'This is the year,' say CMS and ONC

Busy months ahead as ICD-10, Stages 2 and 3 loom
By Mike Miliard
01:00 AM

Speaking to a packed crowd at HIMSS14 this past February, Robert Tagalicod wanted to make sure everyone understood the transformative nature of what promises to be an intense 2014.

"This year will be a very busy year for eHealth," said Tagalicod, director of the Office of E-Health Standards and Services at the Centers for Medicare & Medicaid Services.

To prove his point, he rattled off a list of momentous dates – on the off chance anyone may have forgotten them.

First off, 2014 marks the start of Stage 2 meaningful use attestation. "This is the year," Tagalicod said.

And, the calendar is flipping fast toward the ICD-10 deadline. "This is the year," he said again. "And just to reiterate: The Oct. 1, 2014, deadline is a firm one, and you can quote me."

It may be scary, he admitted, but it's well worthwhile. ICD-10 will be the "foundation for greater interoperability and ease of transmitting electronic data, better quality measurement and reporting of clinical outcomes data, and lower costs and operational efficiencies and administrative simplification," Tagalicod said.

This is also the year where Stage 3 meaningful use comes into closer focus, with different notices for proposed rule-makings expected from CMS and ONC in the second half of 2014.

"We expect in the fall that CMS will release an NPRM for Stage 3," said Tagalicod, with "an accompanying ONC NPRM for the 2017 standards and certification criteria."

This year also marks the launch of CMS' E-Health University. The tool is meant to provide critical information for everything from the incentive program to quality measurement to administrative simplification, for providers at all stages of the journey, said Tagalicod.

It serves a "need for resources wherever you are with your initiatives," he said, "tailored to participants at every experience level."

No question, such assistance is sure to be welcome in many quarters, as hospitals and practices grapple with the challenges of Stage 2.

"There are a lot of providers out there who are feeling a lot of anxiety and a lot of pressure," admitted Mat Kendall, director of ONC's Office of Provider Adoption Support, speaking at another session at HIMSS14.

But Kendall and his ONC colleagues offered the auditorium-sized audience reasons to take heart, stay positive and stick with the program; in a "robust conversation" with stakeholders, they explained the spirit of ONC regulatory policies, shed light on certification criteria and urged attendees to keep focus on the long game of interoperability, data exchange and improved outcomes.

Steven Posnack, director of ONC's federal policy division, asked for a show of hands from those who'd attended HIMSS12 in Las Vegas, where Stage 2 rules were unveiled.

"Close your eyes, and think about how much has changed about your daily work since Las Vegas," he said. "Likely, a lot."

Hard to believe, but "that's the last time we issued a rule making," said Posnack. "Two years ago."

That streak came to an end in February, as ONC launched the 2015 edition of its EHR certification criteria, which Posnack said is meant to build on the commitment to flexibility promised with the 2014 rules.

In a press release announcing the new proposal, ONC noted this is the first time it is issuing certification criteria separate from CMS's meaningful use regulations. Officials say this signals the agency's new regulatory approach – one marked by more incremental and frequent rulemaking.

"The proposed 2015 edition EHR certification criteria reflect ONC's commitment to incrementally improving interoperability and efficiently responding to stakeholder feedback," said National Coordinator Karen DeSalvo, MD, in a press statement.

"We will continue to focus on setting policy and adopting standards that make it possible for health care providers to safely and securely exchange electronic health information and for patients to become an integral part of their care team," she added.

Compliance with the 2015 edition would be voluntary, according to ONC. Developers who have certified EHR technology to the 2014 edition would not need to re-certify to the 2015 edition for customers to participate in meaningful use, according to ONC.

Likewise, those providers eligible to participate in the Medicare and Medicaid EHR Incentive Program would not need to upgrade to 2015 edition criteria to have systems meeting the definition of certified EHRs.

"This provides the opportunity for developers and healthcare providers to move to the 2015 edition on their own terms and at their own pace," said DeSalvo.

Back at HIMSS14, Kelly Cronin, ONC's health reform coordinator, emphasized the importance of keeping focused on big goals, no matter how frustrating certain day-to-day challenges might be.

"We are completely committed to realizing a patient-centered, value-driven healthcare system, and we want to make sure secure exchange of information is going to enable that," she said.

Cronin empathized with all those struggling with the challenges of Stage 2, and perhaps uncertain about the future, but she encouraged optimism.

"A lot of us feel like we've been at this a long time, no matter where you're sitting – whether you're a hospital or a clinic or a vendor or in government," said Cronin. "It’s hard work. We've all had our ups and downs in the past decade, but we have made so much progress, and I think we're so well poised now to take on these challenges and make a lot of progress in the next decade."

"There are a lot of folks out there who feel like they're hitting the wall," said Kendall, using a marathon metaphor. "We want people to push through because the benefits we're talking about are really greater as we go forward."