The federal Health IT Policy Committee met Oct. 3 to fine-tune some meaningful use Stage 3 recommendations as it prepares to seek comments from stakeholders in November. Providers and health IT vendors will have until Dec. 21 to offer feedback on the feasibility of adopting the measures in healthcare settings.

Paul Tang, M.D., chair of the Meaningful Use Workgroup, reminded the committee that Stage 3 is envisioned as supporting new models of care that are team-based and support population management and national health priorities. The challenge is to promote advancement with requirements that are achievable. “We are looking for mature standards that are or could be widely adopted by 2016,” he said.

Many of the proposed measures for Stage 3 have to do with better coordination and transitions of care. For instance, with lab orders the regulations would require electronic health records to have the capability of not just placing lab orders, but to track when results come back. Another proposed measure states that for 10 percent of patients referred during an EHR reporting period, referral results are returned to the requestor (via scan, printout, fax, electronic CDA Care Summary and Consult Report).

Another proposal would require clinicians who refer their patient to another setting of care provide a summary-of-care record for 65 percent of transitions of care and referrals (and at least 30 percent electronically).

The request for comment will also ask stakeholders about approaches to better engage patients and families. The approach may include the results of a pilot project involving an “automated blue button” to allow patients to “subscribe” to their health information and have it downloaded or sent to the place of their choice. A menu item proposes that clinicians provide 10 percent of patients with the ability to submit patient-generated health information.

For Stage 3, the Information Exchange Workgroup is working on certification requirement proposals involving provider directories. To improve care coordination, EHRs will be asked to query a provider directory external to the EHR to obtain entity-level addressing information.

The Privacy and Security Tiger Team has prepared some questions for stakeholders to consider involving the authentication of provider users of EHRs. One main question is whether users of EHRs should have to use another authentication factor beyond user name and password by Stage 3 of meaningful use. The team also asks: “What, if any, security risk issues (or HIPAA Security Rule provisions) should be subject to meaningful use attestation in Stage 3?”

Tang outlined the calendar of work going forward: In January 2013, the Office of the National Coordinator will synthesize comments for the work groups to review. In February, the work groups will reconcile the comments and in March present revised draft Stage 3 recommendations. In April the Policy Committee will approve final Stage 3 recommendations, and in May it will transmit final recommendations to HHS.

In the public comment period of the Oct. 3 meeting, Diane Jones of the American Hospital Association recommended both a delay in the request for comment and a longer time period for stakeholders to respond. She said many providers are currently focused on Stage 1 attestation, while others are working to understand Stage 2. “The reality is that a 60-day comment period would give time for stakeholders to provide a response that is thoughtful, informed and based on experience,” she said.