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12/17/2010
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Meaningful Use Stage 2 Requirements Debate Begins

How much to increase Meaningful Use thresholds from Stage 1 is among the issues the Health IT Policy Committee will address in reviewing draft recommendations.

Slideshow: Who's Who In Healthcare IT
Slideshow: Who's Who In Healthcare IT

Larry Wolf, senior consulting architect, Kindred Healthcare, thought the right answer was to push the whole Stage 2 schedule out. "I'd like to point out that the proposed timeline at the end of this, in fact, puts us in the same bind we were in with Stage 1. The NPRM goes out at the end of 2011, presumably, we'll get the final rule in the summer, so it will only be three or four months until the clock starts on qualifying. We should think about moving out the start of Stage 2 so we signal that Stage 1 continues longer, and then we can give the industry time to implement the things we are proposing in Stage 2 with feedback from Stage 1, and not start Stage 2 until 2014."

Later in the meeting, after discussing a number of other measures, Probst voiced his support of Wolf's proposal. "I actually hope we get back to Larry's comment of 2014 … it does have an impact on the reality of people being able to put all these pieces into place."

Reacting to Blumenthal's comment that Stage 2 thresholds "may not have to be justified scientifically" because they constituted a stepping stone from Stages 1 to 3, Probst continued to urge caution.

"They must be realistic based on what people can actually achieve in Stage 2. Even if they are a stepping stone, if they are an unrealistic stepping stone, everybody's in the river," he said.

Despite having Stage 2 measures in hand, Blumenthal threw two wild cards in the mix. Echoing a sentiment he expressed in an earlier meeting, Blumenthal repeated the idea of creating new paths to MU qualification.

"It is still possible to mix atomic objectives with disease -- or problem-related objectives. One could even imagine a total reconfiguration of the framework that would give people or institutions a chance to take an alternate path altogether with a set of objectives around disease management," he said.

In a second curveball, this one actually thrown by the President's Council of Advisors on Science and Technology -- a group of presidentially appointed experts from universities, industry and other organizations -- its latest report will now have to be heavily considered by the Policy Committee in its formulation of MU Stages 2 and 3. The report "would very much impact what we consider and recommend … would have very important implications … and we will have to take that into account," Blumenthal said.

Specifically around health information exchange (HIE), he said the report, "which is strongly supported by the President and the White House," shows their commitment to it. As such, he advised the Policy Committee to "think, on this issue, more aggressively than we have on some others … this is one area where the administration will feel strongly about pushing us."

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