With so much attention focused this week on waiting for the Supreme Court ruling on the Affordable Care Act, it is easy to forget for a moment that we are also waiting for the Stage 2 Meaningful Use final rule, which should be published in July.

The federal government has done a nice job of making the 1,125 public comments on the proposed rule easy to access on Regulations.gov. Just go to the Regulations.gov docket.


I think it’s worthwhile to read through some of the comments, especially from provider organizations, to understand not only the basis for their general support of the meaningful use effort but also the areas of serious concern they have about implementing the rules. Many comments state their support for the concepts but add that the EHR vendors won’t be able to implement them in the timeline suggested.

Several common themes emerge from the comments. First, there are concerns about clinical quality measures. The New York Presbyterian Healthcare System Informatics Council notes that many of the proposed CQMs do not have publicly available specifications. “CQMs should only be released if national and state quality measures are aligned and the standards have been tested and verified.” The council adds that adequate time should be permitted for vendors to modify their EHRs to capture the CQMs and for providers to implement and adopt the CQMs in the EHR, e.g. at least 18 months.

By far, the least popular requirement in the proposed rule is: “More than 10 percent of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view, download or transmit to a third party their health information.”

Providers believe they should not be held accountable for patient adoption of the patient portal. A comment from a consortium of specialist organizations asks CMS to eliminate the requirement entirely. While they are supportive of patient portals and the ability for patients to be able to review and update their medical information, they note that: “depending on the EHR vendor product, the incorporation of patient portal capabilities into an EHR is yet an additional cost for providers. Additionally, it may also require practices to spend time educating patients on what they are viewing so they can understand the information without causing confusion. In addition, requiring a measurement of patient use is entirely outside of the control of the EP.”

Other comments shed light on variations at the state level, especially involving public health reporting. The California Primary Care Association agrees with the measures requiring submission of electronic data to immunization registries. However, CPCA notes that: “in California the immunization network, CAIR, is not functioning for all providers. Further, in California there are counties that are carved out of the statewide immunization network, which further exacerbates the difficulties of providers successfully meeting this measure. CPCA recommends that CMS put pressure on states to standardize and streamline this process.

It makes similar observations on the submission of electronic syndromic surveillance data: “CPCA agrees with this measure, however recommends that CMS put pressure on states to standardize and streamline this process. In California all the counties handle syndromic surveillance data differently and most CCHCs do not currently have the capability to submit electronic syndromic surveillance data.”

Of course, consumer groups are equally adamant that CMS shouldn’t buckle to pressure from providers in its efforts to give everyone easy and secure online access to their health information in a timely manner as a core requirement.

As soon as the final rule is published, Healthcare Informatics will report on the impact the comments had and we will reach out to CIOs for reaction.