At the Dec. 13 meeting of the federal Health IT Policy Committee, its Meaningful Use Work Group presented some of its proposals for raising the bar on meaningful use of electronic health records in stage 2 of the HITECH Act incentive program and sought input from the full committee. Several proposed changes deal with patient and family engagement via portals and personal health records.
The work group’s co-chairs, Paul Tang, M.D., vice president and chief medical information officer with the Palo Alto Medical Foundation in California, and George Hripcsak, M.D., chairman of the department of biomedical informatics at Columbia University, talked about the possibility of several new requirements, raising percentages on items such as computerized provider order entry (CPOE) and e-prescribing and moving items from menu options to core requirements.
For hospitals, the work group is proposing to boost CPOE usage from 30 percent of patients with at least one medication order to 60 percent in stage 2, and to add radiology and referral orders to medication orders. It also suggested bumping up e-prescribing requirements from 40 percent to 60 percent and recording patient demographics from 50 percent to 80 percent. The recording of vital signs and smoking status would both move from 50 percent of patients to 80 percent.
Several items would move from being menu options to core requirements, including drug formulary checks, a summary of care record, and sending reminders to patients. Also moving from menu to core would be items relating to public health such as reportable lab data and syndromic surveillance.
In the realm of patient engagement, a new proposal would require hospitals to offer at least 80 percent of patients the ability to view and download their health data within 36 hours of discharge. Eligible providers would have to make data available to patients within four days after the information is available to the practice. Another proposal suggested that providers offer 30 percent of patients secure messaging online. With an eye on improving continuity of care, other new proposals include creating a list of care team members for 10 percent of patients and a longitudinal care plan for 20 percent of patients.
Tang noted that these are draft recommendations only and are meant to provide the basis for comment. The full committee will have two more chances to comment before the public is asked for input in January. The final recommendations from the Health IT Policy Committee are expected in the third quarter of 2011, with the Centers for Medicare and Medicaid Services publishing a notice of proposed rulemaking in the fourth quarter.
David Blumenthal, M.D., the national coordinator for health IT, said his office continues to face the challenge of wanting to take the time to get feedback from results of stage 1 as input for stage 2, while at the same time wanting to give vendors and providers as much time as possible to implement the changes required to meet stage 2.