The afflicted had their opportunity to confront their afflicters Thursday evening at a plenary session of the College of Healthcare Information Management Executives' 2012 Fall CIO Forum during a question-and-answer session with two top federal rulemakers for the electronic health-records incentive-payment programs.
The CHIME guests were career civil servants Travis Broome, health insurance specialist with the CMS, and Steven Posnack, director of the Federal Policy Division at the Office of the National Coordinator for Health Information Technology at HHS.
Broome's task has been oversight of the Stage 1 and Stage 2 meaningful-use rules for the incentive programs established under Medicare and Medicaid by the American Recovery and Reinvestment Act.
Posnack's duties have been oversight of the 2011 and 2014 editions of rules for the certification of EHRs and other modular health IT systems used by providers in those incentive-payment programs.
Most of the Stage 2 meaningful-use criteria—which go into effect in 2014—are either extensions of those in Stage 1, but with either higher compliance target percentages or movement of those requirements from an optional “menu” of items to a mandatory core set of measures, Broome said.
Two of what Broome described as the “big steps forward” in the Stage 2 rules were in patient-engagement measures. The new rules require providers to afford capabilities to their patients to access, view, copy and transmit copies of their medical records.
In one, providers will be held responsible to ensure that at least 5% of their patients actually view and download copies of their records. Broome, who said he's often questioned about how that requirement will be measured, wanted to assure the CIOs in attendance that the CMS will be flexible.
“We really want you to be really innovative,” Broome said. “We've already seen lots of innovation with the 5% of viewing, accessing and downloading. If you're worried about measurements, don't let that stop you. We want to work with you and make that innovation happen.”
Both were asked about recent letters from members of the House, and, more recently, the Senate, criticizing the target compliance levels
for the program, which they contend may have been set too low, particularly the thresholds for system interoperability.
Posnack said the levels were set by trying to achieve a balance between the goals of improved care for patient and the realities of what both healthcare providers and IT system vendors could achieve.
“I think it will be a big push,” Posnack said of 2014 certification requirements.
“It's certainly a big push from where we were,” he said. But “interoperability is a journey. You reach one peak and keep climbing to the next. I think we've made significant progress in this last rule making. I think we've pushed as hard as we could for those use cases were the standards were available.”
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