Stage 2 Criteria Need to Encourage HIE, Allow Flexibility, HIT Experts Say

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By Genevieve Douglas  

Stage 2 criteria for the Medicare and Medicaid electronic health record incentive programs do not go far enough to facilitate widespread, interoperable health information exchange, Joel White, executive director of the Health IT Now Coalition, told Bloomberg BNA Feb. 24.

The Health IT Now Coalition is looking forward to working with CMS to improve upon the rule, but “we are really concerned about this interoperability issue,” White said.

According to White, the proposed rule from the Centers for Medicare & Medicaid Services would delay Stage 2 of the $27 billion “meaningful use” incentive programs until 2014 for eligible hospitals and physicians who adopted EHRs and attested to meeting meaningful use in 2011.

Stage 1 criteria of the meaningful use incentive programs require a test of clinical information exchange. The proposed rule would eliminate the requirement to test exchange in 2012 and 2013, White said. As a result, providers and hospitals would not be required to exchange health information for care coordination until 2014.

The proposed rule for Stage 2 meaningful use criteria was released Feb. 23, and will appear in the March 7 Federal Register (see previous article). Comments are due 60 days after publication.

Over the course of 2012, the Department of Health and Human Services is expected to release additional proposed regulations on health information exchange governance, a final rule on Health Insurance Portability and Accountability Act (HIPAA) privacy and security policies, and guidance on participation in the Nationwide Health Information Network, White said.

Additional Comments on Proposed Stage 2 Criteria

In addition to promoting health information exchange through meaningful use of EHRs, CMS should ensure that vendors do not block information from other systems simply because the information is from a different vendor, White said in a Feb. 23 release from the Health IT Now Coalition.

“Any system that blocks information exchange should not be allowed in the program, and should not be subsidized by taxpayers,” White said.

Furthermore, CMS should develop an “appropriate” quality framework that maximizes patient safety and quality outcomes, according to the release. Clinical quality measure criteria should focus on outcomes measures that are computable by an EHR, not process measures that require only documentation of patient data, it said.

Additionally, CMS should continue to work on standards that better engage patients, such as by providing online and electronic access to their information, the release said.

The Health IT Now Coalition is comprised of 62 patient, provider, employer, and payer organizations that support the adoption and use of heath information technology.

Hospital Support for Delay

Alternately, hospitals support the delay of Stage 2 for early adopters in 2011 because vendors and providers need more time to implement Stage 2 requirements given the timing of the rules, AHA Policy Director Chantal Worzala told Bloomberg BNA.

AHA also supports the proposed rule's framework of core and optional objectives that gives hospitals flexibility in meeting the meaningful use requirements, Worzala said.

Worzala expressed concerns, however, with the Medicare payment penalties described in the proposed rule, which could “inappropriately accelerate” the date by which hospitals need to achieve meaningful use to avoid the penalties, she said.

According to the proposal, 2015 payment adjustments would be determined by meaningful use attestation data in 2013 for any hospitals participating in the EHR incentive programs.

While there is an exception in the proposed rule for hospitals beginning meaningful use program participation in 2014, 2015 penalties would still be based on only 9 months of attestation data, Worzala said.

“This timeline leaves little time for hospitals to attest to meaningful use,” she added.

Overall, Worzala recommended that CMS further analyze the implementation data from Stage 1 of the EHR incentive programs.

“Hospital commitment to harnessing the benefits of EHRs is very high,” Worzala said. “We really want to make sure that these regulatory requirements do not dampen enthusiasm for EHR adoption among hospitals.”

Industry Stakeholders Planning to Comment

Overall, the Stage 2 proposed rule reflects the collaborative nature between government and industry, including both prescriptive elements and explicit requests for feedback and ideas, Harry Greenspun, senior advisor for health care transformation and technology at the Deloitte Center for Health Solutions in Washington, told Bloomberg BNA.

Greenspun recommended that stakeholders review the rule carefully and engage in the government's comment process where they see fit to truly have an impact.

The American Medical Association and Siemens Healthcare released statements in response to the rule saying they plan to review the proposal and provide comments.

For More Information

The proposed rule is available at

A fact sheet from CMS is available at

Additional information on the Medicare and Medicaid EHR Incentive Programs is at


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