Mostashari's presentation addressed both provider and electronic health records system vendor requirements for Stage 2 and afforded a first glimpse of the slightly higher hoops through which they will have to jump to qualify for the federal incentive payment programs under the Medicare and Medicaid created by the American Recovery and Reinvestment Act of 2009.
“What you'll see in our presentation today and in the rules tomorrow, is that we stayed the course,” Mostashari said. By that, he said, the rules will contain a host of familiar recommendations from the federally chartered Health Information Technology Policy and Standards Committees submitted to the ONC last summer.
But Mostashari also said the proposed rules will contain some new wrinkles, including an increased emphasis on interoperability, not only between providers, but between vendors' systems.
Elizabeth Holland, director, HIT Initiatives Group, office of ehealth and standards and services at CMS, also said the rules will contain changes to the Stage 1 criteria, effective in 2013, for late-comers to the EHR incentive programs.
Final rules for both meaningful-use and EHR certification criteria are expected to be released later this summer after 60-day public comment periods.
The hoop-jumping in Stage 2 for providers won't begin until at least 2014, thanks to a decision by HHS in November to extend the compliance deadline for Stage 2 for an additional year. HHS opted for the one-year delay for providers who met meaningful-use Stage 1 criteria in 2011.
Mostashari used the term “push” multiple times to describe the directions of the proposed new rules, including a push on interoperability, patient safety, continuous quality improvement and clinical decision support.
“We have really pushed on standards in the certification criteria,” he said. There are standards in Stage 2 for clinical message transport, he said, including a requirement that the federally developed Direct protocol for peer-to-peer “push” messaging “will become a required part of certified health information technology,” Mostashari said.
The proposed rules also will push for a single standard for patient-care summaries, for storing and transmitting lab results, and for recording problem lists.
“There is a lot of interoperability that is going to be added to the 2014 addition of certified health information technology,” he said. The nation's health IT infrastructure is being set for widespread exchange of information, he said, including “a very ambitious target for actual exchange, not just a test, across organizational and vendor boundaries.”
“Initially, the first reaction from all of us is we're glad to know what all of the rules are,” said Dr. Karen Bell. She is chairwoman of the Certification Commission for Health Information Technology, a Chicago-based not-for-profit organization authorized by ONC to test EHR systems. “The second take is there's a lot here.”