Asked whether the CMS will release additional meaningful-use criteria at some point, Mostashari replied that yes, criteria laid out in December in the CMS' notice of proposed rule-making, or NPRM, that were left out of Tuesday's Stage 1 final rule will make their way into the Stage 2 rule.
"Everything that was in the NPRM, we intended it to be part of Stage 2," Mostashari said. "It's all going to be there eventually. The things that were taken out are going to be added back in." Plus, Mostashari said, the Health Information Technology Policy Committee, an advisory panel created under the stimulus law, will look at new criteria for the second, two-year period, Stage 2.
"There are going to be lots of discussions about what should be brought into Stage 2," Mostashari said. "What I can commit to you, it's going to get a lot tougher in Stage 2. We will do our part to make that a lot tougher."
Mostashari answered in response to another question that yes, provider organizations will be beholden to vendors to update their systems to meet Stage 2 requirements. An EHR system's required certification of compliance with Stage 1 criteria—and thus eligible for subsidy payments under the federal program—"is basically going to run out after the end of Stage 1," he said.
Mostashari also took the opportunity in the Q&A to cheerlead a bit for the program.
Although he has no "hard targets" in the short run for physician adoption of EHRs under the federal subsidy program, "I do believe the vast majority will be meaningful users" by 2016, he said.
Matthew Morgan, a Canadian physician informaticist, said that only 40% of Canada's primary-care physicians use EHRs. And that's with government subsidies and no requirements for meaningful use, he said, citing research for a recent article he co-authored and published in the Journal of Healthcare Information Management. Plus, Morgan added, "We give them the money upfront," in contrast with the U.S., which will reimburse providers for purchases after the fact, he said.
"What's in the American psyche that will cause doctors to run out and adopt at the levels you want?" Morgan asked.
"You know what's going to drive this transformation?" Mostashari responded. "It's not the money. It's going to be doing these things because they're the right thing to do.”
Mostashari said EHR skills will come to be understood as necessary for the competent practice of medicine. Information-technology competency, he said, should be considered for inclusion in the criteria for board certification of medical specialties.
"I think the wind is at our backs on this, not just in terms of technology, but in what's expected," he said.