The second stage of the "Meaningful Use" incentive program for adoption of electronic health records (EHRs) will, as expected, be broader and more stringent than Stage 1. But federal officials hope it will also be more flexible for healthcare providers and vendors alike.

The U.S. Department of Health and Human Services (HHS) is proposing that hospitals meet a total of 18 measures of Meaningful Use--16 "core" objectives and two from a menu of four additional criteria. Individual physicians and other "eligible providers" would have to comply with 17 core and three of five menu items, according to national health IT coordinator Dr. Farzad Mostashari.

Mostashari and others from the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare and Medicaid Services (CMS) previewed the proposed Stage 2 regulations Wednesday at the annual Healthcare Information and Management Systems Society (HIMSS) conference in Las Vegas. The proposal is scheduled for publication in the Federal Register Thursday, triggering a 60-day public comment period.

ONC and CMS have promised to finalize the rules by midyear. Stage 2 would begin in 2014, as the proposal would make official an earlier pronouncement that HHS would push back the planned 2013 start date. But the agencies are forging ahead with the goal, set by President George W. Bush in 2004 and reaffirmed by President Obama five years later, of delivering interoperable EHRs to most Americans.

[ Read more from the most important live event in health IT on our HIMSS Special Report page. ]

"We are staying the course" with Meaningful Use, Mostashari said to an overflow audience at The Venetian Wednesday morning. He did acknowledge that Stage 1 may have been moving too fast for some healthcare organizations. "To make true meaningful use of Meaningful Use takes time," Mostashari noted.

The plan highlights standards-based interoperability and patient engagement, for example, calling on providers to adopt a single terminology set for patient problem lists, namely the Systematized Nomenclature of Medicine--Clinical Terms, or Snomed CT. "By 2014 we're going to see a big push on standards-based exchange," Mostashari said.

In Stage 2, hospitals and practices would have to allow at least 50% of their patients to view, download, and transfer electronic copies of their own medical records. One of the optional menu items in the proposal is to permit clinicians to view medical imaging through the EHR.

"We have done whatever we can to increase the flexibility and decrease the burden of these regulations," Mostashari said.

The proposal also takes into account a November 2011 Institute of Medicine report that calls for greater federal oversight of medical errors linked to health IT, by requiring "safety-enhanced design of EHRs." In Stage 2, providers would have to report on eight safety criteria, all related to medications, according to Steve Posnack, director of ONC's Federal Policy Division. Medication reconciliation would expand to "clinical information reconciliation," Posnack added.

The program for certifying EHRs would provide more options, too. Notably, providers would not necessarily have to use complete systems certified through one of the ONC-authorized testing bodies. Instead, they could choose what Posnack called a "dynamic version of EHR technology." They could pick a single, certified EHR or a combination of modules that do "just enough" to meet the core and menu MU standards.

Since Stage 1 Meaningful Use does not correspond to specific calendar years, but rather the first two or three years of a provider's participation, the level of certification required would depend on what stage the provider is attesting to, Posnack said.

No longer would EHR developers have to get up-front certification on whether their products meet privacy and security criteria. Instead, that will be part of the regular certification testing, according to Posnack.

Healthcare providers must collect all sorts of performance data to meet emerging standards. The new Pay For Performance issue of InformationWeek Healthcare delves into the huge task ahead. Also in this issue: Why personal health records have flopped. (Free registration required.)