FAQs: A Joint ONC-CMS Effort. To date, ONC and CMS have released 106 FAQs on a wide range of topics—computerized physician order entry (CPOE), calculation of a Medicaid hospital’s electronic health record (EHR) incentive payments, and the registration process, for example.

As Centers for Medicare and Medicaid Services (CMS) Health Insurance Specialist/Office of E-Health Standards and Services (OESS) Rob Anthony explained to CHIME’s Advocacy Leadership Team members this week, CMS and the Office of the National Coordinator for Health Information (ONC) work in coordination to respond to questions that come from specialty societies and associations such as CHIME, CMS Regional Offices, telephone inquiries and other sources. OESS triages the questions, directing them to the appropriate offices within ONC and CMS. Some questions are jointly developed by both agencies. Final FAQ development rests with OESS that has responsibility for editing, accuracy, coordination and approval of all FAQs. Questions may also be emailed directly to Rob Anthony (Robert.anthony@cms.hhs.gov) and his counterpart at ONC, Steven Posnack (steven.posnack@hhs.gov), director, Federal Policy Division.

HIT Policy Committee Discusses Approach to Stages 2 and 3. Meeting earlier this week, committee members explored how best to meet future meaningful use requirements. For example, should Stage 2 build incrementally from Stage 1 or should there be a set of larger steps structured around measuring and improving patient outcomes? Paul Tang, Meaningful Use Workgroup Chair, expressed a preference for establishing the Stage 3 goals for 2015 first and then backtracking to develop the Stage 2 requirements. The workgroup schedule calls for draft requirements for Stages 2 and 3 by Nov. 19, at which time, the full policy committee will weigh in. Public input will be solicited through a Request for Comment (RFC) in January with release of a notice of proposed rulemaking on the next stages by the fourth quarter of next year.

Committee members also provided feedback on Stage 1 implementation. Concerns were expressed regarding the pending compliance dates for ICD-10 and 5010, accountable care organizations and medical home and other health reform requirements and the capability of both providers and vendors to meet these overlapping challenges. Further, there is a belief by some that the scheduled dates for subsequent meaningful use stages are regulatory rather than legislative in nature, which could be altered directly through administration efforts and thus offer some flexibility. To date, there has been no public confirmation of this assertion. Other concerns centered on the multiple clarifications issued by CMS/ONC, leading some providers to pause or delay preparations for participating in the incentive program.

Better Consumer Meds Information Subject of FDA Initiative. Patient information guides (Patient Medication Information/PMI) currently available often present confusing discrepancies between generic and brand drug information. To address this issue and other information needs, the FDA is working on a uniform patient information medication guide that was the subject of a workshop earlier in October. As discussed by panelists at the Engelberg Center for Health Care Reform at Brookings, thee FDA initiative proposes to offer information to prescribing providers as well as dispensing pharmacies via HIE and EHR/EMR functionality and patient portals. Stakeholders—California Immigrant Policy Center, National Health Council, AARP, pharmaceutical and pharmacy organizations--explored patients’ expectations and how they access the details and warnings, along with feasible solutions for delivering better information to patients.

Future considerations for Patient Medication Information include eliminating paper in favor of electronic distribution in all forms to suit the patient preferences—font, size, language, etc., and lifestyle, including but not limited to smart phone, email, portals. The FDA understands that electronic distribution of sensitive information will require safeguards and “opt-in” patient consent. Electronic formats will allow patients to view/download the specific section or chunk of data of interest such as “Common Side Effects” section, etc. Ultimately, the goal is to integrate this data into patient specific health records such as today’s Patientslikeme.org website.