Public Input Shaped the Guiding Principles for Stage 2 Meaningful Use NPRM

Joshua Seidman and Robert Tagalicod | March 27, 2012

The Department of Health and Human Services (HHS) recently released two notices of proposed rulemaking (NPRMs) related to Stage 2 of the Medicare and Medicaid EHR Incentive Programs that detail proposed Meaningful Use requirements for providers and the Standards & Certification Criteria (S&CC) that delineate proposed requirements for certified EHR products. The vast majority of the proposed criteria derive from the two federal advisory committees that have been lauded Exit Disclaimer as a model for public, open, and transparent policy making processes.

The proposed rulemaking continues to reflect HHS’ desire to create ambitious, but achievable goals that enable eligible professionals and eligible hospitals to continue progress in adopting and implementing electronic health records (EHRs). The proposed rules focus on using EHRs to improve health and health care while reducing the burden on physicians and hospitals where possible. Many of these “north stars” came through loud and clear in both the Health Information Technology Policy Committee (HITPC) and the Health Information Technology Standards Committee (HITSC) recommendations, as well as public input through the committees.

The proposed rulemaking sets ambitious requirements designed to improve health and health care. Every objective in meaningful use aligns with the National Quality Strategy, a framework the Department released in March 2011 that provides a clear roadmap for getting to better health, greater affordability, and better health care. The new core objectives relate to key elements of that strategy, such as secure messaging (secure patient-provider e-mail) to improve communication and patient and family engagement and electronic medication administration record (eMAR) to reduce medication errors in the hospital. In support of care coordination, whereas Stage 1 focused primarily on capturing structured data, Stage 2 proposes to raise the bar on advanced care processes, most notably through demonstrated health information exchange (HIE) and demanding real interoperability. Specifically, the NPRM proposes to drop the “exchange of key clinical information” test in favor of a real use case—exchanging a summary care record using a standardized method of transporting that data from one place to another. In addition, it would require providers to exchange that structured data both outside of their own delivery systems and with providers that use different EHR vendors.

HHS continues a strong push toward a patient-centered delivery system, incorporating additional proposed expectations for “meaningful use” of EHRs that would hold providers accountable for engaging patients and families with meaningful and useful information. Proposed core requirements transition consumer access to data from an “access and copy” paradigm to a “view, download, and transfer” approach in order to provide people with more useful and timely information. Another proposed core objective lays the groundwork for better patient-provider communication through the use of secure e-mail.

While we propose to set ambitious goals to improve health and health care, we recognize that these requirements must also be achievable. To that end, we have proposed reducing reporting on data collection objectives in Stage 2 by addressing concerns of specialists and aligning with other HHS programs.

We worked hard to provide greater flexibility for specialists. It is essential that meaningful use of EHRs ensures that structured data flow to, from, and among the full array of specialty providers. The NPRM proposes new menu item objectives relevant to specialists, including objectives related to imaging for cancer and specialist registries. Additional clinical quality measures were proposed that speak to specialists, as well. The proposed S&CC criteria would allow providers to attest to meaningful use without having to purchase EHR functions that their specialties would never use (e.g., chiropractors would no longer need to purchase e-prescribing modules). We continue to provide clarity around the ability for providers to claim exclusions for objectives that don’t apply to them.

We also proposed greater alignment in reporting requirements, including the option of allowing for group reporting of clinical quality measures, with other relevant HHS programs. We recognize the potential burden that varying requirements could have on providers. Therefore, we propose new approaches to data reporting for quality measurement that align with CMS programs like the Physician Quality Reporting System and meeting the e-prescribing requirements of multiple federal programs. As we noted above, the NPRMs represent proposals. We look forward to continued input from the public via the 60-day public comment process, which informs decision making regarding the final rules that will be released this summer. We enthusiastically invite you to voice your perspectives and share your insights to ensure that the final rules reflect the full range of viewpoints that are affected by these programs.