LAS VEGAS -- Proposed rules for meaningful use stage 2 were stuck at the Federal Register up to and past National Health IT Coordinator Farzad Mostashari, M.D.'s Thursday keynote at the Health Information and Management System Society's HIMSS 2012 conference, he told assembled reporters immediately after the address, because of "formatting issues."
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It was a metaphor of Mostashari's frustrating, often Sisyphean task of creating interoperable standards for health data exchange, and getting the entire U.S. health care system on the same page. He and his ONC and CMS colleagues were forced, at first, to not publicly comment on the rules. Later in the week, they were able to look at the document on their computer screens and share particulars verbally, as Mostashari did when giving attendees a sneak peek at meaningful use stage 2.
"It's natural that people would like to actually read it for themselves, and they'll have plenty of opportunity to do that on the flight home," Mostashari said, indicating confidence that it would be publicly available by the time you read this story, or soon after.
Lack of meaningful use stage 2 proposed rule left HIMSS organizers, attendees in tight spot
The holdup in the rules' Federal Register publication put federal regulators and policy analysts -- who had been scheduled to break down specifics in presentations -- in a tricky spot. Clearly, the rule was supposed to have been released some time before the HIMSS 2012 conference, judging from the program descriptions promising a reality-show style unveiling starting at Monday's preconference symposia.
But the show went on without it. "There was a kind of hype all week," said Charlene Underwood, HIMSS board chair. "We were betting on what day it would come out -- we're in Vegas -- and there was some initial disappointment, I think, that it wasn't here. But we had some confidence it would come out this week."
Before Mostashari's keynote on the second-to-last day of the weeklong conference, with winks and nods and caveats, officials were left to uncomfortably fill time before standing-room only audiences of vendors and health care providers anxious to know what compliance requirements were in the proposed rules.
Forced to explain in nuanced government-speak that they weren't allowed to publicly comment on anything that might be in the rules -- one for vendor certifications of software used by health care providers, and one for the providers themselves to qualify for the Electronic Health Record (EHR) Incentive Programs -- officials shrugged off many HIMSS attendee questions with "I can't talk about that," or vague statements beginning with phrases like "Well, if you look closely at what the HIT Policy Committee recommended in the past, and understand that we take their recommendations seriously…"
The whole situation frustrated some show attendees, judging from conversations overheard in the halls and the groans in question-and-answer sessions for CMS and ONC speakers. It also caused a bit of glee among health care CIOs, feeling a little schadenfreude toward the rule-makers who had complicated their jobs with a triple-whammy of meaningful use, ICD-10 implementation and HIPAA compliance.
There was some initial disappointment, I think, that it wasn't here. But we had some confidence it would come out this week.
Charlene Underwood, board chair, HIMSS
Business as usual despite lack of meaningful use stage 2 rule
For the most part, however, it was business as usual. An informal poll of vendors and providers seemed to indicate that the U.S. health care IT sector collectively took a deep breath and realized two things.
- First, it's only a proposed rule, as the final version will look significantly different than what will amount to a first draft.
- Second, vendors and providers were probably already headed toward compliance with most of what ONC and CMS were planning to throw into meaningful use stage 2, anyway.
"We'd be surprised if more is in there than we've already seen," said Jeff Townsend, Cerner Corp. chief of staff and executive VP. "Usually they take a superset [of rules] and they draw it back. We usually take the position -- knowing how long some of this takes to develop, engineer and get into the field -- 'Shoot for the bigger target and if they pull back, that's fine.'"
Popular patient advocate Regina Holliday saw her biggest wish granted -- a mandate for patients to be given the opportunity to view, download and transmit their medical records online. When meaningful use stage 1 came out, she said it was "wonderful" that rules mandated patients have access to their data within a few days upon request. In her view, it's time to broaden that access.
"It makes absolutely the most sense to do a portal," Holliday said. "If a portal's in place, you don't have to worry about 50% of requests fulfilled -- you open it up to everyone. Anybody who goes into your facility has the ability to get it through a portal."
Tom Hargrove, M.D., chief medical information officer for Trinity Mother Frances health system in Tyler, Texas, found the theater surrounding the release of the stage 2 proposed rule interesting to watch unfold at HIMSS. After all, among his CMIO and CIO peers, the potential pitfalls of ICD-10 implementation are a far bigger concern right now.
"Our organization spent a lot of our ICD-10 money buying our EHR software, because at the same time we're doing an Epic implementation we're taking out our revenue cycle system," Hargrove said. "It will be ICD-10 workable…but of course we still have deal with all the bolt-ons, other vendors, and all the other people we interact with every day, in multiple areas -- and continue to train our coding staff."
Entities left waiting for details on HIE connectivity standards
Also in the HIMSS floor were folks caught between regulators and providers, on tenterhooks waiting to confirm the wording of rules surrounding such issues as standards for data exchange and health information exchange (HIE) connectivity. Mostashari did say that integration with the Direct Project will be a requirement for EHR systems but did not elaborate.
One such exhibitor was Dave Delano, project director for the Regional Extension Center for New Hampshire for the Massachusetts eHealth Collaborative, which also administers the Massachusetts and New Hampshire state HIEs and supports federal quality reporting programs as well.
His agency assists providers in complying with Centers for Medicare and Medicaid Services reporting mandates -- but also must comply with those same reporting rules in order to send data to CMS on providers' behalf. That includes keeping its own software for quality reporting certified by the Certification Commission for Health Information Technology (CCHIT).
"We're in the middle, trying to make these things happen," Delano said. "Stage 2…has a lot of implications for all of us and the constituents we support. We're saying 'Yeah, come on!' because the minute that hits, we're going to be scrambling."
That scramble will include re-informing and re-educating the collaborative's constituents, he said -- and, depending on final meaningful use stage 2 rules, possibly re-engineering data center software architecture to comply with the rules and their deadlines, whenever they are finalized.
Judging from how the stage 2 rule trickled out late this week, that could take a while.