Mostashari: Meaningful Use Stage 2, EHR certification proposals add flexibility

Farzad Mostashari, M.D., national coordinator of health information technology, clarified some aspects of the proposed Meaningful Use Stage 2 and EHR certification rules at a press conference following his keynote speech Thursday at the Health Information and Management Systems Society conference in Las Vegas.

The Notice of Proposed Rulemaking for MU Stage 2 has now been published in the Federal Register.

Mostashari (pictured) described several ways in which the proposed regulations are more flexible than the current rules. For example, he said, specialist physicians will be required to meet only the Meaningful Use requirements that pertain to their specialties and can select menu items that are relevant to them.

Under the proposed rules, he said, medical groups will be able to do batch reporting of data to the Centers for Medicare & Medicaid Services (CMS), instead of having to send in a separate report for each physician. If providers report to accountable care organizations on the same quality metrics required to show Meaningful Use, they won't have to report the data again to CMS, which runs both the electronic health records incentive program and a shared savings program for ACOs.

To meet the Meaningful Use criteria, providers can continue to use EHRs certified under the 2011 regulations until the end of 2013, Mostashari noted. After that, they'll have to use EHRs that meet 2014 certification rules. However, they'll be able to pick only those technology modules they need to satisfy the criteria they have selected plus the base requirements, he said.

And software adapted for mobile devices would not require additional certification if they retain the same functionality, he said.

In the privacy and security realm, Mostashari noted that EHRs will have to encrypt data "unless there is a good reason not to." To be certified, products will have to provide encryption by default on all devices where personal health information is stored.

Mostashari described new certification requirements related to standard clinical vocabularies. The Office of the National Coordinator for Health IT (ONC) is proposing that all EHRs use single terminologies for various data elements, including SNOMED for problem lists, RxNorm for medication lists, LOINC for lab data, and standard terms for immunizations.

Mostashari said EHR vendors are in favor of this type of standardization, even though it will force them to revise their software and their databases. "We've seen overwhelming support of interoperability standards by vendors," he said. "They've recognized that they'd rather not have their engineers work on interfaces and would prefer to focus on usability and population health management."

During a question-and-answer session following his speech, Mostashari praised members of the standards development organization HL7 for quickly approving the new consolidated Clinical Document Architecture (CDA) standard, which includes the Continuity of Care Document (CCD) and several other standardized documents for exchanging information among providers with disparate EHRs. The consolidated CDA can be used to meet the interoperability criteria of Meaningful Use Stage 2.

In his speech, Mostashari said, "We've made more progress on EHR adoption in the past two years than we made as a nation in the previous 20 years."

Predicting that the bulk of physicians and nearly all hospitals would embrace Meaningful Use, he said, "By next year, the majority of care will be documented in EHRs, not paper...There's a massive river flowing of advances in health IT, and there's no going back."

To learn more:
- see the NPRM for Meaningful Use Stage 2 (.pdf)
- read a fact sheet on the stages of Meaningful Use (.pdf)

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