First look at Stage 3

The Office of the National Coordinator for Health IT's (ONC) HIT Policy Committee has released a copy of its proposed recommendations for Meaningful Use (MU) Stage 3 for public comment.

“The Stage 3 vision includes a collaborative model of care with shared responsibility and accountability, building upon the previous MU objectives,” according to the 38-page document, unveiled at the committee's meeting Nov. 7. The report recommended increasing some of the percentage thresholds such clinical decision support interventions from five to 15 percent for all eligible hospitals and eligible providers (EPs), raising the required percentage of clinical lab results implemented in the EHR from 55 percent of results to 80 percent of results, and requiring more than 10 percent of patients use secure electronic messaging to communicate with EPs.

Some of the provisions new to Stage 3 include offering patients the capability to submit patient-generated information and to request amendments to their records online; requiring EHRs to receive, generate or access appropriate immunization recommendations; and requiring EHRs to be able to query other entities for outside records. 

The committee said that to be considered for Stage 3, an objective should support new models of care, address national health priorities, have broad applicability, promote advancement, be achievable and reflect the reasonableness/feasibility of EHR products. The committee prefers that standards for EHRs should be available if not widely adopted.

The committee also said that it recommends that "Stage 3 is the time to begin to transition from a setting-specific focus to a collaborative, patient- and family-centric approach."

ONC added several additional items for public comment, including questions on identity matching, transitions of care and the need for health IT safety risk assessments.   

Speaking during the Nov. 7 HIT Policy Committee meeting, Farzad Mostashari, MD, ScM, the national coordinator for health IT, said Stage 3 offers an opportunity to “jump out of the groove and look for more disruption.” He asked the committee to come “at this with a fresh eye.”

The ability to query patient information should be a top concern, he said, despite immature infrastructure and standards. Patients know that when they go to an emergency room, providers cannot look up their patient information from other healthcare systems. “I want us to reach out and ask again what could we do around querying and the main challenges that have been in place around that complex interoperability. I don’t think it would be responsive if we did not even ask for Stage 3 to move forward on a query-based set of criteria for the certification of EHRs and potentially Meaningful Use. I believe the imperative for exchange is high enough that I want to ask you to reconsider and to reach out and let us be open to the possibility that Stage 3 could include more robust capabilities around queries.”

The HITECH Act placed EHRs at the center of health IT efforts, Mostashari said, but “there is a finite limit to how much we can pile on to certified EHR technologies. It’s not tenable to keeping adding more into Meaningful Use and the definition of certified EHR technology. That may be, in a way, anti-innovative.” He asked what the committee can do to foster innovation –“to both share information with and receive intelligence from a whole panoply of other applications and services that can be built on top of that data architecture. “

Mostashari also questioned whether Meaningful Use requirements are doing enough to establish the privacy and security that must accompany the greater availability and the greater flow of information and are we doing enough to make sure safety is addressed as much as it possibly can be and that we’re setting the stage for innovation.

President Barack Obama’s re-election provided more time, he said, but “before you know it, the opportunity for that urgency is lost.”

The recommendations will be published in the Federal Register later this month, and public comments will be accepted for 45 days after that date. 

The committee will analyze the comments and hold further public meetings about Stage 3 in 2013 before formal rules are issued.