As 2014 winds down, health information technology stands on the precipice of unprecedented opportunities and challenges. Never before has health IT provided such tremendous potential to radically transform medicine by improving healthcare quality and patient safety, reducing costs, decreasing paperwork, expanding access to affordable care, improving population health, and supporting reformed payment structures.

However, this year America’s healthcare system has taken one step forward, two steps back in creating a HIT infrastructure to achieve these goals. Health Data Management reviews the top health IT stories of 2014 and how events over the preceding 12 months have shaped the current state of the healthcare industry.

Hardship Exemptions

The Department of Health and Human Services established five priority goals for fiscal year 2014-2015 and second on that list was the improvement of healthcare through meaningful use of health IT. But, the year began with the Centers for Medicare and Medicaid Services announcing in February at HIMSS14 the availability of hardship exemptions for compliance with Stage 2 electronic health records MU requirements during 2014. The exemption policy was seen by industry observers as recognition by CMS that EHR vendors had not been able to deliver their products on time to keep up with the Stage 2 schedule, as well as the need for the agency to provide flexibility to the program.

ICD-10 Delay

The HIMSS14 conference was also the venue at which CMS officials adamantly insisted that the ICD-10 compliance date of October 1, 2014 was a “firm one." Yet, Congress had other plans. In late March, the House and Senate passed legislation that included a provision to delay the ICD-10 deadline by one year to Oct. 1, 2015. President Obama on April 1—April Fools' Day—signed the legislation into law delaying ICD-10 implementation to October 2015.

Federal HIT Strategy

In April, the federal government proposed a risk-based regulatory framework for health information technology. However, those who were hoping for a new regulatory framework for health IT products were disappointed by the draft report developed by the Food and Drug Administration in coordination with the Office of the National Coordinator for Health IT and the Federal Communications Commission, which critics say “assumes continued and undefined [FDA] authority over regulation of low-risk health information technologies.”

CEHRT Flexibility

In May, responding to a flood of provider protests regarding the federal government's meaningful use program, CMS and ONC announced a proposed rule allowing providers to use the 2011 Edition of certified EHR technology (CEHRT) for calendar and fiscal year 2014. This flexibility was seen as a welcomed reprieve by providers allowing them to use EHRs that have been certified under the 2011 Edition for either Stage 1 or Stage 2 for the purposes of the 2014 reporting year.

Major Data Breach

In August, Community Health Systems—with 206 hospitals in 29 states—reported in a filing with the Securities and Exchange Commission that it had been hacked with protected health information covering 4.5 million patients compromised. Overall, 2014 was a milestone year for health data breaches with healthcare organizations accounting for about 42 percent of all major data breaches reported this year.

Cerner-Siemens Deal

One of the biggest health IT acquisitions in 2014 was Cerner Corp.’s August announcement regarding its $1.3 billion cash deal to acquire the hospital information systems business line of Siemens Healthcare. In fact, 2014 is on track to be the most active year for healthcare mergers and acquisitions in decades, with the health IT sector at its highest level of M&A activity (in terms of dollars) in years.

Apple Launch

The biggest product launch of the year came from Apple. In September, the Cupertino-Calif.-based company unveiled a smartwatch designed to provide consumers with a variety of technology services including comprehensive health and fitness apps to help them lead healthier lives. Called Apple Watch and available in early 2015 starting at $349, the device includes an activity app designed to help motivate users to be more active, and a workout app that provides metrics during workout sessions.

Apple also introduced its HealthKit app, software that synchronizes data from various health and fitness apps and works as a central dashboard where iPhone users can check their health data. Hospital and physician software vendor Epic Systems Corp. is integrating Apple’s HealthKit into its EHR systems, which serve more than 170 million patients per year. Specifically, Epic customers will be able to use HealthKit through Epic’s MyChart app, which the company says is the most popular U.S. patient portal.  

Final Rule

On the policy front, a final rule published on Sept. 4 by Health and Human Services and CMS offered flexibility in attesting for Stage 2 during the short period of time remaining in the 2014 calendar and fiscal years, but retained a provision for a full year of reporting in 2015. In response, 17 provider associations asked the federal government to immediately reverse its decision for a full year of reporting in 2015. And, Reps. Renee Ellmers (R-N.C.) and Jim Matheson (D-Utah) introduced the Flexibility in Health IT Reporting (Flex-IT) Act of 2014 which seeks to mandate a 90-day reporting period in 2015 as opposed to a full year.

ONC Report to Congress

In its annual report to Congress submitted in October, ONC informed lawmakers that although participation in the Medicare and Medicaid EHR Incentive Programs is high and has led to widespread adoption among eligible providers, critical barriers remain for the electronic sharing of patient health information. “Despite progress in establishing standards and services to support health information exchange and interoperability, practice patterns have not changed to the point that healthcare providers share patient health information electronically across organizational, vendor, and geographic boundaries,” concluded the report.

Hospital Attestation

CMS in November extended the deadline for hospitals to attest to meaningful use for the Medicare Electronic Health Record Incentive Program 2014 reporting year. The previous deadline was 11:59 pm EST on November 30, 2014; the new deadline is 11:59 pm EST on December 31, 2014.

Medicare Payment Penalties

And, this month, CMS announced that more than 257,000 eligible professionals will face Medicare payment penalties in 2015 for failing to demonstrate MU in previous years. In response, the American Medical Association said that it was “appalled.” AMA president-elect Steven Stack, M.D., commented that the number released by CMS is “even worse than we anticipated” and that in light of the “dismal number of eligible professionals meeting Meaningful Use” the program needs to be fixed.

As of Dec. 1, 1,681 hospitals and 16,455 eligible professionals have attested to Stage 2 meaningful use. That means less than 35 percent of hospitals currently meet Stage 2 requirements and while eligible professionals have until the end of February to report their progress, only 4 percent of EPs have met Stage 2 requirements to date.

No doubt, a showdown is looming in 2015 between providers/members of Congress and federal regulators. Stay tuned. 

This article originally published by HealthData Management.

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