Many healthcare IT companies are wondering if federal regulators will drop Meaningful Use news during the upcoming HIMSS13 conference. It’s a reasonable concern, since last year the Office of the National Coordinator for Health Information Technology (ONC) unexpectedly announced Meaningful Use Stage 2 rules on the third day of the conference.However, hospitals, health systems and physician's practices can breathe a sigh of relief. While the ONC has drafted preliminary recommendations for the final stage of the federal electronic health record (EHR) incentive program, the earliest the industry will see Meaningful Use Stage 3 is 2016. Stage 2 won’t even begin until 2014 for the earliest adopters.
Draft Stage 3 Rules: A Higher Threshold
Released in November 2012, the public comment period for the draft Stage 3 rules has already ended. The early stage objectives largely reaffirm Stage 2 goals and place higher thresholds for showing Meaningful Use. For example, the draft Stage 3 rules require hospitals and physicians to:
- Use computerized provider order entry (CPOE) for referrals/transition of care orders directly entered by qualified licensed healthcare professionals. Stage 2 required CPOE only for medication, laboratory and radiology orders.
- Implement 15 clinical decision support interventions or guidance related to five or more clinical quality measures that are presented at a relevant point in patient care for the entire EHR reporting period. This is an increase from the five required in Stage 2.
In addition, some Meaningful Use objectives and measures may be retired, including:
- Recording patient demographics;
- Recording and charting changes in vital signs; and
- Recording smoking status for patients 13-years-old and older.
Too Ambitious?
Many in the industry criticize other new objectives as being too difficult to achieve. For example, one new item would require providers to give 10 percent of patients the ability to submit patient-generated health information and request an amendment to their health record online. The rule is designed to either improve performance on high-priority health conditions and/or increase patient engagement in care. However, some physicians don't have control over patient behavior and may find it difficult to meet this requirement.
Another tentative Stage 3 rule could require physicians and hospitals to provide care synopses, setting-specific goals, and instructions for care during transitions of care. However, not all EHRs can be programmed to extract this additional data automatically.
Some organizations, like the American Medical Association, say that much of the Stage 3 criteria would be extremely difficult for physicians to meet, causing some practices to fall short of requirements and exposing them to lower Medicare payments.
Similarly, John Halamka, vice chair of the Standards Committee and CIO of Beth Israel Deaconess Medical Center, said that while the Standards Committee generally agrees with ONC’s current goals for Stage 3, it is concerned about whether they are realistically achievable, considering that standards and interoperability for certain EHR functions and clinical procedures are still evolving.
The American Academy of Family Physicians went so far as to send a letter requesting that ONC delay implementation of Stage 3 until 2017. Glen Stream, AAFP board chair, wrote, "We remain concerned that HHS is attempting to raise the bar for what constitutes meaningful use before the majority of physicians and hospitals are able to achieve the meaningful use Stage 1 or 2 objectives"
A group of EMR vendors also want Meaningful Use Stage 3 deadlines be moved up to a later date and the focus shifted to put a greater emphasis on interoperability. The group, the HIMSS EHR Association (EHRA), represents 40 vendors pulled together by HIMSS that include both enterprise and physician-oriented vendors, such as: athenahealth, Cerner, Epic, eClinicalWorks, Emdeon, Meditech, McKesson, Siemens, GE Healthcare IT and Practice Fusion.
According to a letter by EHRA: “The EHRA strongly recommends that Stage 3 focus primarily on encouraging and assisting providers to take advantage of the substantial capabilities established in Stage 1 and especially Stage 2, rather than adding new meaningful use requirements and product certification criteria. In particular, we believe that any meaningful use and functionality changes should focus primarily on interoperability and building on accelerated momentum and more extensive use of Stage 2 capabilities and clinical quality measurement.”
Ushering in New Models of Care
Overall, ONC designed Stage 3 to support new collaborative care models, with shared responsibility and accountability. ONC said that "Stage 3 is the time to begin to transition from a setting-specific focus to a collaborative, patient- and family- centric approach." Just how ONC will go about this should become clear as the healthcare industry trudges the road forward.
There will be several sessions pertaining to Meaningful Use at HIMSS13, and new to the show is the Meaningful Use Experience. This dedicated area for EHR vendors and providers will make it easy for attendees to find Meaningful Use products that have been certified to meet all mandatory criteria.
Thea Lavin, vice president at Schwartz MSL, will be at HIMSS and would be pleased to meet you to talk about meaningful use and other healthcare IT issues. You can reach her at 415-512-0770 or thea.lavin@schwartzmsl.com.
by Thea Lavin
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There are some times in your career that you feel like you are truly making a difference and the first week of May was one of those times for the Schwartz MSL Healthcare team.
The biggest challenge for HIMSS 2013 attendees will be to break away from the Morial Convention Center to sample New Orleans’ many delights. We encourage you to sample New Orleans’ rich cultural experience. If you are a runner or walker, grab a map and sketch a route for a morning walk or run. Better yet, invite a client or prospect to join you. 
