Does MU Stage 2 stay the course?

Beth Walsh, Editor, CMIO

After much speculation, the proposed rule for meaningful use Stage 2 has finally arrived. I was in the Las Vegas ballroom when Farzad Mostashari, MD, the national coordinator for health IT, announced the highlights of the rule which primarily focuses on patient engagement, information exchange and clinical decision support. The audience cheered when it was conveyed that Stage 1 would be delayed and when Mostashari referred to efforts to increase flexibility and decrease regulatory burden.

To that end, Steven Posnack, MHS, director, federal policy division, Office of the National Coordinator for Health IT (ONC), discussed the rule’s plan for a dynamic EHR model. The new EHR model includes a base EHR that will meet 2014 EHR certification criteria, and builds out to core and module EHRs. Users are familiar with complete and modular EHRs, he said, and those two categories will continue to exist. Providers can meet the definition of a base EHR with either a complete EHR or a combination of module EHRs.

“No longer is the definition of EHR technology built to set, 100 percent criteria," Posnack said. "Rather, it is driven by the meaningful use stage the provider needs to meet. The market needs to react and vendors need to supply different pathways. This is going to be an area where supply and demand need to meet. We think it will be worked out in a logical fashion.”

There is going to be a push on patient engagement, Mostashari said, as well as continuous quality improvement. A new requirement is the ability for patients to view online, download or transfer their records. The move to more patient-centered care in the proposed rule was intentional, he said. In fact, providers will be required to allow at least 50 percent of its patients to have the ability to view online, download or transfer their records through a portal and, further down the line, demonstrate that at least 10 percent of patients are doing so.

The proposed rule also includes “important new requirements for vendors around usability and safety reporting,” he said, as well as many important flexibilities for specialists. Those include everything from scope of practice exclusion, flexibility around what constitutes an encounter and menu items relevant to specialists. The rule also proposes the viewing of images as an optional menu item.

A lot of the proposed rule is “not a dramatic change in direction. We’ve all learned that to truly make meaningful use of meaningful use takes time," Mostashari said. "We continually make better use of meaningful use as a tool for you to help improve patient care—higher quality, safer, more effective, efficient and patent-centered care.”

EMR adoption is up from 2011 at U.S. hospitals but key barriers remain, according to a survey commissioned by the Optum Institute for Sustainable Health. The proposed rule should help with at least one of those barriers: interoperability. The survey found that among those participating in an health information exchange (HIE), data are on average accessible for only 60 percent of patients through the HIE. Two-thirds of respondents found data accuracy/completeness to represent the biggest business and technical issue they faced in using HIE capabilities, followed by inaccessible proprietary systems and high costs of interoperability.

Mostashari said the ONC, with the proposed rule for Stage 2, has "stayed the course." What do you think of the new requirements?

Beth Walsh
CMIO Editor
bwalsh@trimedmedia.com