Republican Tennessee Senator Lamar Alexander on Thursday called on the government to delay Stage 3 final rules – and offered five reasons why.

"The whole purpose of this program is to benefit patients, so that they and their health care providers have quicker and better access to their health histories and their doctors and hospitals and pharmacists can provide them with better care," said Alexander, speaking at his Senate HELP Committee's sixth hearing on electronic health records in recent months. "There is no reason not to take time to do it right." 

Alexander has signaled his support for a meaningful use delay in the past. But this time he got specific, listing his objections to rushing headling into Stage 3 when so many hospitals and practices are still mired in measures for Stage 2.

1. Stage 2 is so onerous, in fact, that just 12 percent of physicians and 40 percent of hospitals have managed to successfully attest. "The modifications to the rule should be adopted immediately so that providers can comply. Rushing out a stage 3 rule now would only make it even harder for doctors and hospitals to meet the program requirements."
2. Penalties and bonus payouts under the new Medicare payment system are inextricably tied with meaningful use compliance. "Under the new Merit-Based Incentive Payment System, 25 percent of a score that determines a provider's penalty or bonus payment will be based on participation in meaningful use," he said. "It's incredibly important to these doctors and hospitals to get the meaningful use program right.
3. Many leading medical institutions with the best electronic health records systems also recommend proceeding with caution. "Physicians and hospitals have said to me that they are literally 'terrified' of Stage 3, because of the complexity and because of the fines that will be levied," said Alexander.
4. A recent GAO report that shows that, in many cases, MU mandates are actually hindering electronic health record interoperability. "GAO polled 18 organizations in the private sector and at the state and local levels working to achieve interoperability and found that the majority of them – 10 of the 18 –believe that 'efforts to meet the programs' requirements divert resources and attention from other efforts to enable interoperability,' he said.
5. The HELP Committee has worked to develop seven areas for legislation to to drive interoperability:

• Decreasing unnecessary physician documentation;
• Enabling patients to have easier access to their own health records;
• Making electronic health records more accessible to the entire health care team, such as nurses;
• Stopping information blocking
• Ensuring that EHR certification "means what it says it does"
• Improving standards
• Ensuring the security and privacy of patient records.

"It would make the most sense to make the final rule consistent with the goals of that legislation," said Alexander, in his prepared remarks.



He added: "I had a piano teacher who always told me, 'Play the music a little slower than you can play it and you're more likely to get it right.'"