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Beyond the expected focus on increased patient access to health data, medical outcomes, and clinical quality and safety, proposed rules for meaningful use stage 3 and vendor certification also contain new features, such as APIs for electronic health records (EHR) systems and patient-generated health data from wellness devices.
And the 300 pages of modifications to the HITECH Act of 2009, which originally created meaningful use, contain few mentions of financial incentives now that most of the $30 billion for providers to digitize health records has been spent -- but it does include extensive language about reduced Medicare and Medicaid reimbursement.
"We've gone from the carrot to the stick," said Charles Christian, chairman of the board of the College of Healthcare Information Management Executives (CHIME), and vice president and CIO at St. Francis Hospital in Columbus, Ga. "Now it's about avoiding penalties."
Patient engagement, API challenges
The new "view, download and transmit" measure -- which has given many physicians and hospital officials trouble when it required only 5% of patients to electronically obtain their health data -- will be hard to achieve at the 25% required in the proposed rule, Christian said.
"We've struggled as organizations with that," Christian said.
On the vendor side, provider CIOs will closely watch the new stage 3 EHR certification rules for the proposed 2015 Edition released by the U.S. Office of the National Coordinator (ONC) for Health IT for how vendors incorporate data-sharing APIs into new EHR platforms, Christian said.
APIs are seen by interoperability advocates as the means by which health data will be exchanged more easily than it is now, both between EHRs from competing vendors and between providers and other providers.
API advocates claim API-based interoperability -- of which the fast-developing Fast Health Interoperability Resources standard is one current example backed by ONC -- will be less expensive and cumbersome than Direct messaging and many HIEs.
Many providers that have struggled to attest to meaningful use stage 2 have cited technical problems with HIEs and Direct in exchanging health data with other providers.
One vendor, athenahealth Inc. of Watertown, Mass., gave a similarly ambivalent review to the new stage 3 vision.
"We are pleased … that the stage 3 proposed rules move beyond check-boxes and provider micromanagement to focus more deliberately on the need to foster actual interoperation in healthcare," Dan Haley, athenahealth's vice president of government and regulatory affairs, said in an email.
However, Haley said that while athenahealth -- which prides itself on the openness of its cloud-based systems -- pledges to enable its clients for stage 3 requirements, the company is disappointed that the proposed rules do not go farther. A bill filed by U.S. Rep. Michael Burgess, M.D., (R-Texas) to legally mandate EHR interoperability would do more for "information sharing and openness," Haley said.
"As written, we believe the proposed rules make incremental improvements to the struggling MU program, but will do little to achieve the potential of information technology to vastly improve care delivery and efficiency in healthcare," Haley added.
HHS wants guidance on wearables data
One unusual aspect of the unveiling of the new rules for providers is the extensive amount of input that CMS solicited not only in the introduction, but also in the statutory text of the document, Christian said.
Among the areas in which federal health IT officials are soliciting guidance is how to use patient-generated data from wearable wellness devices and tracking systems.
Christian expressed skepticism about that effort, saying it is difficult for hospitals to oversee how primary care physicians get and use wellness information, including data about physical activity, blood pressure, heart rate and body weight.
"It seems like Apple and others got their wish to get their information into our records," Christian said, referring to Apple Corp.'s Health Kit app, which appears to be emerging as a standard of sorts for wellness devices from various manufacturers. Microsoft. Corp. and other companies also have health apps.
Stage 3 will be hot at HIMSS
Following HHS' release on Friday of the proposed meaningful use provider rule and a related vendor certification rule, there is a public comment period until May 29 for both draft regulations. Under the proposal, providers will start attesting to meaningful use stage 3 -- the final stage of the program -- in 2017, and new Medicare payment adjustments would take effect in 2018.
With the short comment period, providers, vendors and others in health IT will likely make stage 3 a top discussion item at the HIMSS 2015 annual conference in Chicago next month, Christian said. Karen DeSalvo, M.D., national health IT coordinator, is slated to make the final keynote at the event.
Christian said that while healthcare CIOs will take many of the proposed new requirements in stride, they are bound to be unhappy with a mandated 365-day reporting period for stage 3 for most providers and a dramatic increase in the number of patients required to use electronic health portals.
Federal officials say stage 3 is progress
It's clear healthcare regulators think the stage 3 and vendor certification drafts offer a step in the right direction. "ONC's proposed rule will be an integral component in the shared nationwide effort to achieve an interoperable health system," DeSalvo said in an HHS release.
"The certification criteria we have proposed in the 2015 Edition will help achieve that vision through provisions that consider the range of health IT users and uses across the care continuum, including those focused on interoperable standards, data portability, improved transparency, privacy and security capabilities, and increased oversight," DeSalvo said.
CMS' top meaningful use official, Patrick Conway, M.D., the agency's acting deputy administrator and chief medical officer, said in the HHS release that the proposed stage 3 rules simplify meaningful use, advance health IT by improving healthcare quality and align meaningful use with HHS' value-based reimbursement program.
The proposed measures for providers are grouped in 18 main categories, with 15 new core measures, fewer than in stage 1 and stage 2.
"That doesn't make it any less difficult," Christian said.
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