CHIME Statement on Meaningful Use of Health IT

 The College of Healthcare Information Management Executives (CHIME), on behalf of our more than 1350 healthcare chief information officers across the U.S., is pleased to submit this statement for the record sharing our views on “meaningful use of health information technology.”  CHIME serves as a voice of the healthcare IT executive within the U.S., informing and influencing public policy leaders and other officials on the role of information technology in transforming the delivery of healthcare, while providing members with the latest information regarding new HIT legislation, regulations and polices. Founded in 1992, CHIME provides a highly interactive and trusted environment to enable senior professionals and industry leaders to collaborate and exchange best practices.  

 As healthcare IT executives charged with leading the implementation of electronic medical records (EMRs) and other IT tools to improve the quality and effectiveness of patient care, we are excited about an expanded Federal focus on encouraging the adoption of health IT, and at the same time we are well aware of the enormous challenges in achieving this goal.  Under the American Recovery and Reinvestment Act (ARRA) of 2009, hospitals and physician practices beginning in 2011 are eligible for incentive payments under Medicare as well as payments for serving Medicaid patients by demonstrating “meaningful use of health information technology.” Failure to do so by 2015 will result in reduced payments for Medicare, specifically. Title IV of ARRA articulates three general criteria as evidence of meaningful use: 

(1) Quality metric reporting; (2) Connection to exchange data; and (3) Certified systems.  

CHIME’s comments address numbers one and two. 

 Quality Reporting and Outcomes 

CMS currently collects 30 quality measures as part of its Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) program, which requires most hospitals to submit data for specific quality measures for health conditions common among people with Medicare, and which typically result in hospitalization. ARRA adds to these efforts a direct tie for use of health IT to improve care.  The bottom line for these efforts is better health/better outcomes. Using an EMR and other IT tools to accomplish this goal is clearly about outcomes and less about the technology. It is CHIME’s view that meaningful use must focus on outcomes and not mandate specific functionalities. 

 Phased Approach to Adoption 

Across the U.S., there are approximately 5,000 hospitals. This diverse universe includes community hospitals, large multi-hospital systems, teaching institutions, rural facilities, critical access hospitals and small specialty hospitals, among others. Some of these facilities are experiencing financial hardship, particularly in today’s strained economic environment. Loans and a reasonable hardship delay could assist those least able. On the other hand, some hospitals are more financially able to move forward now with health information exchange (HIE), computerized physician order entry (CPOE) and outcomes improvement to earn incentive funds.  

 As reported in “Use of Electronic Health Records in U.S. Hospitals” (Jha, DesRoches, Blumenthal, et al, NEJM 2009; 360), only 1.5 percent of U.S. hospitals have a comprehensive electronic-records system and an additional 7.6 percent have a basic system. Adoption was higher among larger institutions, major teaching hospitals, facilities that are part of a larger system or those located in urban areas. Non- adopters cited inadequate capital for purchase, concerns about maintenance and resistance on the part of physicians.

Recognizing this diversity and low adoption rate, CHIME supports phasing in criteria for meaningful use to encourage early adoption without raising the bar too high, too early. During later years, we recommend raising the bar to encourage continued development and progress by those who have adopted EMRs.