Farzad Mostashari, M.D., the national coordinator for health IT, held a hastily arranged press conference on the morning of Thursday, Feb. 23, as the proposed rule for Stage 2 of meaningful use under the American Recovery and Reinvestment Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act was being readied for publication in the Federal Register. As Dr. Mostashari explained to journalists gathered in a meeting room at the Venetian Sands Expo Center in Las Vegas, the proposed rule for Stage 2 was ready for publication, but an electronic formatting snafu had delayed its formal publication. Please “chill,” Dr. Mostashari implored the assembled press. He also told members of the press that the proposed rule would appear online within the next day, as attendees at HIMSS12 and across the healthcare industry awaited the electronic unveiling of the proposed rule.

In other words, as soon as the formatting complication is worked out, the proposed rule will be published online.

In the meantime, Mostashari said that he and his colleagues at the Office of the National Coordinator for Health IT (ONC) very carefully and attentively took in the comments and concerns of all the stakeholders around healthcare IT in fashioning the Stage 2 proposed rule. “We listened,” he intoned several times during the press conference, which began with his recitation of some of the broad-brush changes to the Stage 2 proposed rule, and a host of questions from the assembled members of the press.

Among the changes he cited included the following:

• “The update really addressed the needs of specialists,” Mostashari said, adding a range of outcomes quality measures more applicable to specialists.
• On the other hand, no core measures were eliminated.
• “The absence of imaging in meaningful use was an oversight the first time around,” he conceded, and said the proposed rule makes significant mention of the importance of imaging informatics-related elements.
• The proposed rule confirms the previous policy change that allows all providers to spend two years in Stage 1, and also allows providers to spend two years in Stage 2. The term Mostashari used to refer to the adjusted schedule was “individual escalator.” For example, if a provider organization or individual attested to Stage 1 on Nov. 15, 2011, that provider would have two years from that date to attest to Stage 2.
• The Medicaid MU program will be providing greater flexibility, especially for pediatricians. Among other elements, providers reporting on the Medicaid quality measures will be able to do so in batch style, rather than one at a time, as previously required.
• In response to concerns from vendors, Mostshari said that “We also propose where there are adaptations of the software, they don’t require new certification if they retain the same functionality, so that vendors don’t need every slight variation of software to be certified.”
• In a public session the previous day, Mostashari had also noted that another vendor-related change will be that it will not be necessary for providers to purchase software elements they won’t use, simply to demonstrate meaningful use across the spectrum of clinical information systems.

Mostashari also tipped his hat to the concerns of medical group leaders, noting that “We also provided for group reporting for quality measures, so they don’t have to split out individual quality measures. That’s a very important point of flexibility. We’re seeking comment on whether there should be group reporting for functional measures as well, and also seeking comments on the [feasibility of] group reporting for e-prescribing. He also said, “We deem reporting for PQRS [the federal Physician Quality Reporting System], so that if you report to them, you are fine with MU; we’ve aligbned reporting with reporting for PQRS and other deemed agencies.”

In response to a question from Healthcare Informatics, Mostashari elaborated a bit on his initial mention of imaging informatics, saying that, in response to criticism that Stage 1 of MU had ignored imaging informatics, “We got a lot of good comments, constructive comments, from companies and from stakeholder groups around imaging, and we were happy to be able to incorporate some of their thoughts into Stage 2.”

As Mostashari indicated, it was purely because of a technical formatting glitch that the proposed rule had not yet already been published in the Federal Register on the morning of Feb. 23. Stay tuned for further reports; Healthcare Informatics will update its readers as new developments occur.