Health & Human Services Department officials are already considering measures for the second stage of meaningful use even before healthcare providers get started on tackling the 2011 first stage requirements of the incentive program.
The Health IT Policy Committee wants to prepare recommendations on 2013 meaningful use criteria by next April in order to give vendors enough time to build-in themore sophisticated applications into their electronic health record systems.
"Vendors need about 18 months to develop additional functionality," said Paul Tang, chairman of the meaningful use workgroup at a committee meeting Sept. 14.
"We're trying to stick with the roadmap philosophy as we did for stage one to give signals to vendors and providers," said Tang, who is chief medical information officer of the Palo Alto Medical Foundation.
The challenge is that the committee must come up with recommendations for second stage meaningful use objectives before they will be able to analyze the practical lessons and experiences from providers who set up EHR systems and meet the first stage requirements.
The Centers for Medicare and Medicaid Services has said it could begin to pay the first incentives as early as May 2011.
George Hripcsak, co-chair of the meaningful use work group, said, "there's a trade-off here between working with vendors about EHR certification on the one hand and on the other, we want to have as much time as possible to look at actual use of stage one. Hripcsak is a bio-informatics professor at Columbia University.
Not a lot is known yet about providers' experience with applying meaningful use; most of the data comes from industry surveys about what providers intend to do, said Dr. David Blumenthal, the national health IT coordinator.
However, over the next six months CMS and ONC will be "intensively educating" healthcare providers and the public about the meaningful use incentives.
The work group is ramping up their activities, including holding informational hearings and issuing a request for comments in November or December to gauge the health care community's sentiments about the direction and timetable for the 2013 second stage meaningful use criteria.
Another team of experts " the quality work group " is beginning to discuss more robust clinical quality measures for 2013. Blumenthal, who leads the group, said he wants to come up with "meaningful measures for an EHR environment that are better risk adjusted and more sensitive to clinical data, and measures that may be longitudinal since EHRs can fairly effortlessly develop serial data about a single patient."
But Judy Faulkner, a workgroup member and chief executive officer of Epic Systems, a health IT software company, said she was concerned that the "government is going to get into the electronic health record design business."
How the government sets meaningful use parameters has a significant impact on the health care software industry, she said, citing the need for "5, 000, 6,000, up to 7,000 hours of work (to meet) the final rule of stage one, not just making changes to software but going back and retrofitting users' software so we can stay on the same version."
