The delay, they said, is intended to allow the CMS and ONC to focus on helping providers meet Stage 2's demands for patient engagement, interoperability and information exchange, as well as use data collected during that phase to inform policy decisions for Stage 3.
The proposed rules are expected to be released in the fall of 2014 for the requirements providers must meet for Stage 3, as well as the 2017 Edition of standards health IT developers must build and test their systems to match.
The start of Stage 2 was Oct. 1 this year for those hospitals that have already met Stage 1 criteria for at least the prior two years. For physicians and other “eligible professionals,” the clock starts for Stage 2 on Jan. 1, 2014. A separate rule extending Stage 2 by a year is expected sooner and will be grafted onto another, as yet an unspecified HHS rule already started on the lengthy rule-making process, according to the CMS.
The program, created under the America Recovery and Reinvestment Act of 2009, has paid out about $17 billion since January 2011, according to the latest CMS data.
As the CMS pointed out in its announcement Friday, 85% of hospitals eligible for payments under the program and more than 60% of physicians and other eligible professionals have received money from its Medicare, Medicaid and Medicare Advantage divisions for adopting, implementing, upgrading and or meaningfully using health information technology that's been tested and certified to ONC standards.
Friday's action is not unexpected.
In September, members of Congress called for a delay of Stage 2 and a Modern Healthcare analysis of the federal government's own EHR testing and certification results for Stage 2-ready EHR systems and their components indicated a serious lag in overall health IT industry readiness for the Stage 2 upgrades. Since there is considerable lag time between developers having a system ready and the ability of provider organizations to install and reach maximum utility with even an upgraded EHR, that lag time would impact provider readiness to meet the more stringent meaningful-use targets in Stage 2.
The Health Information and Management Systems Society immediately welcomed the news. “This additional time to attest offers an opportunity for increased feedback and analysis on technology implementation, eClinical Quality Measure reporting, and progress toward interoperability that will enhance the ability of eligible hospitals and eligible professionals to meaningfully use health IT, and thus improve the quality and cost-effectiveness of patient care,” the Chicago-based trade group said in a statement.
In another effort to address that lag, the CMS proposed a new, “voluntary” set of health IT system testing and certification criteria to be called the 2015 Edition. The current 2014 Edition of testing and certification criteria will remain “the baseline” for vendors and developers, but the 2015 Edition criteria would “be responsive to stakeholder feedback, address issues found in the 2014 Edition, and would reference updated standards and implementation guides that we expect would continue momentum toward greater interoperability,” the statement said. The 2015 Edition would be voluntary in that neither vendors nor providers would be required to create or use the updated technology.
Unmentioned in Friday's announcement was the looming federally mandated nationwide conversion to the International Classification of Diseases 10th Revision of diagnostic and procedural codes.
Reider replaced former ONC chief Dr. Farzad Mostashari, who stepped down Oct. 5. In an interview with Modern Healthcare the day before, Mostashari advised against going slow on Stage 2 and the more function-rich 2014 Edition software that goes with it.
“There should be no hesitation about realizing that we need to, as a country, be using 2014-certified software by the end of 2014—we just need to do that,” Mostashari said. Reider said that the federal government isn't backing off.
“We're continuing to move forward aggressively,” Reider said. “We're keeping the pedal to the metal, and yet we are recognizing it's going to take additional time to get ready for Stage 3 and we wouldn't have the time to do that if we didn't extend Stage 2.”
Follow Joseph Conn on Twitter: @MHJConn