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Fewer certified EHRs for Stage 2 may pose problems for hospitals, doc practices
By Joseph Conn Posted: September 25, 2013 - 4:00 pm ET

There is growing concern that far fewer software developers have certified electronic health-record systems for use by healthcare providers under federal Stage 2 meaningful-use requirements than under Stage 1.

A Modern Healthcare review of the Certified Health IT Product List compiled by HHS' Office of the National Coordinator for Health Information Technology shows that just 79 companies, providers and other organizations have developed software and had it tested and certified to ONC-determined software functionality standards for Stage 2 meaningful-use requirements. In comparison, there were 988 developers of health information technology systems tested and certified for Stage 1.

This could cause problems for hospitals and office-based physician practices, which must advance quickly from Stage 1 to Stage 2 to avoid penalties but still don't have tested and certified systems for meeting the Stage 2 requirements.

Experts say vendors are facing problems as they try to develop EHR systems capable of performing calculations for measures providers must report to the CMS under the Stage 2 meaningful-use requirements.

“I've had a number of vendors calling me in a panic about it,” said Alisa Ray, executive director of the Chicago-based Certification Commission for Health Information Technology, one of several organizations that test and certify health IT systems for eligibility in the federal EHR incentive payment program. “It's not just one or two vendors. We've seen it again and again.”

This evidence of the slow progress of EHR developers to upgrade, test and certify their software to the more stringent Stage 2 criteria is one reason some are pushing for a delay in Stage 2 meaningful-use requirements. On Monday, 17 Senate Republicans wrote to HHS Secretary Kathleen Sebelius calling for a partial delay. They said that EHR vendors “are under tremendous time pressures” to upgrade and ensure their products are tested and certified for use in the EHR incentive payment program.

The American Medical Association, the American Hospital Association, the National Rural Health Association, the College of Healthcare Information Management Executives, the Medical Group Management Association, the American College of Physicians, and the Tennessee Medical Association have all weighed in calling for a Stage 2 delay or adjustment.

“In the last few weeks, it started to come to a head,” Ray said. “We always poll and communicate with our customers and ask, 'When are you going to test?', and we've pretty much seen everyone with good intentions say, 'Oh, I'm coming in the second quarter or the third quarter, and they end up pushing their schedule back as they run into the complexity.”

Ray said some of the gnarliest problems hit the vendors when they try to develop systems to automatically add up numerators, denominators and do the calculations on percentage-based measures providers must report to the CMS as part of their Stage 2 meaningful-use requirements.

The clock for the Stage 2 requirements starts Oct. 1 for hospitals that have already attained at least two years of meaningful use of a certified EHR system under the federal program, which aims to boost the use of interoperable health IT systems in the U.S. healthcare industry.

So far, the government has paid out $16.2 billion to providers participating in that program, including nearly $9.7 billion to hospitals, and better than 81% of the roughly 5,000 hospitals eligible for the programs under Medicare and Medicaid have received payment.

To qualify for continued payments, however, and to avoid penalties of cuts to their Medicare reimbursements, these experienced meaningful-user hospitals must step up the ladder and achieve 90 consecutive days of meaningful use measured against the more stringent Stage 2 criteria within the fast-approaching 2014 federal fiscal year.

But to do that, they must have installed and train staff to efficiently use health IT software—either a complete EHR or a sufficient collection of modular IT systems—that has been tested and certified as having sufficient functionality for them to meet the Stage 2 criteria set by federal rule.

According to the ONC's list, hospitals have used 3,343 “complete” EHR systems in inpatient settings from 38 developers to receive payment under the Medicare portion of the program, according to a database kept by the ONC and the CMS.

More than 90% of those installations are of complete EHR systems for inpatient use from the top 10 vendors. Eight of the top 10 have at least one health IT product tested and certified against the ONC's 2014 Edition criteria.

But just two of the next 10 vendors with complete EHRs for inpatient use sold to hospitals have a tested and certified product on the list. These companies have 229 of those systems installed and used by hospitals paid under the Medicare EHR incentive payment program, federal data shows.

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