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    There needs to be accountability for the lack of interoperability


    How is it that certified EHRs are still not interoperable? Not to mention that 12 years ago interoperability was emphasized in the Rand Corporation study, which was financed by several of the leading IT vendors.

    To put this in proper perspective, it is essential to look at how independent physicians have been held accountable.[4] To qualify for the maximum reimbursement for the adoption and implementation of a certified EHR under the requirements of the HITECH Act, physicians needed to demonstrate meaningful use by July 1, 2012. Each year thereafter, the maximum reimbursement decreases, and as of January 15, 2015, for those not accepting Medicaid assignment, the reimbursement totally disappeared. Also, as of January 1, 2015, penalties were applied to Medicare payments for physicians who did not demonstrate meaningful use of a “certified” EHR.


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    Let me emphasize that reimbursements and avoidance of payment penalties was based on a complicated process of reporting meaningful use to the Centers for Medicare & Medicaid Services (CMS). This was most burdensome for small medical practices that lack ancillary staff. Remember, this was based on demonstrating meaningful use of a tool that the majority of physicians found not clinically useful. Now let us review these time frames.

    The HITECH Act was enacted Feb. 17, 2009. In essence, physicians’ reimbursement, based on failure to demonstrate meaningful use of a “certified” EHR, started to decline July 1, 2012, about three and a half years after enactment.

    As of Jan. 1, 2015, with failure to demonstrate meaningful use, any and all reimbursements were lost and penalties began. This represents almost six years after enactment of the HITECH Act. Wow! The IT industry, to date, has had almost an eight- to 12-year grace period to achieve interoperability while physicians began feeling the wrath of meaningful use within three and a half years of enactment, and penalties at six years after enactment. Then again, maybe grace just naturally flows to the Digital Deity?


    TRENDING: Why are EHRs still so terrible?


    The Office of the National Coordinator of Health Information (ONC) has presented a report to Congress on health information blocking.[5] In the report, it presents findings similar to those in the study cited above. However, in this 38-page report, it seems to take a feckless, ambivalent position on enforcement. For example, on page 11, in defining interference with the exchange or use of electronic health information it mentions “…organizational practice that make doing so more costly or difficult.” Subsequently, on page 13, it again addresses this, “Charging prices or fees (such as for data exchange, portability, and interfaces) that make exchanging and using electronic health information cost prohibitive.”

    Next:  'The responsibility or lack thereof needs to fall directly in the lap of the IT industry'

    Keith Aldinger, MD
    Dr. Aldinger is an internist who practices in Houston, Texas.

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    • [email protected]
      Doctor Keith, right on the point; we have been using an EMR since 2000; it was developed by my wife, an internist; we have had 6000 patients on it for years; it is slick, fast, disease management based, and user friendly; our transcription service ended two weeks after we started the software called Isprit; the problem is certification and interoperability; the "big guys" pushed for expensive certification to crowd out the little guys; each vender program is proprietary and "secret" so therefore, will not allow for "talking" between the software programs; how right you are in stating we physicians suffer the wrath of the government while the software companies get away with non compliance; we are done with "meaningless use", anyways, and have gone to Direct Primary Care , free of the curses and reprimands of the government and insurance companies; we work for our patients now and no one else; great article, good luck, [email protected]

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