Initial feedback positive on direction of MU stage 2 proposed rule

Compared with the industry pushback that accompanied the initial meaningful use proposal two years ago, the quiet following the release of the stage 2 proposed rule is telling. The reaction has been overwhelmingly positive.

Observers say that the Office of the National Coordinator for Health IT (ONC) is maturing its process to obtain the views of many large and small healthcare providers, technology vendors and innovators, academics and consumers through an open process of meetings, hearings and comments and available transcripts in order to develop the regulation with the right balance.

The public/private Health IT Policy and Standards committees, which advise ONC and in turn the Centers for Medicare and Medicaid Services (CMS), have led the process, collecting, questioning and analyzing best practices and practical experiences from the field to help guide their recommendations.

CMS released its proposed rule for the meaningful use of EHRs stage 2 on Feb. 23. ONC released its accompanying standards and certification proposed rule the following day.

John Glaser, CEO of Siemens health services, said it is “very clear that these proposed rules and criteria reflect the input of multiple stakeholders through the Health IT Policy Committee.”

Indeed, Farzad Mostashari, MD, the national health IT coordinator, said that much of what the proposed rules for meaningful use and certification criteria presented was predictable. One of the most important functions of the federal advisory committees is that they provide “predictability, so that there aren’t any sharp turns that would create a sense of uncertainty in the industry and the development process,” he said at the Feb. 29 meeting of the standards committee.

However, CMS and ONC did “push harder” than the committees recommended around interoperability and health information exchange, Mostashari said.

The agencies clearly listened to the advisory committees, said Janet Marchibroda, chair of the Bipartisan Policy Center’s health IT initiative. “I can see so much of the feedback in the words and in the characterization and rationale in the proposed rule,” she said after an initial scan of the 455-page document.

“I think that comes from more experience for all of us -- not only the federal government, but the CIOs in the field and the vendors who are integrating the standards and technology,” she said.

Going from a rule to implementing it requires lots of judgment calls that need to be made and unintended consequences that can’t be anticipated, Marchibroda added.

The proposed rule also paid attention to making the meaningful use process more clear. “You could see a real focus on reducing complexity and burden, consolidation of some similar but slightly different provisions, and clarity,” Marchibroda said.

In developing their meaningful use recommendations, the advisory committees do their work in the open, ask for public feedback multiple times, and the response by the public is taken very seriously, said Dr. Paul Tang, vice chair of the Health IT Policy Committee and chief medical information officer at the Palo Alto Medical Foundation. “I think that has contributed to a better product,” he said.

“The benefit of having diverse members is that you get a lot of input at the time you’re creating things so there is not as much rework,” he said.

The turnaround time for the committee’s work has been quick, and the level of participation by the members, who are volunteers, has been very high, Tang said.

The feedback from early adopters is that although it is a lot of work, it will be worthwhile, he said. At a hearing he asked if there were any meaningful use measures that weren’t useful or should be dropped.

“To a person, nobody said there was anything that they would have left out. So we seem to be going in the right direction and hopefully [have] the right amount of push versus pull,” Tang said.

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