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Workgroup begins work on Stage 2 of meaningful use rules

Policymakers are exploring the next stages of the meaningful use rules designed to encourage IT adoption among health care providers. CPOE and quality reporting will be key.

The first stage of meaningful use rules haven't taken effect yet, but policymakers already are turning their attention to the second and third stages of the program designed to encourage the greater adoption of information technology among health care providers.

On Sept. 22, the Meaningful Use Workgroup of the federal Health IT Policy Committee held the first of two day-long brainstorming sessions that signal the beginning of work to draft the criteria doctors and hospitals will follow after 2012, when Stage 2 is set to begin.

Expect a lot more discourse on such issues as computerized physician order entry (CPOE), drug interactions indicators, advance directives, and quality measures and clinical decision support. While the workgroup is delving into ways to extend current meaningful use rules and develop new ones, those areas in particular were questioned deeply.

Under the federal Electronic Health Record Incentive Program (EHRIP), Medicare and Medicaid providers demonstrate they are meeting meaningful use rules and are eligible for incentive payments. The five-year program is voluntary, but providers that don't demonstrate they have adopted and are using health IT after 2015 will see cuts in their reimbursement from the Centers for Medicare & Medicaid Services (CMS), which oversees EHRIP. The policy committee is run by the Office of the National Coordinator for Health Information Technology, or ONC, which works in conjunction with CMS on meaningful use and technology standards.

Calling CPOE "extraordinarily important" as one of the central functions of EHR systems, Dr. Paul Tang, physician and workgroup co-chair, said the goal of the meaningful use rules is to influence the ordering behavior of providers. To get there, all orders -- not just those for medication, but radiology and laboratory orders as well -- will have to become part of the criteria. For Stage 1, providers must demonstrate only that they are using CPOE for medication orders.

Speaking to at the American Health Information Management Association (AHIMA) Convention & Exhibit in Orlando, Fla., Tang said there are “strong signals” that CPOE will be expanded from 30% in Stage 1 to 60% in Stage 2, widening the spectrum of orders covered to potentially include labs and other studies and not just medications.

“The reason we focus on CPOE is because that’s where you’re influencing the decisions made by physicians,” Tang said. “You want to bring the information that bears on those decisions right in front of their faces, right at that time.”

Clinical decision support and quality measures reporting are two other significant components of the meaningful use rules. A separate workgroup is focusing on recommending the quality measures that should be included, but the Meaningful Use Workgroup is considering ways to set priorities that guide providers to work on specific patient conditions.

To that end, the workgroup discussed expanding clinical decision support criteria to include suggestions from the National Priorities Partnership. The 32 organizations in the collaborative have created targets for improvements in six areas, from patient engagement to overuse of health care resources. The Meaningful Use Workgroup suggested requiring providers in Stage 2 to address four high-priority conditions from within those six areas.

Expect to see requests for testimony and feedback, in particular on the subjects of advanced directives and electronic insurance eligibility. The CMS has signaled it specifically wants more information in those areas, according to Tony Trenkle, director of CMS' Office of e-Health Standards and Services, who spoke during the meeting.

Expect a lot more discourse on such issues as computerized physician order entry, drug interactions indicators, advance directives, and quality measures and clinical decision support.

Advanced directives indicate the kind of treatment patients want during end-of-life care. CMS and other policymakers would like it recorded in the electronic record that patients either have an advanced directive or have chosen not to create one. CMS has signaled that this criterion will become a core requirement in the next stages of meaningful use rules.

The workgroup hopes to have its ideas ready for a first round of comments and feedback by year's end, with more fine-tuning and drafting expected to occur through the first half of 2011 before final recommendations are brought to the full committee.

The first stage of meaningful use rules go into effect Jan. 1, 2011. Hospitals and eligible providers will be able to submit proof that they followed meaningful use criteria around April 2011. The first incentive payments could come in May, CMS has said.

In the meantime, the Meaningful Use Workgroup plans to cull ideas from all the experiences providers will have with Stage 1 over the next eight months as it develops its criteria for stages 2 and 3. By the second quarter of 2011, policymakers should have information about which types of health care organizations are ready for meaningful use, said Tang, who is vice president and chief medical information officer at the Palo Alto Medical Foundation. "We wanted to use that information as part of the mix of input that goes into our recommendations," he said during the workgroup meeting.

Don Fluckinger contributed to this report. Let us know what you think about the story; email Jean DerGurahian, News Writer.

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