After a 'bridge' year for Meaningful Use, 2014 could be painful for providers

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The electronic health record world covered a lot of ground in 2013, some of it positive, some of it not. Here's our annual look at the top stories that dominated the headlines in FierceEMR in 2013--and a few that we might expect to see in 2014.

2013: A bridge year

The "middle" movies in trilogies--"Catching Fire" for "The Hunger Games" series or "The Two Towers" for "The Lord of the Rings" series--sometimes are referred to as "bridge" movies. They may be fine on their own, but their main purpose is to bridge the gap from the beginning to the end (or beyond, if the "Pirates of the Caribbean" franchise is any indication.)

That's what 2013 was for EHRs. We're two years past the 2011 onset of the Meaningful Use program, the early adoption and the initial fanfare. Providers are beginning to get used to them. Adoption rates are continuing to climb. The government has paid out more than $17 billion in incentive payments. EHRs clearly are here to stay.

But 2013 also was a transitional year from Stage 1 to Stage 2 of the Meaningful Use program. This year was all about getting ready for Stage 2, complaining about Stage 2 and trying to delay or reconsider Stage 2.

While the latter didn't occur, the Centers for Medicare & Medicaid Services did attempt to throw the industry a bone by extending Stage 2 and delaying Stage 3.

2013 also was a transition year for the government's champions of EHR adoption. Farzad Mostashari, M.D., stepped down after three years as National Coordinator for Health IT; Karen DeSalvo will take his place later this month. Out with the old, in with the new.

EHR upsides, downsides in the real world

Now that EHRs are more established, we all have had a chance to see their potential to improve patient care, although simply the use of an EHR won't do that; they must be used correctly. On the other hand, we also saw that the data stored in EHRs holds great promise for affecting population health by identifying at-risk patients or other issues and for research.

This also was the year that unveiled that EHRs are not the cure-all for what ails the industry. Default settings and templates are unintentionally compromising patient safety, while copy and paste functions are creating billing issues. The Meaningful Use program itself is inadvertently creating healthcare disparities between "have" and "have not" providers. Moreover, as providers integrate with each other to deal with new payment models, they're running into unintended business consequences.

2014: A higher bar

So what will the new year bring? 

First and foremost, I believe that Stage 2 of the Meaningful Use program, which starts in 2014, will bring grief to a lot of providers, who will have trouble meeting its more rigorous requirements. More providers will drop out of the program. Some vendors still scrambling to meet the 2014 edition certification criteria will simply give up. Some of the remaining vendors will consolidate. To that end, DeSalvo will have a very short honeymoon. In addition:

The government will start taking legal action against inappropriate EHR use

While the U.S. Department of Health & Human Services and its Office of Inspector General put EHR use on its radar in 2013, this is the year when we'll see actual government enforcement action stemming from EHR use. It's going to take several forms. Government contractors also will step up their denial of claims attributable to cloning. OIG, no doubt, will prosecute a few providers for fraud and abuse stemming from upcoding and improper copying and pasting.

There also will be at least one headline of a settlement agreement with a provider where a former health IT employee or billing clerk is the one that "blows the whistle" on his or her employer's inappropriate EHR activity.

Some attesters will be returning their incentive money  

If 2013 was the year of the big incentive payout numbers, 2014 will see CMS reigning these payments back in as they increase scrutiny around provider entitlement. The agency already has been chastised for sloppy attestation policing and must redeem itself.

Patients will be front and center

Since Stage 2 of Meaningful Use includes new patient engagement requirements, providers are going to have to reach out to patients to entice them to engage in their own care efforts more often. Providers will do so in a variety of ways, including increased education about accessibility and incentives offered to patients.

Simultaneously, patient safety will continue to be of great concern as more patients view and access their electronic records and become more involved in their care. More vendors will adopt the code of conduct and there will be greater emphasis on how EHR use impacts patient safety.   

These are indeed interesting times. Hopefully, dear readers, we shall weather them together. - Marla (@MarlaHirsch @FierceHealthIT)