Public comments will play a major role in defining meaningful use of healthcare IT, according to federal officials.
The Office of the National Coordinator for Health Information Technology and the Centers for Medicare and Medicaid Services will accept comments through March 15 on the Notice of Proposed Rulemaking (NPRM) for the EHR Incentive Program for Medicare and Medicaid.
David Blumenthal, MD, National Coordinator for Health Information Technology, said the NPRM, published Jan. 13, is not a done deal.
"We want to get it as right as possible," he said during an HIT Standards Committee meeting on Wednesday. "I would not hold back any comments because you think they are irrelevant. If it's within the scope of the regulation, we want to hear about it and we'll try to get it right."
The proposed rule contains 25 measures that providers must use to qualify for federal incentives beginning January 2011. The rule also contains 23 measures through which hospitals must demonstrate meaningful use of healthcare IT for incentives beginning Oct. 1, 2011. The incentives are spelled out in the American Recovery and Reinvestment Act of 2009 (ARRA).
Jodi Daniel, the ONC's director of the Office of Policy and Research, said the ONC's ability to change the proposed rule will be limited to removing or tweaking aspects already there. The government is prohibited from adding anything new to the proposed rule because it will not have allowed for that item to have prior public comment, Daniel said.
The Interim Final Rule (IFR) on Initial Set of Standards, Implementation Specifications and Certification Criteria for EHRs – also published Jan. 13 – will not be as easy to change, Daniel said.
According to Daniel, because the IFR is effective 30 days from when it was published, the government will be hesitant to change it too much because some parties may be already working to comply with it. However, she added the government still would like to hear comments, and some changes will be made.
Daniel said the ONC will work with the CMS to make sure the two rules are aligned and "work well together" after any changes are made.
Janet Corrigan, a member of the HIT Standards Committee, said she's surprised the rule proposes to use more measures than were recommended by both the HIT Policy and HIT Standards advisory committees. Though these measures are grounded in national priorities, she said, they might not have been selected had the federal government started with a clean slate.
"We need to make a plan for an even better set of outcomes over time," she said.
Corrigan is president of the National Quality Forum, a non-profit organization of healthcare stakeholders who help to set care standards. Most of the measures adopted by the ONC and CMS for the proposed rule were taken from those approved by NQF.
Karen Trudel, deputy director of the CMS Office of E-Health Standards and Services, said the goal of those framing the rule was to build a good solid base. "We were that trying to be inclusive and get measures on the table and get everybody talking," she said.
Trudel said the CMS and ONC are hoping the comment process will help refine the measures proposed for 2011. "If these measures aren't linked to an outcome, we need to know that," she said. "We very definitely need lots of pubic input."
Blumenthal said government officials want the public and committee members to comment if they think some of the measures detract or don't add to the ultimate goals. "Nothing would make us happier than to simplify the regulatory burden on providers who are trying to comply with meaningful use," he said.
Trudel said the more specific comments are, the more likely they will be used. "Any changes we make have to be a logical outgrowth of what we've already published," she said.
Trudel, along with other federal officials who worked on the rules, said it will be difficult for the government to find a sweet spot between those who want the bar raised to achieve health quality outcomes sooner and those who want it lowered to increase the likelihood of healthcare IT adoption.
She said the best way to comment on the rules is online at regulations.gov.
The federal government will issue a final rule on meaningful use in late spring, Blumenthal said.
