In response to the public comments to its proposals for Stage 2 of meaningful use, the federal Health IT Policy Committee’s Meaningful Use Workgroup suggested altering several proposed thresholds and raised the prospect of a new menu item involving recording a patient’s family health history.

At its April 5 meeting, Chairman Paul Tang, M.D., vice president and chief medical information officer at the Palo Alto Medical Foundation in California, led the group through a fast-paced and wide-ranging discussion. Here are some highlights:

Paul Tang, M.D.

E-prescribing: The initial Stage 2 called for increasing from 40 percent for eligible providers to 50 percent of orders, for both ambulatory and hospital discharge. Although they agreed they should be included, a large majority of hospitals expressed concern with the 50 percent threshold. Some panelists noted that patients leaving the hospital often don’t have a regular pharmacy or don’t know its name. The consensus was that the hospital discharge threshold should be lowered in Stage 2 to 20 percent.

EMAR: Stage 2’s initial proposal called for 30 percent of hospital medication orders to be automatically tracked via electronic medication administration record (EMAR). After much discussion of the best way to measure meaningful usage, the workgroup decided to suggest the measure be having EMAR in use in of one of the hospital’s clinical units, rather than the 30 percent figure.

Hospital portals: Stage 2 had proposed that 80 percent of patients are offered the ability to view and download via a Web-based portal, within 36 hours of discharge. After much discussion, the workgroup agreed that it was likely that a hospital portal would remain a menu item in Stage 2 because so few have made progress on it, but they stressed they want it to be required in Stage 3. They also agreed to change that timeline to 72 hours from 36 and drop the 80 percent threshold. But they will retain the requirement that more than 10 percent of all patients seen by the EP are provided timely electronic access to their health information subject to the EP’s discretion to withhold certain information, and hospitals must offer electronic discharge instructions to at least 80 percent of patients.

Family history: The workgroup considered a recommendation that providers should be able to electronically accept patient family history information. Neil Calman, M.D., president of the Institute for Family Health, noted that collecting such information is going to become critically important in the era of accountable care organizations. To do predictive modeling, these organizations are going to be expected to have family history input on patients so they can make predictions about people’s healthcare. “We should make sure systems are capable of doing it in a structured way,” he said. Others noted that the Policy Committee would need more input from the public before making any decision, but that perhaps it could communicate that this will be a requirement in the future.

Health information exchange: Stage 1 required performing at least one test of certified EHR technology’s capacity to electronically exchange key clinical information; the initial Stage 2 proposal required connecting to at least three external providers. The comments from providers suggested that conducting health information exchange with three providers would be difficult. After much discussion and disagreement, the group moved toward a proposal of requiring the ongoing bidirectional exchange of data with at least one external clinical partner rather than three, through NHIN Direct or through an HIE.

Meaningful use waiver: Although public commenters expressed interest in a waiver on meaningful use for high-performing organizations based on clinical quality measures, the consensus of the workgroup was that there will not be enough clinical quality measures available in time for Stage 2 to allow for that.

Patient reminders: As a menu item, Stage 1 required eligible professionals to send appropriate reminders to more than 20 percent of all unique patients 65 or older during the EHR reporting period. The initial Stage 2 proposal was to move that item to core. The workgroup suggested changing that to 10 percent of patients of all ages.

The group will report to the full Health IT Policy Committee on April 13.