WASHINGTON – The draft proposals for measures for meaningful use Stage 2 are taking shape. The panel has incorporated more emphasis on making the patient an active participant in healthcare and more exchange of health information as central to a number of the objectives.

An advisory panel presented its draft proposals for the next stage of meaningful use to the federal Health IT Policy Committee at a meeting May 11 in a step towards establishing the near-term agenda.

The panel also weighed in on timing options, showing favor toward delaying Stage 2 by one year to 2014, but with some members also expressing the need to maintain the momentum of the original timeline for 2013. 

Nothing was decided at the meeting as the meaningful use work group will offer its final recommendations to the committee in June.

Ultimately, the Centers for Medicare and Medicaid Services will determine the aggressiveness of the timing and objectives.

Farzad Mostashari, MD, the national coordinator for health IT, summarized the dynamic tension of “keeping our eye on the prize and feet on the ground, being clear about where we want to go but also being cognizant of where we are today.”

“No hospital CIO should feel that they have to make a choice between do I prepare for accountable care or do I go for meaningingful use," he said. "We should make meaningful use the roadmap of what we need to do to succeed where increasingly care is going to be reimbursed based on quality, efficiency, coordination and safety rather than pure quantity."

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Among the initial proposals, some measures from Stage 1 were moved from the optional menu category to core or required for Stage 2, such as incorporating laboratory results as structured data for 40 percent of test results ordered.

In other measures from Stage 1, the thresholds were increased to encompass more patients or make the electronic process more pervasive, such as the use of computerized physician order entry for 60 percent of patients with at least one medication order from 30 percent. The measure is expanded to include laboratory and radiology orders. 

New measures

Other measures are new, such as hospital labs sending structured electronic lab results to outpatient providers for at least 40 percent of labs sent electronically.

The next stage of meaningful use in 2013 also has more measures for engaging with patients, such as physicians offering secure messaging online with at least 25 patients sending secure messages. Providers will also supply a method, such as a list, for patients to enter data for their record. 

Matching up Stage 2 to Stage 3

Some committee members were concerned that Stage 2 measures were not rigorous enough to offset similar challenges in Stage 3.

“I’m concerned with when we get to Stage 3, we’ll be forced to water down requirements because providers have not moved far enough in Stage 2,” said David Lansky, a panel member and CEO of the Pacific Business Group on Health. 

For example, a number of quality measures around efficiency require imaging data to be available to evaluate the use of imaging studies. “If we’re not setting a very high bar for capturing image data in the record, we’re not going to be able to apply clinical decision support to it and not measure performance on efficiency and appropriateness of the imaging,” he said. The same applies to information exchange targets, such as for care coordination, to produce the data to coordinate care. 

Timing also is critical. The CMS will release the final rule for meaningful use stage 2 in mid-2012, while hospitals could start their reporting period as early as October, compressing development and deployment.

Paul Tang, MD, chair of the meaningful use work group and chief medical information officer at the Palo Alto Medical Foundation, outlined the timing options as maintaining the 2013 timeline with a one-year reporting period by providers or shortening the reporting period to 90 days like stage 1. A third option delays stage 2 until 2014.

The delay option would affect only the early adopters who qualified for meaningful use in 2011 and the maximum amount of incentives. 

“But it is highly unlikely that folks who are early adopters in 2011 are going to stop advancing either accomplishing a higher threshold of existing functionality or adding functionality that would be in stage 2,” he said.

Panel members also cited the requirement for providers to establish ICD-10 coding as part of the mix for delaying Stage 2.

However, Paul Egerman, committee member and software entrepreneur, preferred reducing the scope of measures or the reporting period. In the end, CMS may reduce the scope through its rulemaking process, as it did in stage 1.