HIT Policy Committee workgroups: Stage 3 rule in need of fine-tuning

The Health IT Policy Committee workgroups agree with much, but not all of the Centers for Medicare & Medicaid Services' suggestions in its proposed rule implementing Stage 3 of the Meaningful Use program.

In Tuesday's Health IT Policy Committee meeting, members of the Advanced Health Model and Meaningful Use workgroup said they agreed with the proposed rule's aims of simplification, burden reduction and flexibility. However, they said, rule could use some adjusting.

For instance, said workgroup co-chair Paul Tang of the Palo Alto Medical Foundation, if CMS offers a reporting period shorter than one year, every provider should be required to use the same shorter reporting period in order to facilitate interoperability. What's more, the public health reporting requirements, such as the need for bi-directional exchange, also should be tweaked, said Joe Kimura, from Atrius Health.

There was further disagreement with some of CMS' proposed requirements for health information exchange (HIE). For instance, while the Interoperability and HIE workgroup agreed with the rule's goals in general, the workgroup found some of the suggested thresholds too high.

"We don't want to penalize people for what's genuinely out of their control," workgroup chair Micky Tripathi said. For instance, he said, the threshold for sending a summary of care record should be 40 percent, not the proposed 50 percent. The threshold for new measure 2, receiving and incorporating electronic summary of care records, should be 25 percent, not CMS' proposed 40 percent, and providers should have discretion as to what to incorporate. There should also be an exclusion regarding records coming from providers not using certified EHR technology. 

If the thresholds are going to remain high, Tripathi said, then more exclusions should be allowed.

A number of commenters did not agree with some of the workgroup's recommendations, such as whether to allow medical assistants to conduct reconciliations, or whether record "selfies" shared within an integrated delivery system should be counted as part of the thresholds.  

National Coordinator Karen DeSalvo, meanwhile, said she expects to continue to lead ONC "for some time," adding that Health and Human Services Secretary Sylvia Mathews Burwell considers health IT "essential to her initiatives." DeSalvo has been appointed to be assistant secretary for health at HHS but has not yet been confirmed.

The proposed rule and the proposed rule on 2015 certification criteria were published in the Federal Register March 30. Comments are due May 29.

To learn more:
- access the meeting materials