LAS VEGAS -- "We've stayed the course," National Coordinator for Health IT Farzad Mostashari said of the proposed requirements for Stage 2 of the meaningful use incentive program.
On Thursday, federal officials released the proposed rule on the Stage 2 requirements for health care providers. Officials plan to soon release a proposed rule on certification criteria for EHRs that support Stage 2 requirements.
During a Wednesday session of the the Healthcare Information and Management Systems Society's annual conference, officials from the Office of the National Coordinator for Health IT and CMS gave attendees at a "sneak peek" at the much-anticipated proposed rules for Stage 2.
Mostashari said, "There's a lot that's familiar" in the proposed rules, which closely mirror recommendations from the Health IT Policy and Standards committees.
Mostashari said, "We listened and we learned," adding, "We have done whatever we can to increase the flexibility and decrease the burden of these regulations."
He said, "To make truly meaningful use of meaningful use takes time."
Pam McNutt -- senior vice president and CIO of Methodist Health System in Texas -- said there were "no tremendous surprises" in the overview of the proposed rules, and "as expected," the regulations represent "an escalation from Stage 1." Still, McNutt said, "As we learned in Stage 1, the devil is in the details."
Proposed Rules Highlights and Initial Reaction
As the health care industry prepares to wade through the hundreds of pages of the Stage 2 proposed rules, here are some of the highlights and initial reaction.
Hybrid Menu-Core Structure Maintained
The proposed rules maintain the structure of the hybrid core-menu objectives for Stage 2. Under Stage 1 of the program, eligible providers have to meet 15 core objectives and five of 10 menu objectives, while eligible hospitals have to meet 14 core objectives and five of 10 menu objectives. Under the Stage 2 proposal, eligible providers must meet 17 core objectives and three of five menu objectives, while eligible hospitals must meet 16 core objectives and two of four menu objectives.
McNutt said she was pleased to see that federal officials kept some menu objectives for Stage 2.
Mostashari told reporters that although there was talk of moving to exclusively core objectives, ONC "thought it was important to provide some of that flexibility."
Timeline
The proposed rules officially extend Stage 1 to fiscal year 2014, retain the 90-day reporting in the first year and allow all eligible providers and hospitals to be in each stage for two years, regardless of when they start.
McNutt said it was "very good news and very realistic" to hear that all eligible providers and eligible hospitals will have a full two years to participate in each stage. She said, "We don't want people throwing in the towel, saying, 'It's just too hard' or 'It's not worth the money.'"
Mostashari said the timeline tweaks allow for an "overall escalator" for the meaningful use program, as well as "an individual escalator" that didn't previously exist.
Increased Alignment With Other Federal Programs
In response to feedback, the proposed Stage 2 regulations aim to better align clinical quality measures and reporting across federal programs, such as Physician Quality Reporting System, accountable care organizations and patient-centered medical homes.
During his keynote speech on Thursday, Mostashari called improved coordination among federal agencies, as well as state and local agencies, "a challenge and an opportunity."
Increased Push for Health Data Exchange
The proposed rules also include an "ambitious push" for health information exchange, Mostashari noted. Under Stage 1, eligible providers and eligible hospitals are required only to test the electronic exchange of health data. However, under the proposed Stage 2 rules, eligible providers and eligible hospitals would have to actually exchange patient data with an organization that uses a different certified EHR system.
Marc Willard, CEO of Certify Data Systems, said, "Today's meaningful use Stage 2 announcement sent a clear message: The exchange of health information across provider and vendor lines is no longer an option." He added, "The meaningful use Stage 2 exchange requirement is going to push hospitals and physician practices to find bidirectional enterprise HIE platforms that can connect every last physician in a community, regardless of which EHR vendor is used. Health systems must look beyond their own walls to connect with even the most remote physician, quickly and without disrupting native workflows."
Bill Spooner, CIO of Sharp HealthCare in San Diego, said the health information exchange provision was not a surprise, adding, "We all know that's better health care."
McNutt said that while health information exchange is important, the requirement "could be challenging" and "worrisome" for smaller hospitals in "what we call the HIE white space." She added that there might be some sort of exception for health care providers located in areas without a functional HIE.
Increased Push for Patient Engagement
Mostashari also announced an increased emphasis on patient engagement. Under Stage 2, health care providers would be required to provide at least 50% of their patients with the ability to view online, download and transmit their records within four business days. Eligible providers also must demonstrate that more than 10% of unique patients they see during the reporting period are taking advantage of that ability.
Jeff Donnell -- president of NoMoreClipboard, a PHR vendor -- said, "We are not at all surprised that patient engagement will continue to play an increased role in becoming a meaningful user of health information technology. Allowing at least 50% of patients to view, download, and transfer electronic copies of their own medical records can be (and is) a reality with the use of a patient portal."
Brian Ahier -- health IT evangelist at Mid-Columbia Medical Center and president of Gorge Health Connect -- praised the focus on patient engagement, noting that it is "critical to improving health."
McNutt said the provision is a "key component," demonstrating to patients that "not only can we, but we desire them to be engaged with us." However, she said it could be a "challenge getting 10% of patients" to access their records online.
Spooner said the increased emphasis on patient engagement was "expected." He said that although it could be a challenge, health care providers will have to make their websites and tools more attractive to patients. Spooner said, "You wouldn't go to Amazon if it wasn't an easy website" to navigate.
New Menu Objectives
The proposed rules include two new menu objectives for Stage 2:
- Electronically reporting to a cancer or specialty registry; and
- Viewing images through an EHR.
McNutt was pleased with both additions. She said that registries are "really helping with public health" and that a lot of hospitals already have "spent a lot of money in the area" of imaging.
Mostashari noted that imaging was something ONC received a lot of feedback on. He said that the ability to view or link to imaging "really means something to patients."
Certification Changes
On the certification side, the proposed rules allow for "gap certification," meaning that vendors would need only to get new features mandated under Stage 2 certified, not existing features already certified under Stage 1. Steve Posnack, director of ONC's Federal Policy Division, said about 40% of 2014 certification criteria would be eligible for gap certification.
Another new certification provision would allow health care providers to meet meaningful use by using a complete EHR, a single EHR module or a combination of EHR modules.
Ahier said that new vendor requirements for usability and patient safety are "a very positive sign, as the plethora of certified products is clogging the marketplace," adding, "There are likely some certified, but not quite useful products, and making certification requirements a bit more stringent will hopefully cull the field."
For more details about the proposed rules for Stage 2, read today's iHealthBeat news story on the topic.
Tough Road Ahead
McNutt said the timeline for Stage 2 will be a challenge. Even if vendors immediately begin to work on updating their systems and then make tweaks in the summer after the final rules are released, they won't be ready to roll out their products until early 2012, she said. McNutt noted that health care providers will be competing for vendors' attention to upgrade their systems and then will have to conduct a testing period, which lasts three to four months at Methodist. She said it is "a little worrisome" that hospitals must be ready by Oct. 1, 2013, to start reporting for Stage 2.
McNutt said, "We hoped they'd give us another 90-day startup period for any new measure in Stage 2." Although she said it's unlikely the federal government would offer that extra time at this point because it "wasn't in the spirit" of the original law, "it would be a solution" to the time crunch problem.
Spooner agreed that the timeline will be challenging but said it's doable. He said, "I think it's going to be a real charge" at Sharp.
While health care providers were pleased that the proposed Stage 2 requirements are fairly reasonable, it means Stage 3 will be a "pretty big jump," McNutt said. She said that as proposed, it "seems very difficult" to get a majority of health care providers to Stage 3.
"You have to wonder if they'll back off on the penalties," McNutt said, pointing to the federal government's decision to delay the ICD-10 deadline "when the [American Medical Association] screamed loud enough" as a sign of flexibility.
During a media briefing, iHealthBeat asked Mostashari how he would respond to predictions from the health care provider community that the federal government will not actually go through with penalties called for in 2015 under the meaningful use program. He said, "People have an opportunity now to establish the information foundation that can help them deliver care that is more coordinated, that is safer, that is more effective." He added that over the next few years, financial incentives will help "defray some of the costs and disruption" associated with the transition. Mostashari said, "That's why they should do meaningful use ... not because they could get 99 cents on the $1 in 2015."
He said, "It is our hope and our expectation that the vast majority of providers and nearly every hospital [will become] meaningful users."
Comment Period
Comments will be accepted for 60 days after the proposed rules are in published in the Federal Register. Holland encouraged stakeholders to be balanced in their feedback by providing information about what they agree with, as well as what they'd like to see changed. She noted that significant changes were made to Stage 1 of the program based on feedback.
Ahier said, "The devil is in the details, so I expect a very robust comment period." He said, "Everyone should remember to comment on those parts that they like as well as what they don't like," adding, "As we learned from the Stage 1 process, you may love a particular aspect but if you don't speak up and it is removed you could regret it."