When weighing in on Stage 2, specificity matters

John Loonsk, MD, CMO of CGI Federal

At the risk of being very “inside the beltway,” the following comments are directed at the numerous national associations, advocacy groups, and other interested organizations who are gearing up to submit comments on the two meaningful use Stage 2 notices of proposed rulemaking (NPRMs) recently published in the Federal Register by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC).

Meaningful use is now known by many, but the NPRM comment process is still a somewhat arcane part of government for most. And while NPRM commenting can seem almost like a sport “inside the beltway,” increasing numbers of healthcare providers are realizing that these particular regulations will have a very practical impact on their everyday practices in an increasingly electronic healthcare world.

Making the technology, not just the providers, do more

There are a lot of details to digest in the hundreds of pages of these two regulations. Many of the details are dedicated to encouraging providers to use their EHRs to accomplish “meaningful” activities such as CPOE, quality reporting and health information exchange. The hope is that doing so will overcome some of the industry’s misaligned incentives and convert on the vision for health IT. Like birds evolving capabilities for flight, however, things in the middle may be ugly.

At risk is that during these intermediate stages, the burden of the meaningful use demands will not be balanced by actual capabilities of the technology to help achieve the outcomes. Nowhere is this clearer than in the area of quality measures. In most settings, technology is not really helping with the management of quality yet and we are far from automating the reporting process. The measures, however, and their huge demand for comparable data, keep on coming.

In this context, the comments herein focus on those parts of the NPRMs that can actually help make the technology reduce provider burden and make the EHRs do more for the providers instead of just asking the providers to do more with their EHRs.

A one way street

Unfortunately, the regulation and comment process is not well suited for advancing technology with the kind of specificity that it frequently requires. CMS believes that the potential commenters for Stage 2 are better informed about the process than they were for Stage I, but it is still important to note that comments on an NPRM almost never lead to anything substantial being added to the final regulation. There would be no review of the new content.  So while details may be clarified and additional descriptive text may be added, for the substance of the rules, comments can really only lead to requirements coming out and/or weakening the actual regulation.