According to the organization of healthcare CIOs, an additional 12 months to meet the stage 2 requirements "will give providers the opportunity to optimize their EHR technology and achieve the benefits of stage 1 and stage 2; it will give vendors the time needed to prepare, develop and deliver needed technology to correspond with Stage 3; and it will give policy makers time to assess and evaluate programmatic trends needed to craft thoughtful Stage 3 rules."
At present, stage 2, which was postponed by a year from the initial time frame, encompasses 2014 and 2015. CHIME's proposal would probably result in stage 3 being pushed back from 2016 to 2017, said George Hickman, the board chair of CHIME, in an interview with InformationWeek Healthcare. Adding a year to stage 2, he said, "implies more working time for building a good stage 3."
[ Doubt about regulations' timeline has been brewing for a while. Read Docs, Hospitals Say Delay Meaningful Use Stage 3. ]
Right now, he noted, "stage 3 is not well defined." Extending stage 2 will enable policy makers to measure the experience of healthcare providers in stage 2 and incorporate that into stage 3. In addition, he said, it will provide more time to improve the interoperability of systems and devise a reliable national solution for matching patients with their data.
On the interoperability front, Hickman, who is executive VP of Albany Medical Center in Albany, N.Y., noted that only four EHRs have been certified so far to send and receive messages using the Direct secure messaging protocol. Pointing out that "Direct is one way to meet [stage 2] data exchange requirements around transitions of care," he asks, "How many vendors are ready to get their products certified in that area? And do providers have time to adopt and implement that and exchange data with other providers?"
Albany Medical Center is the first healthcare organization in the state of New York to use Direct "in a production environment for both its hospital and its ambulatory clinics," he said, and so far no other providers in the area have developed a similar capability.
"It feels like we're the first to invent the fax machine," said Hickman. "Nobody else has a fax machine yet, and we're waiting for others to catch up so we can have some data exchange. And here we are, almost halfway through 2013 and nearly a year away from when we'd attest to stage 2."
This is one example of the nationwide problem with the stage 2 timetable that CHIME is trying to address, he said. "If we're there and others aren't there yet, and that's the lion's share of providers, we need to slow things down a bit so we can get everybody caught up."
CHIME's letter also calls for Congress to encourage the Office of the National Coordinator of Health IT (ONC) to develop a nationwide patient matching system to replace the piecemeal solutions that provider organizations and health information exchanges across the country have devised. Noting that this is a patient safety issue, Hickman said that a national patient identifier -- opposed by privacy advocates -- is one way to approach this. Alternatively, a standardized matching algorithm could be developed to identify patients uniquely, he said.
The Health Information Management and Systems Society (HIMSS) espoused the same idea last fall, and a prominent health IT advocate and consultant recently started a petition at whitehouse.gov to lift the Congressional ban on a national patient identifier.
CHIME also raised the issue of excessive auditing of providers in the Meaningful Use program, which can lead to auditors looking beyond attestation to Meaningful Use. Hickman cited auditors who, according to other CIOs, have pried into whether the use of certified EHRs to protect security complies with the latest HIPAA regulations.
Overall, Hickman said, the senators' white paper raised "some issues that were worth looking at." CHIME agrees that the Meaningful Use program, like any other taxpayer-funded program, should be scrutinized and held accountable, he said.
"On the other hand," he added, "we believe that it would be a mistake to 'throw the baby out with the bathwater.' To believe that some things should be scrutinized doesn't mean that the program as a whole should be called into question. We think it's a great program, and we want it to continue."
Many CIOs, he pointed out, "built incentive money into the business cases that they took to their boards to get the funding to go down the path and implement EHRs and interoperability. To pull that money off the table would not be prudent or helpful to what we're trying to do as a nation to create a health information network."