As developers of electronic health-record systems pore over two new rules released last week governing Stage 3 of the federal EHR incentive-payment program, vendors are remembering Stage 2 rules and the problems they created for both EHR vendors and their customers.
Vendors want to know if the new rules will be more focused and flexible than prior rules and whether they will promote more effective quality measurement and interoperability between systems and users, said Mark Segal, vice president for government and industry affairs at GE Healthcare IT and chair of the Electronic Health Record Association. The EHRA is an affiliate of the Healthcare Information and Management Systems Society, a Chicago-based health IT industry trade group.
Key to it all is whether “developers have enough time to meet new functionality and regulatory requirements,” Segal said. “We want to be really mindful of the challenges that providers and developers have faced in Stage 2.”
Federal policymakers, in their initial planning for the transition from Stage 1 to the more stringent requirements of Stage 2, underestimated the time it would take for developers to build the mandated changes in EHR functionality into their systems, sparking protests from provider organizations almost from the program's beginning.
Subsequent product-development delays cascaded onto providers, with many having difficulty implementing the upgrades in time to meet their meaningful-use targets by program-mandated deadlines. Eventually, the CMS was forced to extend, via hardship exemptions, the lifespan of Stage 1, delay the start of Stage 2 for some providers and push back the start of Stage 3 into 2017.
Segal said the CMS decision, reflected in its new rule released Friday, to again move the start date for Stage 3 from 2017 to 2018 is a good move. “CMS definitely acknowledged the delays they saw in Stage 2.”
But it remains to be seen whether even with the extra year's extension there will be enough time for developers and providers to adapt to the changes in the new rule, Segal said.
“We had not called explicitly for a move to 2018, but what we have asked for is a good solid, 18-month minimum for all the things we need,” Segal said. Those needs include not only the CMS releasing its final rule on meaningful use, but also a companion rule by the Office of the National Coordinator for Health Information Technology at HHS for testing and certifying EHR systems. An ONC proposed rule for what it's calling the 2015 Edition software requirements also was released Friday. The EHRA also wants to know, before its 18-month window opens, what quality measures are required and specifics on how its systems will be tested for certification.
Final rules for Stage 3 and the 2015 Edition are not expected until late this year. Consolidated quality reporting metrics for Stage 3 meaningful use are also pending, as are final EHR testing specs.
The proposed rule indicated that providers wishing to step up to Stage 3 might do so voluntarily in 2017, but Segal said “we're still concerned that the timeline is unrealistic for deployment in 2017.”
With the advent of accountable care organizations and an increasing shift to performance-based reimbursements, general healthcare providers who are at financial risk for populations of patients are, as a result, also under pressure to keep better track of patients receiving treatment from outside behavioral health providers.
But data for behavioral health falls under more stringent state and federal privacy laws, many of which oblige providers to obtain a patient's consent each time their medical records are shared with another provider, even for treatment.
Handling this more sensitive information mixed in with their own general health data with its less-stringent privacy rules has been troublesome for general health providers.
Work by the ONC, the Substance Abuse and Mental Health Services Administration, the Veterans Affairs Department and several private developers has produced a technological approach to the problem called Data Segmentation for Privacy, or DS4P, which is now being used by early adopters at the VA and some private-sector providers.
The ONC included a DS4P requirement in its proposed rule for the 2015 Edition.
It's too early to tell what challenge DS4P presents for developers, Segal said.
“It's new functionality,” Segal said. “We'll be looking at that and consulting with our members.”