Panel weighs delaying stage 2 of meaningful use

By Mary Mosquera
11:32 AM
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An advisory panel that is shaping measures for the next stage of meaningful use has suggested delaying stage 2 by one year until 2014 as an option to allow vendors and healthcare providers more time to update and roll out more advanced technology.

It is one of the approaches for dealing with the compressed timeline for establishing stage 2 of meaningful use of certified electronic health records (EHRs), but it would come at the expense of early adopters.

The delay option would primarily affect healthcare providers that have met meaningful use in 2011, according to members of the meaningful use work group, a panel of the Health IT Policy Committee.

“This is a compromise,” said Dr. Paul Tang, the work group chair. It doesn’t delay the overall program. 

“It only affects one group, the group that comes in in 2011. Because of the way the rule is written, those people would be subject to a loss of one year’s incentive,” he said at a May 3 panel meeting. Tang is also chief medical information officer at the Palo Alto Medical Foundation. 

The option would give other providers a third year in which to qualify for stage 1 incentives instead of two, and potentially attract more providers to participate because they would have more time, he said.

Providers and vendors have told the panel, the Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare and Medicaid Services (CMS) that there is not enough time to develop new functionality for EHR software and establish it in practices. The final rule for stage 2 of meaningful use is not expected to be released until mid-2012.

At the same time, new care delivery methods, such as accountable care organizations, will rely on the adoption of advanced functions and features of stage 2 meaningful use that are being drafted now, including health information exchange.

[See also: Accenture's 5 tactics for running health IT like a business. And: NASCIO's 9 tips for starting NIEM.]

“We want to step back and see what we can do to maintain the momentum and progress made, and now more than ever with the pressures of ACO models and new payment mechanisms that may be in our future and the national quality strategy,” Tang said. 

The panel will bring its meaningful use measure recommendations to the policy committee next week and its timing suggestions in June.

Dr. Neil Calman, a panel member and CEO of the Institute for Family Health in New York, did not favor slowing down the process. Meaningful use has created a lot of momentum. He cited the functionality being drafted in stage 2, such as patient visit summaries, that will help coordinate care.

“There are parts of the reform process that we’re going to end up being an anchor and a drag on instead of leading,” he said. 

David Lansky, a panel member and CEO of the Pacific Business Group on Health, proposed that the panel focus on priorities for the functions needed to improve care and the larger objectives in the national quality strategy and reform approaches.

“I would worry about making sure that the information exchange functionality, care coordination functionality and patient engagement functionality are in the product and at least minimally in the criteria as soon as possible because all the other key parts of reform depend upon it,” he said.

While there was a lot of support expressed for delaying stage 2, that option also transfers pressure on timing for stage 3 in 2015. 

The other option the panel is considering is to proceed as originally planned on the timeline for stage 2 in 2013, with new functions and increased thresholds for 2011 measures, but possibly shorten the reporting period to 90 days instead of one year to give vendors and providers more time to update technology and clinical processes. 

Steve Posnak, ONC’s director of its federal policy division in the Office of Policy and Planning, suggested that the panel come up with a scorecard on each option that rates them on some key factors, such as momentum and meeting priorities. The advisory panel only provides advice.

“We have to solve the problem. We’ll find something that will make people equally mad on both sides, which will indicate that is a good policy," he added wryly.