HIT incentives in Massachusetts: Less carrot, more stick

Health care providers all over the country are all worked up because they say that the federales' regulations on meaningful use of certified EHRs go too far, too fast. 

They should be glad they're not in Massachusetts, where EHR use will soon be required as a condition of licensure of physicians, hospitals and community health centers. 

The word got out, thanks to Secretary of Health and Human Services JudyAnn Bigby, who spoke at last week's HIT conference hosted by Governor Deval Patrick and the MA Health Data Consortium.  This seemed to be news to some folks out there, but these requirements are deep in the heart of Part II of the Massachusetts health reform law (Chapter 305 of the Acts of 2008).  Much of the coverage in August 2008 didn't mention the EHR-for-licensure provisions, but the HealthBlawg post at the time highlighted the EHR requirement as a condition of licensure as one of the important bits enacted in Chapter 305.  Another helpful bit: $25 million available in grant monies to providers to help implement EHR systems — a drop in the proverbial bucket.

Here is the statutory language imposing the requirements:

SECTION 15.  [M.G.L. c. 112, s. 2 is amended to read in part:]  The board [of registration in medicine] shall require, as a standard of eligibility for licensure, that applicants show a predetermined level of competency in the use of computerized physician order entry, e-prescribing, electronic health records and other forms of health information technology, as determined by the board. [Effective January 1, 2015, per Chapter 305, Sec. 58.]

SECTION 36.  Notwithstanding any general or special law to the contrary, on or before October 1, 2012, the department of public health shall adopt regulations requiring hospitals and community health centers, as a standard of eligibility for original licensure and renewal of licensure, to implement computerized physician order entry systems as defined by the department. The systems shall be certified by the Certification Commission for Healthcare Information Technology or a successor agency or organization established for the purpose of certifying that health information technology meets national interoperability standards.

SECTION 37.  Notwithstanding any general or special law to the contrary, on or before October 1, 2015, the department of public health shall adopt regulations requiring hospitals and community health centers, as a standard of eligibility for original licensure and renewal of licensure, to implement interoperable electronic health records systems, as defined by the department.  The system shall be certified by the Certification Commission for Healthcare Information Technology or a successor agency or organization established for the purpose of certifying that health information technology meets national interoperability standards.

To review:  Deadlines start hitting in less than 18 months.

October 1, 2012

Massachusetts hospitals and community health centers must be using interoperable CPOE systems, as defined by DPH, that are CCHIT-certified, as a condition of licensure.

January 1, 2015

Massachusetts physician licensure is conditioned on demonstration of competency in using CPOE, e-prescribing, and other forms of HIT, as determined by the Board of Registration in Medicine. 

October 1, 2015

Massachusetts hospital and community health center licensure is conditioned on implementing interoperable EHRs, as defined by DPH, that are CCHIT-certified.

So here's my take on some of the problems with this legislation.  First of all, there are a few holes in the system: 

• Facilities other than hospitals and community health centers provide a great deal of health care — e.g., freestanding clinics, including diagnostic imaging centers, cancer treatment centers, ambulatory surgery centers.  If you're going to mandate EHRs, better go whole hog.
• Practitioners other than physicians provide a heckuva lot of health care services, too — same argument as above applies to nurse practitioners, optometrists, etc.
• Certification by an alternative to CCHIT, if recognized by HHS under the HITECH Act, would not be recognized under this law, which refers to CCHIT "or a successor."

Second, the CCHIT certification system is more focused on the large enterprise "legacy" EHR systems, as is the NHIN structure that's been described by the federales.  The one encouraging note on that front is the development work being done on NHIN Direct, explained in a lucid post by David Kibbe at The Health Care Blog.  NHIN Direct will be providing some of the "backbone" and "handshake" hardware and software needed to make interoperability work for many health care providers.  At this point, it's hard to say what CCHIT certification standards will look like three to five years from now, and whether they will make sense for all providers covered by the Massachusetts law.

Bottom line: An interesting model put out there by the Commonwealth for the rest of the country to consider . . . and more moving parts to keep track of for Massachusetts health care providers.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting