Meaningful Use Stage 3 not the end of government health IT involvement

We're all still digesting the hundreds of pages in the proposed rule implementing Stage 3 of the Meaningful Use program and the 2015 Edition of certification criteria. Clearly there's a lot to review.

According to the U.S. Department of Health and Human Services, "these proposed rules will give providers additional flexibility, make the program simpler, and drive interoperability among electronic health records, and increase the focus on patient outcomes to improve care." 

An initial reading does bear some of this out. Reporting now will be the same for all participating providers, and on a calendar year basis. Some of the objectives offer options. Quality data for reporting purposes will be aligned.  

But the rules also raise several some preliminary questions about the decisions the Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health IT are making.

For instance, while there are only eight objectives in Stage 3, they're pretty meaty. The new patient engagement requirements are extensive. Some providers have already expressed concern that the objectives are too ambitious and burdensome.

And look at the objective to protect patient health information. Security of electronic data has already been a big problem in 2015. The proposed rules aim to strengthen the privacy and security measures of Meaningful Use, adding administrative and physical safeguard requirements and more use of "enabled" audit logs.

But aren't those already required by HIPAA?

There's also this, more fundamental question: Assuming Stage 3 is even needed, what happens when it's over? Does the government pack up its health IT bags and go home?

Many people want it to. Some have gone so far as to recommend that ONC has no authority beyond Meaningful Use, that the agencies should get out of the business of health IT, and let market forces take over.

Those people, however, haven't done their homework.

Let's venture back to the dark ages of 2009 and the birth of the HITECH Act.  

Many think of it just as two parts: creating the Meaningful Use program to provide incentives for the adoption of EHRs, and strengthening HIPAA. 

Not true. Even a quick look back to the HITECH Act reveals that it includes a whole host of "specific objectives, milestones and metrics," including quite a number that have yet to be accomplished, including:

  • The electronic exchange and use of health information and the enterprise integration of such information
  • The utilization of an electronic health record for each person in the United States (which was supposed to occur by 2014)
  • The incorporation of privacy and security protections for the electronic exchange of an individual's individually identifiable health information
  • Methods to foster the public understanding of health information technology
  • Strategies to enhance the use of health information technology in improving the quality of health care, reducing medical errors, reducing health disparities, improving public health, increasing prevention and coordination with community resources, and improving the continuity of care among health care settings
  • Specific plans for ensuring that populations with unique needs, such as children, are appropriately addressed in the technology design, as appropriate, which may include technology that automates enrollment and retention for eligible individuals

HHS knows this. It even called the proposed Stage 3 rules just "one part of a larger effort."

Stage 3 may be the final stage of the Meaningful Use program. But unless there are major changes in the law, the government will be a major player in health IT for years to come. Stakeholders must come to the table knowing that. - Marla (@MarlaHirsch and @FierceHealthIT)

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