EHR interoperability, regulations top patient record concerns
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Major health IT and healthcare organizations -- ranging from the College of Health Information Management Executives (CHIME) to the American Medical Association (AMA) -- initially were mostly upbeat about new, looser meaningful use reporting rules that CMS and the U.S. Office of the National Coordinator for Health IT (ONC) released this week.
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The federal regulators' move, during National Health IT Week in Washington, D.C., signaled a distinct slowing of the pace of meaningful use at a time when most providers have already switched from paper records to EHRs and the $30 billion in taxpayer incentive funds for digitizing records has been largely paid out.
CHIME board Chairman Charles E. Christian said in a statement that the group was pleased CMS adopted the 90-day reporting period for meaningful use attestation sought by many providers, extended the stage 3 comment period by 60 days and softened requirements that patients be able to immediately view their health records electronically.
Patient rights advocates have tried unsuccessfully to get CMS to keep the so-called view, download and transfer meaningful use measure that formerly required providers to prove that 5% of patients could obtain their records electronically through the EHR.
CHIME welcomes changes
"CHIME and its 1,700-plus members agree with CMS that it is time to focus the meaningful use program on adoption of information technology systems that improve both the quality and safety of patient care," Christian said in the release.
Also, Christian said CHIME welcomed ONC's final rule on the certification of EHRs for meaningful use, developed after the agency weighed some 2,500 comments on the proposed rule.
Among the key provisions for meaningful use stage 3 starting in 2017, according to an ONC fact sheet, are:
- Eight objectives for eligible professionals and eligible hospitals. In meaningful use stage 3, more than 60% of the proposed measures require interoperability, up from 33% in stage 2.
- Public health reporting with flexible options for measure selection.
- Care quality measures reporting aligned with CMS quality reporting programs.
- Finalization of the use of APIs that enable the development of new functionalities to bridge across systems and provide increased data access.
ONC says new rules are flexible
In response to complaints from providers that many meaningful use reporting rules were arbitrary and inflexible, ONC relented by shortening the attestation period for stage 3, and positioned the simplified stage 3 measures as designed to improve care quality and interoperability.
According to ONC: "The stage 3 requirements are optional in 2017. Providers who choose to begin stage 3 in 2017 will have a 90-day reporting period. All providers will be required to comply with stage 3 requirements beginning in 2018 using EHR technology certified to the 2015 Edition. Objectives and measures for Stage 3 include increased thresholds, advanced use of health information exchange functionality, and an overall focus on continuous quality improvement."
The final certification rule also uses flexible reporting periods that are aligned with other programs, including moving from fiscal year to calendar year reporting for all providers beginning in 2015, and offering a 90-day meaningful use reporting period in 2015 for all providers, for new participants in 2016 and 2017, and for any provider moving to meaningful use stage 3 in 2017.
HIMSS reaction also positive, AMA mixed
Along with CHIME, the Healthcare Information and Management Systems Society (HIMSS), which counts most major EHR vendors as members, said in its own statement that it approved of the substance of the new CMS and ONC regulations.
The AMA's reaction was more mixed. The AMA represents many solo practitioners and small physician practices that have complained most loudly about meaningful use, and the influential organization has been critical of the CMS incentive program that has doled out some $30 billion to healthcare providers since 2009.
"The AMA continues to believe that stage 3 requires significant changes to ensure successful participation, and improve the usability and interoperability of electronic health record systems," AMA President Steven Stack. M.D., said in a release. Stack also said he recognized that the government regulators were "listening" to the AMA and other advocates in granting exemptions for providers struggling with attesting to meaningful use.
Federal regulators explain changes
Patrick Conway, M.D., acting principal deputy administrator and chief medical officer at CMS, explained why the agency resisted widespread calls from the industry to postpone release of the stage 3 rule.
"We're announcing an additional 60-day public comment period in particular to facilitate additional feedback about our vision for the EHR incentive program going forward and how it incorporates into broader delivery system reform efforts," Conway said.
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