5 questions for the health IT regulators

Anyone who's ever wondered how the sausage that is Meaningful Use is made would have enjoyed yesterday's session at the College of Healthcare Management Executives Fall forum, dubbed a "dialogue with the regulators."

The Centers for Medicare & Medicaid Services' Travis Broome, special assistant to the consortium administrator, and Steven Posnack, director of the federal policy division for the Office of the National Coordinator for Health IT, answered audience questions about core requirements, health information exchange and interoperability and what's next for the Meaningful Use program.  

Will politicians scuttle Meaningful Use?

Even though some members of Congress and the Senate have questioned Meaningful Use incentive payments, the program isn't going to suddenly go away, Broome and Posnack said.  

"It's the law and the secretary doesn't really have the discretion to suspend the program. If someone becomes a successful meaningful EHR user, the regulations are out there on how to do that [and] they are entitled to the incentive payment. It really would take, at a minimum, a new regulation … It's not like [U.S. Department of Health & Human Services Secretary Kathleen Sebelius] can just write them back and say 'I agree--we're going to suspend.' It doesn't work like that," Broome (pictured right) said. "My political bosses have no desire for that to happen. We're dutifully crafting responses."  

"The Senators have asked to meet with us in the next nine days, Posnack added. "So we know where we're going to be going when we get back to D.C."

Are the Meaningful Use rules working?  

"We've made significant process in this recent rulemaking. Two years ago … I don't know if we necessarily had all the tools we needed to push as hard as we did," Posnack said in response to an audience question about information exchange and interoperability. "We've really started to grow a community around faster generation of standards, faster development. We've got a lot of building blocks in place to make, in certain instances, significant process--transitions of care being one of them."

Is there room for creativity in the regulations?

One piece of advice from Broome: Don't let those vendors push you around.  

"We really want you to be innovative--we've already seen a lot of innovative ideas dealing with the 5 percent of patients viewing, downloading or transmitting" their health data, Broome said. But if a developer tells you that CMS says something must be done one way and you don't feel that way is in the best interest of your organization and your patients, speak up, he added.

"Even if your developer's not involved and you think you have this bright idea but you're worried it doesn't quite fit the Meaningful Use objectives or you're worried about how to measure it … don't let that stop you. Contact us. We want to work with you. We want that innovation to happen. We want those ideas to flourish," Broome said.

Flexibility is baked in, Posnack (pictured right) added. "One of the things we did in response to everyone's comments for this recent rulemaking was to tilt the regulatory framework that we originally proposed to make it a little more dynamic and to make it more flexible for all of you out there that are implementing different certified technologies," he said.

What's new in health information technology quality measures?

Broome said that the concepts of Meaningful Use and its quality measures will spread to other programs and regulations. "For the quality measures, really, there were two big pushes … ramping up certification and … alignment moving forward," Broome said. "We're looking hard at how HIT is going to underpin all the other things that CMS is doing now. And a lot of those things use clinical quality measures."

One goal is to merge and align quality measures across programs to create one measure set. "Different programs might use different measures from the set but the set it the set," he said.  

Will there be a Meaningful Use Stage 7 ... or 77?

The concept of stages is a regulatory construction Posnack said. The concept wasn't in the statute but, rather, evolved over time.

"There could be stage 77 when all of us are no longer here or are cryogenically frozen. My grandchildren's grandchildren will be writing those rules. It really depends on the need of the industry moving forward," Posnack said. "The payment adjustment is in perpetuity until Congress changes the law. So that will continue on. And if there's a continuing need to push in different areas to make healthcare better, to make health IT use better, a new stage could evolve."

Of course, Broome said, future "stages" won't necessarily include incentive payments. "It might morph into something [closer to] general guidance, stuff ONC used to do before it had millions of bucks to throw around."

Meanwhile, some organizations are looking for greater challenges, Posnack added.

"Stakeholders [have] come out and said 'we haven't seen ourselves represented in the promise and the potential of health IT. And we were really counting on Stage 3 to deliver those things. And for those even more forward-looking, they're counting on Stage 4 to deliver some of those care delivery, health IT-driven … changes," Posnack said.

"That will be a tricky balance as we continue to move forward."


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