On Aug. 24, one day after the Office of the National Coordinator for Health Information Technology (ONC) released the final 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, Jeffrey Smith, assistant director of advocacy for the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME), spoke exclusively with David Raths, Senior Contributing Editor at HCI.

The federal Centers for Medicare & Medicare Services (CMS), Smith says, appears to have heeded comments that CHIME and other provider groups had submitted that had asked for some modification of the EHR meaningful use reporting period. “They acknowledged the timeline crunch between the publication of this rule and when reporting would have begun, but they also made clear that if you wait until 2015 to meet Stage 2, you will have a 365-day reporting period,” Smith Said. “So they drilled down to the pressure point on this issue and surgically removed it.”

Jeff Smith

The two most contentious aspects of Stage 2, Smith added, were the requirements around allowing patients to view, download and transmit their health information and rules about health information exchange crossing vendor and organizational boundaries. On the first topic, CHIME members were not opposed to providing that type of technology for patients. They got caught up in how they were going to be on the hook for people actually using it, Smith said. And the fact that the threshold was lowered from 10 percent of patients to 5 percent doesn’t help much. “Just because you build it doesn’t necessarily mean people will come,” he said, adding that hospital executives in areas where patients have limited Internet access might wonder how they will accomplish this goal. Do they need to set up kiosks in the hospital? They may feel like it is getting them off track from improving care and moving more toward checking a box to earn the incentive, he said.

On the HIE silos question, organizations such as CHIME were quite strong in their language in calling the requirement that 10 percent of health information exchanges must be outside your organization and with a different EHR vendor untenable, Smith noted. “People were crying bloody murder, and I don’t think CMS bought it.” But CMS did note that because measurement of organizational and EHR vendor use of interoperability partners would be difficult, they lifted that requirement and instead substituted the requirement that providers show the ability to do one exchange outside their  silo. “CMS and ONC can use this as a talking point: You cannot be a Stage 2 meaningful user unless you show the ability to exchange data outside your silo,” Smith said. “And we think that is a good thing.”