Radiologists Urge Modifications To Meaningful Use Draft Guidelines

Representatives from five medical specialties—radiologists among them—last week offered their final proposed changes to the draft guidelines for Stage 2 of the U.S. government's Meaningful Use Stimulus Program. The contingent of physicians—who aside from radiologists included pathologists, ophthalmologists, surgeons, and specialists in the areas of allergy, asthma, and immunology—made their case at a May 13 meeting in Washington, DC, before the Meaningful Use Workgroup of the Office of the National Coordinator for Health Information Technology (ONC). Participating radiologists and pathologists expressed similar viewpoints during the meeting, pointing out that individuals in their respective fields had decades ago pioneered the adoption of electronic recordkeeping decades ago, and that the overwhelming majority of radiology and pathology practitioners "meaningfully use" these technologies on a daily basis. They also urged that technology that already exists and works successfully be incorporated into the Stage 2 Meaningful Use criteria recommendations, and that medical specialists not be required to purchase electronic capabilities they do not need and will not use to qualify for incentive payments from the federal government. The Friday hearing followed a meeting hosted by the U.S. Department of Health and Human Services (HHS) Health IT Policy Committee earlier in the week, at which the Meaningful Use Workgroup presented a revised draft proposal for Stage 2 criteria. While it is not yet known whether the facts and recommendations presented during the May 13 meeting spur the workgroup to further modify to the final proposal slated for submission to the HIT Policy Committee on June 8, Keith Dreyer, PhD, co-chair of the American College of Radiology's (ACR) IT and Informatics Committee, and David Booker, MD, governor of the College of American Pathologists (CAP), both made strong arguments that additional changes are needed. According to Dreyer, an estimated 85% of all U.S.-based radiologists already use RIS and PACS on a daily basis, and many healthcare facilities employ simple Web protocols to insert images into their EHRs for use by affiliated physicians and clinical staff. "Through its rapid adoption over the past decade, the value of this digital medical imaging technology and its integration to the EHR has become essential to the clinical care of patients," he tells the workgroup. Dreyer adds that “the challenge today is incentivizing those same facilities to share their image data with other neighboring medical facilities as well as the patients themselves.” While CDs are used to transfer images from one facility to another, "a preferred and fully realizable approach, if incentivized through a mechanism like meaningful use, would be true electronic exchange." Quoting David Blumenthal, MD, former ONC national coordinator for healthcare IT, who stated in January 2011 that "we can't have an effective EHR system that can't move images," Dreyer reminds the committee of a 2011 meeting co-sponsored by ONC and the National Institutes of Health (NIH). The purpose of that meeting was to explore capabilities and opportunities related to diagnostic imaging. "The resounding take-home messages from that ONC-NIH meeting were that the capabilities and standards exist now, that image and imaging data exchange is a critical component of EHR technology, and that imaging-related information should be implicitly included in meaningful use criteria because of its importance to the diagnosis and treatment of patients," he asserts. In addressing the committee, Dreyer also describes both the patient safety and financial benefits of using clinical decision-support systems interfaced with computerized physician order-entry (CPOE) systems, emphasizing the contradiction that while stage 1 CPOE certification criteria require systems to have the functionality to order radiology exams, the latter is not a requirement of stage 1 Meaningful Use requirements. Requiring CPOE without use of clinical decision-support tools will not be as effective either. Adding these requirements to stage 2 is “a no-brainer because the solutions already exist and are in clinical use," according to Dreyer, and “these tools have years of supporting evidence behind them and are ready for prime time in stage 2 Meaningful Use." Concluding his remarks, Dreyer states that the ACR's position that healthcare coordination, efficiency, and quality improvement would be best achieved through Meaningful Use requirements that are relevant to medical specialties."Specifically, the Centers for Medicare and Medicaid Services (CMS]) and ONC should provide meaningful use functionality objectives and measures that will improve medical imaging care, including functionality measures for structured reporting, communication of critical findings, access to key image data, and recording and monitoring of radiation dose," he says. "These types of specialty-centric functionality measures should be used in place of other meaningful use measures that have no bearing on radiology practices today.”