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As the Proposed Stage 2 Rule Is Released, Early Reactions to the Broad Outline

February 24, 2012
by Mark Hagland
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CIOs and industry experts look at the bigger picture around meaningful use

It was rather a split-screen situation on the afternoon of Thursday, Feb. 23, at the Sands Expo Convention Center in Las Vegas, as the Office of the National Coordinator for Health IT (ONC) released the proposed rule for stage 2 of meaningful use, during the midst of the HIMSS Conference. Some attendees were already boarding planes for flights home by the time the news broke that the proposed rule had finally been published online; earlier in the day, national coordinator for health IT Farzad Mostashari, M.D., had explained to journalists gathered for a hastily arranged press conference that a technical glitch had led to a delay in the actual publication of the final rule.

But by early afternoon, the rule had been put online, and some healthcare IT stakeholders began plowing through its 455 pages, even as others dashed to the airport to get back to their hometowns. At this very early stage, of course, no one had had the opportunity to fully analyze the proposed rule; but, based on some of the information that Dr. Mostashari had revealed in the previous two days at HIMSS12, and on some of the information contained in news reports, including this magazine’s initial report, on what was said at Thursday’s press conference, some CIOs and industry experts had initial comments to make.

Bobbie Byrne, M.D., CIO at Edward Hospital & Health Services in Naperville, Ill., had attended Dr. Mostashari’s Tuesday town hall meeting, and said Thursday morning that, “Like everybody else, I’m very interested to actually read the rule, because when somebody’s presenting, it sounds good, but the devil is always in the details. But,” she added, “I was very pleased that they seemed to have really listened to and fixed some of the things about stage 1 that were really quirky. For example, under the previous rule, you were required to own EHR technology for something you were never going to use. So, for instance, let’s say you don’t write prescriptions, which is unusual; but you still have to own e-prescribing software. And I thought that was silly; that didn’t make sense. So I liked that. I also thought that the other piece that was a small thing but was very good, was a recognition of the importance of images in the record, and that was something that had been missing in stage 1.”

Kara Marx, R.N., CIO at Methodist Hospital in Arcadia, Calif., said she had mixed feelings about what she had learned so far. On the positive side, she said of the leaders at ONC and at the Centers for Medicare and Medicaid Services (CMS) more broadly, “It’s always promising to see that they’re listening and that they’re willing to make adjustments. You have to hope that they’re building some trust, and that everyone will take advantage of this.” She also cited as “fantastic” the selection of David Muntz as principal deputy at ONC in January, considering it an additional sign of federal health authorities’ willingness to take into account healthcare leaders’ range of concerns around all MU-related issues.

On the other hand, with regard to the adjustment of timetables and deadlines that has taken place both around stages 1 and 2 of meaningful use and also around the deadline for the transition to the new ICD-10 coding system, Marx, who expects to help lead her hospital to stage 1 attestation within the next several weeks, added that, while she supported the ICD-10 delay, both such types of delays could actually depress somewhat the enthusiasm of those working in patient care organizations that have pressed forward more aggressively to meet the previously mandated timetables.

Looking at the bigger picture

Some industry experts believe it’s important to keep in mind what an iterative process meaningful use has become, and will inevitably continue to be. One of these is Harry G. Greenspun, M.D., senior advisor in the Health Care Transformation & Technology division of Deloitte LLP. The Washington, D.C.-based Greenspun said on Feb. 23 that “I think the really important thing for people to remember is that, when the proposed rule for stage 1 first came out, people were up in arms about things. Then, when the comment period began, people made comments. And when the final rule came out, people were surprised by two things: one, the extent to which their comments were incorporated into the rule. And two, the thoughtfulness of the ONC staff in considering those comments. This has become more of a dialogue-type process,” he emphasized.

“The big impact right now,” Greenspun added, “is that you can have all these types of technological innovations, but it’s only with the turn towards value-based purchasing and accountable care, and then you add in the consumer engagement element to this, that we’re now in a situation where there’s an alignment of planets” in terms of truly leveraging technology to improve patient care delivery and healthcare operations. “Now,” he said, “we can use technology to make things happen.”

Like all those with whom Healthcare Informatics editorial team members spoke on Thursday, Byrne, Marx, and Greenspun emphasized that they needed time to thoroughly review the full text of the final rule before making any comprehensive judgments. As industry leaders and experts do review the final rule, HCI will bring its readers their comments and reactions, along with additional reporting, as new developments emerge.