'Meaningful Use' Workgroup Incorporates Public Comments Into Stage 2 Criteria

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The Office of the National Coordinator for Health Information Technology's workgroup on “meaningful use” began April 5 incorporating public comments into its proposed criteria for Stage 2 of the electronic health records incentive program.

For many of the meaningful use objectives, the workgroup aimed to clarify or define the intent of the objective for the broader health care community.

ONC received more than 400 public comment submissions on the workgroup's proposed criteria for Stage 2 of the Medicare and Medicaid EHR incentive programs.

For objectives related to improving the quality, safety, and efficiency of health care, such as computerized physician order entry (CPOE), drug interaction, and electronic prescribing, the proposed criteria remained predominantly unchanged.

However, for clinical decision support, the workgroup agreed that the criteria for certification should be more specific. Clinical decision support (CDS) capabilities should include:

• providing a method of displaying to the provider the source or citation of the CDS;

• allowing rules to be configured to enable decision support based on patients' context, such as clinic visit or admission status;

• responding to information in patient charts about the patients' problems, allergies, medications, and vital signs; and

• integrating CDS with other EHR capabilities.

The meaningful use workgroup is aiming to make final recommendations on Stage 2 objectives, criteria, and implementation specifications in June. CMS is expected to publish the proposed Stage 2 meaningful use rule by the end of calendar year 2011, and publish the final rule by mid-2012.

Patient Engagement Criteria.

For many objectives related to improving patient engagement in care, such as clinical summaries, electronic access to health information, and discharge summaries, the easiest way to satisfy all of these requirements could be through making the data and information available to patients via a patient portal, Paul Tang, chair of the meaningful use workgroup and Palo Alto Medical Foundation chief medical information officer, said.

While the hospital portal requirement would be optional for achieving Stage 2 of meaningful use, by Stage 3 of the incentive program meaningful use it should become mandatory, workgroup members agreed.

Other forms of communication between patients and providers, such as secure messaging, would be mandatory, however, Tang said.

More complex objectives, such as engaging in bidirectional health information exchange and medication reconciliation, will require further discussions, workgroup members said.

Timing Options.

Workgroup members voted to explore recommendations made in comment letters to change the Stage 2 reporting period requirements from a full year to 90 days. This change would give implementers of health IT systems an additional nine months to prepare for Stage 2 of meaningful use, Tang said.

Some workgroup members expressed concerns with making the timing change, and said the workgroup should first analyze how such a change would affect the incentive program before making an official recommendation on the matter.

Charlene Underwood, workgroup member and director of government and industry affairs for Siemens Medical Solutions, said the additional nine months of preparation may not be enough to make the changes necessary for Stage 2. Underwood did, however, support looking into reducing the time of the reporting period.

Several workgroup members urged that the advisory group wait until there is more evidence on how the first phase of the meaningful use program is working in hospitals and physician practices. “We really need to see how Stage 1 is being implemented in the field,” Deven McGraw, workgroup member and director of the Center for Democracy and Technology's Health Privacy Project, said.

By Genevieve Douglas

Additional information and materials from the meeting and workgroup are available at http://healthit.hhs.gov/FACAs by clicking on the April 5 entry for the meaningful use workgroup.

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