EHR Vendors Tell Federal Advisors They Want Narrower Stage 3 Requirements

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By Alex Ruoff  

May 27 — Federal regulators should take a “highly focused approach” and add no new certification requirements for Stage 3 of the meaningful use program, electronic health record vendors told federal advisors May 27.

Jonathan Zimmerman, vice president and general manager of clinical business solutions for GE Healthcare IT, at a meeting of the Health Information Technology Policy Committee's meaningful use workgroup, said Stage 3, which is expected to begin in 2017, should “add as few new certification requirements as possible and look for opportunities to eliminate existing requirements” and focus on improving the interoperability of EHR systems.

“Meaningful use is very complex. Each measure has detailed specifications and these, in turn, generate many questions and [frequently asked questions], often requiring revised and ever more detailed guidance,” Zimmerman said. “This complexity affects vendors and providers and hinders our ability to plan for orderly development and implementation. It also has required substantial diversion of our resources and those of our customers to understanding and communicating about the meaning and intention of specific meaningful use provisions.”

The Health IT Policy Committee, the main advisory body for the Office of the National Coordinator for Health IT, issued recommendations to the Centers for Medicare & Medicaid Services on requirements for Stage 3 in March.

The recommendations included requirements that would be new in Stage 3. For example, if adopted, the recommendations would require health-care providers to demonstrate the ability to use their EHRs to follow up on the results of laboratory tests and specialty consultations they order for patients.

The Health IT Policy Committee is working on its response to the CMS's proposed rule for Stage 3, expected sometime this fall.

Vendor Requests

Health-care provider and hospital representatives told the workgroup May 20 that physicians and hospitals are struggling to meet requirements of Stage 2 of the meaningful use program and will not be prepared to move on to Stage 3 in 2016.

The CMS on May 20 released a proposed rule that would delay the start of Stage 3 of the meaningful use program until 2017. The proposed rule would also give some health-care providers and hospitals an extra year at Stage 1 before moving on to Stage 2 in 2015.

Leigh Burchell, vice president for government affairs for the EHR vendor Allscripts and vice chair of the EHR Association, an EHR vendor industry group, said May 27 that the committee should “learn from many of the current challenges associated with Stage 2” and narrow the program's requirements. She said Stage 3 should not include any requirements not included in Stage 2 and should merely expand existing requirements.

“The emphasis, in evaluating what to keep, should be on greater and more effective use of the far-reaching and robust Stage 2 requirements and associated EHR capabilities, as well as any needed enhancements for interoperability, care coordination and more effective and less costly quality measurement,” Burchell said.

The EHRA in March asked the Health IT Policy Committee to remove several public health reporting requirements from the proposed recommendations on requirements for Stage 3.

The Health IT Policy Committee removed a requirement for reporting syndromic surveillance data to public health agencies. However, the committee's recommendations for Stage 3 requirements included several public health reporting requirements, such as reporting medication adherence, and focused on supporting both public health efforts and new models of health-care delivery that emphasize team-based population management care.

Calls for More

Mark Savage, director of health IT policy and programs for the National Partnership for Women and Families, a patient advocacy organization, said at the May 27 meeting that the committee should require new EHR functionalities in requirements for Stage 3.

He said patients surveyed by the NPWF wanted to be able to make amendments to their electronic record, a functionality not recommended by the Health IT Policy Committee.

“Patients want to share relevant health information with their provider and they want some control over their records,” Savage said.

William O'Byrne, executive director of the New Jersey-HITEC, the regional extension center for New Jersey, said there has “been a public recognition that there's a lot of value” for patients from the meaningful use program.

“Doctors are getting more data than they've ever had before and, more importantly, patients can experience the value of electronic health information: they can make appointments more easily, can obtain their records more easily and can get referrals more easily,” he said.

To contact the reporter on this story: Alex Ruoff in Washington at

To contact the editor responsible for this story: Kendra Casey Plank at

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