LAS VEGAS—“Here we come, interoperability and exchange,” said Farzad Mostashari, MD, national coordinator for health IT, at the annual 2012 Healthcare Information and Management Systems Society (HIMSS) conference, when he subsequently announced the proposed rule for meaningful use Stage 2, which will be published in Federal Register on Feb. 23, and a delay in the reporting requirements for Stage 1.
A huge crowd awaited Mostashari's presentation on the proposed rule. Most importantly, and greeted with cheers, was the announcement of an extension of Stage 1 until fiscal year 2014. The rule retains the 90-day reporting requirement in the first year of Stage 1 and all providers will continue to be in Stage 1 for two years.
“We’ve stayed the course,” said Mostashari, adding that a lot of the proposed rule is the result of listening to and learning from Stage 1 feedback. The three biggest drivers of the proposed rule are patient engagement, information exchange and clinical decision support.
“We’ve seen a remarkable increase in the adoption of EHR technology for outpatient providers and hospitals,” but exchange of information is still lacking. By 2014, when Stage 2 is in effect, “we’ll see a big push for standards-based exchange, because we can’t wait another five years.”
There is going to be a push on patient engagement, he said, as well as continuous quality improvement. “We take very seriously the president’s executive order to increase flexibility and decrease regulatory burden. We tried to be as flexible as possible.”
Regarding information exchange, the proposed rule includes standards for transport and the Direct protocol will become a required part of certified EHR technology. The rule also provides for optional certification to the Simple Object Access Protocol (SOAP) approach for information exchange. “We are pushing for the first time in our patients’ history a single consensus for standard lab results,” Mostashari said, as well as messaging standards, public health reporting, vocabulary and a single standard for problems.
“We’re seeing the infrastructure for widespread exchange,” he said. “As a reflection of that, we are proposing a push for very ambitious exchange” that includes actual exchange of data across organizations rather that just testing of exchange.
A new requirement is the ability for patients to view online, download or transfer their records. The move to more patient-centered care in the proposed rule was intentional, he said. In fact, providers will be required to allow at least 50 percent of its patients to have the ability to view online, download or transfer their records through a portal and, further down the line, demonstrate that at least 10 percent of patients are doing so.
The proposed rule includes “important new requirements for vendors around usability and safety reporting,” he said, as well as many important flexibilities for specialists. Those include everything from scope of practice exclusion, flexibility around what constitutes an encounter and menu items relevant to specialists. The rule also proposes the viewing of images as an optional menu item.
“We really worked very closely with colleagues across the federal government to make sure that clinical quality measures are aligned,” Mostashari said, regarding physician quality reporting, patient-centered medical homes, the Joint Commission and more. The rule is “long and thoughtful” around quality measures. His team also considered which pieces of EHR technology certification are needed to ensure that providers can yield what is expected in the way of reliable and accurate quality measures. “We’re not going to get there until we try.”
A lot of the proposed rule is “not a dramatic change in direction. We’ve all learned that to truly make meaningful use of meaningful use takes time. We continually make better use of meaningful use as a tool for you to help improve patient care—higher quality, safer, more effective, efficient and patent-centered care.”
There will be the customary 60-day comment period on the proposed rule and the Office of the National Coordinator for Health IT team encouraged the audience to provide both positive and negative feedback. The comment website now includes a standardized template.