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AMDIS: ONC advisor says meaningful use final rule achieves balance

OJAI, Calif.–The goal was to make meaningful use ambitious, but achievable, said Farzad Mostashari, senior advisor for policy and programming at the Office of the National Coordinator for Health IT (ONC), who clarified several points and answered many questions about meaningful use at the AMDIS Physician-Computer Connection Symposium Thursday.
 
“No one got everything they wanted, but I think we got it right,” Mostashari said.

He highlighted changes in the final rule that were made based on input from clinicians:
  • Administrative transactions have been taken out of the final rule. Linking administrative and clinical data is essential to long-term value of the U.S. healthcare system, he said, “but the issue we heard was on timing: Transition from 4010 [standards for HIPAA transactions] to 5010 right in the middle of Stage 1 would have meant that outpatient practice management systems or even EHR-integrated solutions wouldn’t meet the requirements." The ONC has signaled its intent to include administrative transactions in Stage 2 in 2013 and beyond, he said.
  • Fewer core measures and an optional menu set of 10 measures, five of which can be deferred, allow for greater flexibility. Core required measures—computer physician order entry (CPOE) and clinical decision support systems support among them—are “things that are fundamental to being able to do other things,” such as electronic reminders and timely delivery of patient care summaries, he said.
  • Patient access to records and after-visit summaries must include a paper option. In terms of formatting, in Stage 1, “every system has to be able to produce either CCR [Continuity of Care Record] or CCD [Continuity of Care Document],” said Mostashari. “You can take a CCR or CCD document, and put it into a style sheet that creates a PDF from that.”
  • The CPOE/decision support requirements make it easier to get started and help in accurate quality measure reporting, he said. “We went from 11 orders on the inpatient side to one—start with medications.” Stage 1 meaningful users must show that 30 percent of all patients who have something on the medication list must have at least one CPOE-generated medication order.

The originator of the order, not a transcriber, should input the order: “The goal is to be able to have intelligence at the point of care,” he said. Non-physicians with legal authority, those with ordering privileges, can initiate an order into the system.

These changes in the final rule will help make meaningful use easier to attain, Mostashari said. “It’s going to be hard, but it’s doable. I hope you’ll agree that for motivated providers, meaningful use is much more achievable than it was before.”

Following are some of the questions from the audience:

Q: There is some concern that the bar has been lowered. Are you concerned that reducing core measures and changing CPOE requirements might mislead facilities into thinking we don’t have to do very much differently than we’re doing today?
A: I think we struck a balance, because it’s important that there be a sense of momentum around this, so we can bring pressure on the ecosystem as a whole. Achieving meaningful use is not crazy-hard, but there’s some basic stuff that’s not being done consistently that can help.

Q: Do you have a goal for the number of doctors year to year who will become meaningful users?
A: We’re going to have to wait and see. We don’t have a hard target, but by 2015 the vast majority will be meaningful users.

Q: Regarding e-prescribing of controlled drugs: are you talking to the Drug Enforcement Administration (DEA)?
A: We’ve been talking to the DEA. Part of what we pushed for was to get the rule out. People needed enough clarity to start trying it out. This is another example where the rule is out; we have clarity and now it’s up to people to see if it’s workable.

Q: What about requirements for Phase 2 and beyond?
A: Everything that was in the NPRM [notice of proposed rulemaking] for meaningful use, we want to be there in Stage 2. Part of [the final rule objective] is helping people to set the road map.

Q: Will vendors need to upgrade systems for Stage 2?
A: Yes. The certification process is not ideal, but we wanted to get something out there quickly. The limited approach will run out at the end of Stage 1.

Q: If we’ve changed the goals for meaningful use, will we still have the data accessible to transform healthcare?
A: Standards for information exchange are going to get a lot tougher in Stage 2: Stage 1 information exchange has been limited by the absence of infrastructure.

Q: Is ONC working to figure out how much improvement we’re going to get in terms of cost and improved quality of care?
A: ONC is doing some modeling around that. A lot of this is about how you implement. The big unknown is whether we are going to see a bigger bang for the buck, or … whether new entrants who are doing this to get meaningful use payments will get less than superior results than those who have been leading the charge in the past.

Last Updated ( Tuesday, July 20 2010 )