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EHR regulations, interoperability top patient record concerns

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Policymakers defend interoperability standards in meaningful use

Interoperability standards in meaningful use have been criticized as too weak. Policymakers say they are part of an incremental approach.

The interoperability standards in the meaningful use rules have come under fire in recent months for being too weak. But representatives from The Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare and Medicaid Services (CMS) are defending what they call strong provisions to move the industry forward.

Speaking in a June 6 webinar, "CMS and ONC eHealth provider webinar on advancing interoperability," Steve Posnack, director of the ONC's Federal Policy Division, said the stage 2 rules may not deliver full, industry-wide interoperability immediately. Policymakers have to take into account limitations inherent in the regulatory process, as well as provider and vendor readiness to adopt standards.

Posnack compared criticism of the lack of interoperability in the stage 2 rules to people faulting the government for there being no cars on the road that are ready to meet higher gas-mileage standards. There isn't a lot regulatory agencies can do if the industry doesn't produce products that comply with stiffer requirements.

We are making a lot of progress, and we're moving in an incremental and deliberate fashion.

Steve Posnack,
director of federal policy division, ONC

Still, he said progress is being made, and this progress will be more apparent as providers start transitioning to stage 2 of meaningful use.

"It's best to remember it's not one-size-fits-all," Posnack said. "It's not one solvable problem. We're about to get there; it's coming and you're going to see it very soon. We are making a lot of progress, and we're moving in an incremental and deliberate fashion."

The webinar responded to criticism that has been leveled at the meaningful use program in recent months for not doing enough to advance interoperability standards.

In May, a group of six Republican senators sent a letter and white paper to Department of Health and Human Services Secretary Kathleen Sebelius asking the agency to address what the senators see as insufficient policies for supporting interoperability.

In the letter, the senators say that failing to achieve full system-wide interoperability by the end of the incentive phase of the meaningful use program could jeopardize the entire $35 billion health IT investment made through the HITECH Act.

Travis Broome, team lead for policy and oversight of health information technology initiatives at the CMS, said during the webinar that interoperability is a critical issue. But he said the stage 2 meaningful use rules do more to advance interoperability standards than many people recognize.

For example, he pointed out that many of the standardized data sets initially mandated by stage 1 are preserved in stage 2. These include problem lists, medication lists, medication allergy information, demographic data and smoking status. In addition, an optional menu item from stage 1, recording laboratory information in the standard Logical Observation Identifiers Names and Codes, is now mandatory under stage 2. Family health histories and patient progress notes also must be standardized.

The most important provisions advancing interoperability will be ones requiring providers to transmit standardized transition of care documents, Broome said. The stage 2 rules require providers to electronically exchange standardized documents in 10% of all transitions of care and referrals. The rules also require physicians to prove that at least one of these transmissions goes to a medical office outside their network that uses a different EHR system.

Broome said stage 1 was mostly focused on making sure information followed patients and that the means by which this was accomplished was secondary. The stage 2 rules are more focused on standardizing the movement of information. 

"Rather than just getting credit for moving it and making it follow the patient, now we're focused on using standardized methods," he said.

Let us know what you think about the story; email Ed Burns, news writer or contact @EdBurnsTT on Twitter.

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Essential Guide

EHR regulations, interoperability top patient record concerns