Provider Backlash Threatens to Gut MU Public Health Objectives

The chorus of health care provider complaints about growing federal HIT requirements, from Meaningful Use (MU) to switching to ICD-10 diagnosis codes threatens to claim some public health victims.  On February 19 the Meaningful Use workgroup of the US HIT Policy Committee (HITPC) responded to the latter’s pressure to reduce the number of Stage 3 MU objectives by voting to delete electronic reporting of reportable lab results (ELR), syndromic surveillance (SS), and reducing requirements for reporting to public health registries.  They declined to endorse a new objective for clinical case reporting of reportable conditions, but appear posed to recommend continuing reporting to immunization information systems (IIS, often called immunization registries) and adding the capability for EHRs to upload immunization histories from an IIS.

Ironically, ELR and SS were common (but far from universal) even before Meaningful Use. An impediment to rapid expansion of ELR to new hospitals was the need to convert in-house lab codes to LOINC (but this is now MU-required for in-hospital lab reporting anyway).  Meanwhile, providers that had happily submitted HL7 Admission, Discharge and Transfer (ADT) messages for SS in the past were confronted by more complex message requirements in Meaningful Use rules.  Some providers questioned why they should spend time and money sending standardized data when many public health jurisdictions could not accept it electronically.   Thus these efforts resemble half-built bridges, with those on neither shore willing to invest enough to finally meet in the middle.

The MU Workgroup decisions reflect a narrowing of HITPC focus from simultaneously meeting five large social goals (one being improving public and population health) to enabling “transformation of care” as envisioned in medical homes and accountable care organizations.

Some providers might enjoy short-term savings by avoiding MU standardized reporting, but then face ongoing costs and retarded outbreak response associated with inefficient manual reporting.  Of course such cost-efficacy depends on health department adoption of standardized electronic reporting.  Progress was reported in 2013 with 95% of jurisdictions receiving some ELR, and the share of 20 million annual reports received electronically rising 62% from 54% in 2012. That represents 1,600,000 fewer manual reports yearly and 1,600,000 more communicable illnesses addressed more quickly and efficiently, just in the earliest stages of MU.

Public health advocates are typically best represented at the MU workgroup level, so greater effort is required to modify HITPC recommendations and proposed rules changes. The MU Workgroup will return to the discussion (unclear how final are the recommendations at this point) on  March 4 and it seems likely HITPC will take up the topic March 11.  Interested parties can tune in.  Health.e.volution has learned the Joint Public Health Informatics Task Force of public health associations is crafting a strategy, so concerned agencies and individuals can contact their association to get involved.

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