HIMSS, ACP join chorus line of Stage 3 detractors

Count the American College of Physicians and the Healthcare Information and Management Systems Society among an increasing number of high-profile groups calling for changes to the proposed Meaningful Use Stage 3 rules recommended by the ONC's Health IT Policy Committee in November.

Already this week, the American Medical Association, the American Hospital Association and the College of Healthcare Information Management Executives have shown skepticism in their comments on the proposed criteria, with the AMA calling for an outside evaluation of the program and CHIME calling the Stage 3 thresholds "unrealistic."

Now the ACP, which represents 133,000 internal medicine physicians and medical students, is expressing concern that proposed measures don't focus enough on measuring improvements in patient outcomes.

"The Stage 3 proposal continues to be a large and growing collection of functional measures," Michael Zaroukian, chairman of the ACP's Medical Informatics Committee, writes in a letter to National Coordinator for Health IT Farzad Mostashari. "The proposed Stage 3 measures appear nearly identical in structure to those in previous stages. There are no measures specifically related to outcomes."

Zaroukian also calls the proposed measures "arduous" and "difficult to meet," and says that eligible providers and hospitals could interpret them as focusing too much on "increased documentation" rather than improved outcomes.

"Many of the prescribed practices do not appear to consider the logistics or practicalities of the day-to-day practice of medicine," Zaroukian says.

"As a consequence, we believe the requirements are likely to result in new, inefficient workflows and activities that shift physicians focus away from the intended goal of IT-enabled patient-centered care and toward habits in which our eyes and attention are taken away from our patients and instead focus too much on the data we need to get into the computer system for purposes that conflict with our sense of what is truly needed for quality, safety and value."

HIMSS chair Willa Fields and President and CEO H. Stephen Lieber, meanwhile, call for the Stage 3 final rule to be published "at least 18 months before the beginning of the required implementation period," saying that the gap will give developers ample time to make necessary changes to their technology, as well as for certification.

Fields and Lieber also call for a shift in the program's implementation to a model that focuses more on "encouraging and assisting providers to take advantage of the substantial capabilities established in Stages 1 and 2" including interoperability.

"We recommend this approach, rather than adding large numbers of new Meaningful Use requirements and product certification criteria and revisiting the desirability of major changes every two years," they say.

To learn more:
- here's the ACP letter (.pdf)
- check out the HIMSS letter (.pdf)