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MU Workgroup Seeks Path to Flexibility

March 22, 2011
by David Raths
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Options include limiting new requirements, delaying Stage 2

In response to concerns expressed by the provider community and software vendors, the Meaningful Use Workgroup of the federal Health IT Policy Committee used its March 22 meeting to begin looking for ways to offer flexibility in functional requirements, timing or both.

Representing the Office of the National Coordinator, Joshua Seidman, Ph.D., director of meaningful use, summarized some of the concerns expressed in written comments in response to Stage 2 proposals. They included that the proposed timeline does not allow sufficient time for safe development, testing, and release of new functionalities, distribution of upgrades, and training of user on the new features. Seidman noted that that ONC also received comments on the other side, arguing that delays in implementation of additional functionality would hinder health reform and interoperability efforts.

Paul Tang, M.D., chair of workgroup, noted that in Stage 1, the menu approach provided flexibility by requiring electronic health record vendors to provide a wide range of capabilities, but not asking providers to turn them all on at once.

Paul Tang, M.D.

Another Stage 1 approach was requiring only a 90-day reporting period. Tang suggested one option for Stage 2 would be to continue the 90-day reporting period option. “That would allow an additional nine months for providers to get things accomplished before they have to be operational with fully functional Stage 2 EHRs,” Tang said. Another timing option, he added, would be to delay Stage 2 based on a threshold of some percentage of providers that have achieved Stage 1. The problem with that approach is that it delays putting in place functionality that will be required for care coordination and health reform initiatives.

Another option, Tang said, is to raise thresholds on the current functional requirements, moving everything from menu to core, but not adding new functionalities. “That does advance the EHR as a platform to improve care,” he noted, “but does not advance health information exchange, which is a major goal of Stage 2.”

During the discussion period, workgroup members expressed concern with starting to make changes to timelines without more information. Representatives from ONC and CMS said it was too early to assess how well providers are doing with Stage 1. Some members said of the options Tang mentioned, the 90-day reporting period is the least objectionable.

Christine Bechtel, vice president of the National Partnership for Women & Families, stressed that it was important to better understand the challenges on criteria first before making decisions on timelines. “If we say we’re not going to have any new functionality, where does that leave us?” she asked.

Tang said the workgroup would meet several more times this spring with the goal of having the whole Health IT Policy Committee approve its Stage 2 recommendations in early June.