in the new thresholds for the Patient Electronic Access Objective;
• Reconsider the "unrealistic goal" of the 2016 hospital electronic prescribing requirement; and
• Take into account the timing of the release of the final rule in terms of the "short turnaround in meeting" its requirements (Slabodkin, Health Data Management, 6/16).

Electronic health record vendors' processes for creating user friendly designs varies, according to a study published in the Journal of the American Medical Informatics Association, FierceEMR reports.

Study Details

For the study, researchers reviewed the user-centered design processes at 11 undisclosed vendors. They also sought to identify challenges vendors face when integrating usability with EHR development.

According to FierceEMR, the Office of the National Coordinator for Health IT's 2014 Edition EHR Certification Criteria requires vendors to:

• Show their user-centered design process; and
• Report the results of usability testing.

Study Findings

According to the study, EHR vendors' user-centered design processes can be divided into three categories:

• Well developed;
• Basic; and
• Misconceptions, such believing that responding to requests and complaints qualifies as user-centered design.

Barriers to improving EHR usability varied by which category a vendor was in, according to the study (Durben Hirsch, FierceEMR, 6/9). For example, vendors with:

• Well-developed user-centered design processes reported issues with getting providers to share health IT hazards associated with the EHR system (Ratwani et al., JAMIA, 6/6);
• Basic user-centered design processes faced knowledge gaps and had difficulty recruiting experts to discuss such processes; and
• Misconceptions did not see the need or business case for investing in user centered design processes.

The study also found that some vendors, particularly smaller companies, did not have any EHR usability experts on their staff.

According to the researchers, the findings suggest EHR certification requirements might need to be modified. They also recommended that further research be conducted to determine whether there is an association between usability and the quality of the process used (FierceEMR, 6/9).

Study Finds Disparities Between Early, Late EHR Adopters

There are "systematic differences" between early adopters of electronic health records and those who did not use EHRs before implementation of the meaningful use program, according to a study published in Health Affairs, EHR Intelligence reports.

Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified EHRs can qualify for Medicaid and Medicare incentive payments.

Details of Study

For the study, researchers analyzed meaningful use participation among more than 26,000 physicians in New York between 2011 and 2012.

The researchers examined payment data for those years from CMS and the New York Department of Health (Gruessner, EHR Intelligence, 6/9).

Findings

In 2011, about 80% of New York physicians did not participate in the meaningful use program. However, the rate increased significantly in 2012, Politico's "Morning eHealth" reports (Pittman/Tahir, "Morning eHealth," Politico, 6/9).

According to the study, participation in the Medicaid incentive program increased by 2.4 percentage points between 2011 and 2012, while participation in the Medicare incentive program rose by 15.8 percentage points (EHR Intelligence, 6/9).

Specifically, the study found that of the 26,368 physicians studied:

• 8.5% participated in the Medicaid program in 2012, up from 6.1% in 2011; and
• 23.9% participated in the Medicare program in 2012, up from 8.1% in 2011 (Jung et al., Health Affairs, June 2015).

According to the study, early adopters of EHRs were more likely to continue participating in the meaningful use program and "less likely to be nonparticipants or late adopters or to skip a program year," compared with physicians who did not use EHRs until after the incentive program started ("Morning eHealth," Politico, 6/9).

The study also found that early adoption of EHRs was associated with:

• Access to resources and organizational support for EHR implementation;
• Increased financial capacity; and
• Prior experience with health IT.

The researchers said the findings suggest that while the meaningful use program helped advance EHR adoption, using the systems consistently poses its own barriers. As a result, the program has led to a gap in quality among providers.

Joshua Vest -- co-author of the study and an assistant professor of health care policy and research at Weill Cornell Medical College --  said, "Without additional support to move forward, there is the potential to stall out among those [providers] who don't have the resources or capability to adopt EHRs" (EHR Intelligence, 6/9).