The Centers for Medicare and Medicaid Services is about to publish a notice to correct inconsistencies in the meaningful use final rule, its top e-health official said, as well as guidance for providers on how to meet quality measures required by the health IT incentive program.
Both documents are now in the federal clearance process, the last step before publication, said Tony Trenkle, director of CMS' Office of e-Health Standards and Services, at a meeting Oct. 20 of the Health IT Policy Committee.
CMS also has answered 106 frequently asked questions to date about meaningful use on its Web site, which the agency is revising to make it easier to sort. It is also working with the Office of the National Coordinator to make a joint presentation of meaningful use information for the public.
Turning their attention to the future, committee members wrestled with how high to raise the incentive bar for the next stage of meaningful use.
The discussion revolved around whether changes in the second stage 2013 incentives should be incremental, building on first stage data collection requirements, or whether providers should be pushed to take bigger steps toward improving and tracking patient outcomes.
Dr. David Blumenthal, the national health IT coordinator, said that although the HITECH Act stipulates the time frame for meaningful use, the committee should not pull back its ambitions just to meet the deadline.
"I would encourage us not to curtail our ideals and vision simply because we are anxious about the time frame or we may miss the opportunity to conceptualize a very important set of possibilities," he said.
The committee favors establishing 2015's stage 3 objectives and then working backward to the second stage measures in 2013, said Dr. Paul Tang, chairman of the meaningful use work group.
"We need to signal what we would like to have happen in stage 3 and then we can have stage 2 as a checkpoint on the way to stage 3, Tang
said. "We have to remember that this is a program not about buying software but about measuring and improving outcomes for individual and population health," he said.
Blumenthal said several key issues remain unfinished from stage 1 deliberations, including creating a technical infrastructure for health information exchange and the work of the Privacy and Security Tiger Team, whose job he described as "(protecting) information both at rest and in transit so the public has confidence and trust in the health systems' ability to steward their health information capably."
Latanya Sweeney, a committee member and director of the data privacy lab at Carnegie Mellon University, urged the committee to include privacy measures in future meaningful use criteria because they were largely absent in the 2011 requirements.
"The fact that the meaningful use final rule has zero privacy measures and incentives is not good," she said. "The idea of privacy not being part of the incentive structure and left to a regulatory hammer over someone's head makes for a difficult regulation and loses the beautiful notion of meaningful use and incentives."
While committee members are grappling with how to move forward, other changes are underway that overlap meaningful use policymaking. For instance, under the health reform law, HHS will develop a national quality strategy and models for accountable care organizations.
Meanwhile, providers are deploying Version 10 of the International Classification of Diseases (ICD-10) billing and diagnostic code, which will replace the current ICD-9 code set in 2012.
Trenkle said it was critical to make sure that all these activities do not "create a disconnect or inhibitors." And Blumenthal said, "We can't ignore the fact that we are part of a much larger enterprise."
