A Huge Week for Health IT/Informatics

This past week was a busy week in the health IT/informatics world, as the US government released a flurry of rules and documents around health IT. As I tell my students, it is great to be living in this ever-changing part of the history of our field.

Probably making the most news was the release of the rules for Stage 3 of the EHR Incentive (also known as "Meaningful Use") Program by the Centers for Medicare & Medicaid Services (CMS). The Meaningful Use Program has taken its share of lumps in the last year or two, with the challenges providers have had in meeting its Stage 2 criteria and how it has consumed bandwidth that might be put toward other innovation by the healthcare system as well as the vendors. CMS has seem to have gotten the message somewhat, and the new criteria do dial back some on the requirements.

With the new rule, Stage 2 will be modified significantly. Some acute relief will be provided in the form of reduced requirements, from the necessity of reporting only 90 days (as opposed to a full year) of annual reporting to modification of the "view, download, and transmit" (VDT) requirement from five percent of an EP's patient panel to one single patient and reducing the secure messaging requirement from five percent to just being required to have the capability.

Also changed in Stage 2 itself, now called Modified Stage 2, which will be in effect from 2015-2017. The number of objectives is reduced to ten for eligible professionals (EPs) and nine for eligible hospitals (EHs), with each having one or more measures. The objectives are:

1. Protect Patient Health Information
2. Clinical Decision Support (CDS)
3. Computerized Provider Order Entry (CPOE)
4. Electronic Prescribing
5. Health Information Exchange
6. Patient Specific Education
7. Medication Reconciliation
8. Patient Electronic Access
9. Secure Electronic Messaging (EPs only)
10. Public Health Reporting

Starting in 2018, Stage 3 will become active, with the same objectives as above but with some more rigorous criteria for some of the measures. There is, however, one qualification to Stage 3, which is the opening of a comment period for how it could be changed to align with the new value-based care rules for Medicare. With the addition of calls for Stage 3 to be delayed or outright abandoned, it is not clear what it will ultimately look like.

The full rule is available, as is a brief summary. As always, my preference is for a detailed overview that provides enough detail for the informed reader, somewhere in between the minimally informative short summary and the exhaustive detail of the entire review, which CMS has also provided. (Note to standards developers! I prefer this approach for documentation of standards as well, eschewing both the superficial overviews as well as hundreds-of-pages implementation guides.)

Always a companion to the release of rules for the EHR Incentive Program is the release of the Health Information Technology Certification Criteria by the Office of the National Coordinator for Health IT (ONC). However, as noted by ONC, going forward the EHR Incentive Program will be decoupled from Health IT Certification. The EHR Incentive Program will still required use of certified products, but certification will also be used for other health IT functionality. As with CMS, a short summary and the detailed rule are provided, with the only interim document at this time being a Powerpoint deck that was used in the Webinar ONC presented to describe the new criteria.

The week’s activities did not, however, stop with release of the meaningful use and certification rules. ONC also released a final version of its Federal Health IT Strategic Plan for 2015-2020.
The stated mission of the plan is to "improve the health and well-being of individuals and communities through the use of technology and health information that is accessible when and where it matters most.” This will be achieved through four goals:

1. Advance Person-centered health and self-management
2. Transform health care delivery and community health
3. Foster research, scientific knowledge and innovation
4. Enhance the nation’s health IT infrastructure

One of the objectives of the fourth goal is to implement the Shared Nationwide Interoperability Roadmap, which was also released by ONC this week in its final Version 1.0 form. The roadmap was accompanied by an updated version of ONC's 2016 Interoperability Standards Advisory, which provides an exhaustive list of the best available standards and links to their implementation specifications. These releases were described in a blog post by ONC Director, Dr. Karen DeSalvo.

As if this week’s activities were not enough, last week was another major milestone, with the switchover to ICD-10-CM by hospitals physician offices, and others who bill in the healthcare system. Eerily similar to Y2K a decade and a half ago, there were very few reports of problems, presumably because the community was well-prepared. Of course, only time will tell, particularly if providers start having claims denied because of faulty coding.

Another recent event pertinent to all of the above occurred the week before, when I presented the inaugural Clinical Informatics Grand Rounds at OHSU. The Grand Rounds series will be part of our normal Thursday Conference Series, and I usually kick off the series each academic year. This year I chose to talk on the topic, HITECH and Meaningful Use: Results from the Grand Experiment and Future Directions. My talk (video and slides available) was built around a proclamation I made in this blog on January 24, 2010, in a posting entitled, Informatics Now Lives in a HITECH World:
"This is a defining moment for the informatics field. Never before has such money and attention been lavished on it. HITECH provides a clear challenge for the field to 'get it right. It will be interesting to look back on this time in the years ahead and see what worked and did not work. Whatever does happen, it is clear that informatics lives in a HITECH world now." Going forward, it will continue to be interesting to pause and reflect.