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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

HITECH's Meaningful Use Stage 2 requirements started their year-plus journey through federal advisory committees, regulation writers, public comment, and countless revisions after a draft set of recommendations were floated for discussion at this month's HIT Policy Committee meeting.

Outlined by Paul Tang, M.D., vice chair of the committee and chair of its Meaningful Use Workgroup, the measures generally seek to increase thresholds established in Stage 1 as they climb to a Stage 3 apex. In a preface to his presentation, Tang, who is VP and CMIO at Palo Alto Medical Foundation, emphasized that the committee would have two more opportunities to review the measures. He, and National Coordinator for HIT David Blumenthal, M.D, also wanted it known that, as much as possible, findings from Stage 1 would be analyzed and referenced in the formulation of Stage 2.

Despite Blumenthal's assurance, some committee members were concerned about the increases. "Are the percentages arbitrary?" asked Intermountain Healthcare CIO Marc Probst. "We don't have any history, and we haven't gathered a lot of detail about what's been brought in (from Stage 1) and the success rates, so I don't know if going from 30% to 60% is a high mountain or an average mountain."

Tang had proposed that, in the area of CPOE, 60% of medication, lab, and radiology orders entered by licensed professionals (without specifying transmission mode) be done electronically, as opposed to 30% of just medication orders in Stage 1. In Stage 2, he called for 60% of orders (outpatient and hospital discharge) to be transmitted thorough ePrescribing, if that fit the patient's preference. Hospital discharge was not included in Stage 1, Tang said, because that functionality was not available in the marketplace. "We're hoping that, with two years experience, vendors can put this functionality in their systems in the inpatient sector."

But Probst said he was concerned about the aspirational nature of such a measure. "There are a lot of challenges with ePrescribing -- just certifying an application takes months and months. I don't know where vendors are with this, but it seems that if it doesn't exist today, it's a pretty high bar to put out there, and then have faith they will get there in time for hospitals to actually implement that functionality."

Judy Faulkner, CEO, Epic Systems Corporation, said some of the wording used in the regulations needed to be tightened up.

"I think we need to be specific everywhere we say 'in general' or 'appropriate' evidence-based interactions. Anything that is vague at the end of this won't be vague, and if the vendors are to do this on time -- and there's very little time -- all that vagueness needs to be cleared up very quickly. 'Appropriate' demographics needs to be defined throughout everything if we're going to make the dates."

Blumenthal said ONC was "acutely aware" of the tight timeline, but couldn't make the dates so early "that we don't take into account the experience of Stage 1. The question is how late can we make it so that we can learn from Stage 1, how early can we make it so we can provide a warning to the industry about where we are going? I don't think there's a right answer to that."

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