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Halamka and Tripathi take aim at meaningful use stage 3

The health IT world reeled when CMS and the Office of the National Coordinator (ONC) for Health IT unleashed more than 700 pages of proposed rulemaking for meaningful use stage 3 for healthcare providers and EHR vendors.

Now two of health IT’s leading thinkers and innovators  — Beth Israel Deaconess Medical Center CIO John Halamka, M.D., and Massachusetts eHealth Collaborative president Micky Tripathi — have essentially deconstructed the verbiage in a co-written post on Halamka’s widely read blog.

Now rocketing around the Internet, their analysis is a mostly factual condensation of the sprawling proposed rules released last Friday, whose length and byzantine construction the authors gently make fun of.

“Providers and vendors alike were all hoping for something lean and clean,” write Halamka and Tripathi, who are colleagues in the Argonaut Project, a new coalition of competing vendors and other health IT players that have come together to develop the emerging Fast Health Interoperability Resources standard, or FHIR.

But their post also delves into the critical realm with sections labeled the “good,” the “bad,” and even the “ugly.” These two sometime iconoclasts chide federal health IT officials, with whom they have worked closely for many years, for what they see as needless complexity and trying to please too many people and thereby failing to prioritize.

As for the good, the authors call the proposed rules, which now will go through what is likely to be a spirited 10-week comment period, “a good first draft.”

Halamka and Tripathi say that while the rulemaking is long, CMS should be commended for essentially streamlining and consolidating “stray threads” from meaningful use stage 1 and stage 2.

They also give good marks to both CMS and ONC for their work on the new certification rules and their strong emphasis on APIs. This direction, they note, is in line with on dramatically boosting interoperability, efforts by ONC’s Health IT Standards Committee (HITSC), and the goals of the Argonaut Project, which is housed at Tripathi’s eHealth Collaborative.

Halamka is vice chairman of HITSC, Tripathi was a member of the JASON Task Force, and both advocate for stronger interoperability capabilities for EHRs.

The bloggers also say it’s good that all players will start off with stage 3 in 2017 and 2018, as opposed to stages 1 and 2, which have found different providers attesting to different stages in separate years.

Now for the ugly.

While they say stage 3 is more focused than previous stages, Halamka and Tripathi are convinced that meaningful use is still an onerous burden for the most part on providers and vendors.

Overall, they argue that meaningful use in many areas is disconnected from how physicians practice medicine in the real world.

“The sheer number of requirements may create a very high, expensive and complex set of barriers to product entry,” they write. “It may stifle innovation in our country and reduce the global competitiveness for the entire U.S. health IT industry by over-regulating features and functions with complicated requirements.”