Critics take fire at AHA's designation of Stage 2 as 'not feasible'

With a May 7 deadline for submitting comments on the proposed rule for meaningful use Stage 2, some of the largest associations representing healthcare organizations and professionals submitted their comments last week, some to great criticism.

The American Hospital Association (AHA) and the College of Healthcare Information Management Executives (CHIME) expressed concerns about the timing and the content of the proposed rule.

AHA submitted a 68-page letter on April 30, in which AHA Executive Vice President Rick Pollack warned that the requirements for Stage 2 were "not feasible," especially since more than 80 percent of hospitals haven't attained Stage 1. That's partly because vendors have yet to offer the capabilities necessary to meet the high standards. 

"Many of the proposals put regulatory requirements ahead of actual experience with these technologies—an approach that will likely have unintended consequences," Pollack wrote.

CHIME CEO Richard Correll and Board Chairman Drex DeFord expressed similar concerns, declaring the objectives "overly ambitious" in a 46-page letter.

The two organizations agree with the delay of Stage 2 to 2013, but say the start date should be pushed back even further. CHIME also recommended that in the first year of Stage 2 providers should demonstrate meaningful use during a 90-day reporting period, similar to Stage 1, and require a full year reporting period only after the first payment year. The proposed rule requires that meaningful use be demonstrated for the full year throughout all of Stage 2.

AHA is particularly concerned with the proposed objective on providing patients with the ability to access, download and transmit their protected health information via patient portals, citing security issues and claiming that it went "well beyond" current technical capabilities.

Deven McGraw, a lawyer and director of the Health Privacy Project at the Center for Democracy and Technology, and also a member of the federal Health IT Policy Committee, protested in a blog post, suggesting the AHA arguments were one more attempt to resist long-needed change.

“The argument that the existence of these HIPAA provisions prevents CMS from imposing more meaningful access to patient data as a condition of receiving substantial taxpayer subsidies is the legal equivalent of a "hail mary pass” (or an attempt to throw spaghetti on the wall to see if any of it sticks),” McGraw wrote. “HIPAA is a baseline health privacy law, and laws that provide more rights to patients are expressly not preempted. If a state were to take CMS’ proposed meaningful use requirements and make them law, that law would stand as not being preempted by HIPAA. There's no basis for the argument that CMS can't create conditions on meaningful use dollars that give patients greater rights.”

She continued: “Congress specifically stated in the HITECH legislation that created the EMR meaningful use incentive program, that the federal government’s health IT programs should focus on advancing the delivery of patient-centered care, protecting the privacy and security of electronic health information, and prioritizing the ability of individuals to securely access their health information.”

Also taking criticism with the AHA's comments, Vice President of the National Partnership for Women & Families Christine Bechtel, a member of the Health IT Policy Committee, wrote in a blog post that AHA "has little interest in advancing meaningful use criteria that would result in tangible benefits to patients."

She added: “Objecting to the proposed 36-hour timeframe for patient access to information after discharge, the AHA instead advocates a 30-day timeframe for access to such basic, crucial and highly time-sensitive information as discharge instructions, medication lists, lab test results and care transition summaries… This is the very information that can help keep patients from being readmitted unnecessarily.”