HIT Policy Committee approves Stage 3 recs after debate

After much debate during the March 11 Health IT Policy Committee meeting, members of the federal advisory committee voted to approve the Meaningful Use (MU) Work Group’s Stage 3 recommendations.

The recommendations were scaled back from 26 to 18, with those surrounding care planning, reminders, eMAR, imaging, medication adherence and amendments scrapped for now.

The MU Work Group focused on four areas of emphasis: clinical decision support (CDS), patient engagement, care coordination and population management.

“We need to be careful to weigh the impact on providers,” said Paul Tang, MD, co-chair of the committee, when introducing the updated Stage 3 recommendations. “We can’t burden them unnecessarily. We need to be flexible as we can be.” He also said the Work Group made a point of avoiding requirements where the standards are not mature and tighten its focus. “We carefully selected those with the most bang for the buck.”

Under the view, download, transmit (VDT) requirement, the Work Group changed the Stage 3 recommendation from having information available within four business days down to 24 hours. Tang acknowledged that would take some effort on the part of providers but “timeliness of getting information is really important. It deserves as quick a turn-around as possible.”

Under care coordination recommendations, Tang said summary of care at transitions and notifications are “two areas that are still challenging.” The Work Group recommends categorizing transitions and a new requirement for providers to send electronic notification of significant healthcare events within four hours. The recommendation previously said “a timely manner,” which they realized was open to interpretation.

The MU timeline calls for a notice of proposed rulemaking to be published in the fall with the final rule issued in the first half of 2015. That should allow for time to include more feedback from Stage 2, he noted.

National Coordinator for Health IT Karen DeSalvo, MD, MPH, MSc, stressed that MU is only one tool the ONC has to advance the health IT agenda. "This is the next chapter of this program, but not the last chapter," she said.

Several committee members expressed dissatisfaction with the outcome of two years of policy development work but some pushed for more and some said providers already are overburdened.  

DeSalvo pointed out that approving the recommendations would allow the Standards Committee and others to begin the process of testing the realistic technical opportunities and feasibility of the proposed measures. Several committee members expressed interest in writing letters to accompany the recommendations that would outline their concerns or objections. ONC plans a series of listening sessions as an opportunity.

Software entrepreneur Paul Egerman said more should have been done to review results from Stage 2. For example, “some things in patient engagement have worked extremely well and some are more questionable. We need to understand to make better recommendations.”

“I think we’re going too slow,” said Neil Calman, MD, president and CEO of The Institute for Family Health. “If we keep slowing down, we will have wasted billions of dollars,” he said, referring to incentive payments.

More than $20 billion already has been spent, said David Lansky, PhD, president and CEO of Pacific Business Group on Health. “The goal has always been to get to outcomes. There are lots of individual trees and bushes we’ve been whacking at” but the aggregate doesn’t meet the goals.” He also cited the committee’s “rearview mirror process” where “we need to create some space for much more aggressive forward movement in this model.”

While he said he appreciates the comments about moving faster, Marc Probst, CIO of Intermountain Healthcare, added that providers are working incredibly hard and still are not going to meet the requirements of Stage 2. “I love this list for Stage 3, it’s exactly what we need to be doing but the industry is hurting to get done what we’ve already put on the table.”

“What good is Stage 3 if nobody gets there?” said Gayle B. Harrell, a Florida state representative appointed to the HIT Policy Committee by the Speaker of the U.S. House of Representatives.