Meaningful Use Rules Give CIOs Wiggle Room

Meeting the new federal meaningful use standards will require much heavy lifting. And health IT leaders should already be preparing for what comes next.

What are healthcare CIOs talking about now that ICD-10 is live?

Meaningful use deadlines took center stage at the annual meeting of the College of Healthcare Information Management Executives (CHIME) in Orlando, FL, last week. But attendees also found time to talk about what comes after meaningful use—namely, CCDA and CEHRT.

Two meaningful use dates now loom large. The first is December 15, when the 60-day comment period on the stage 3 final rule expires. While some industry observers consider the comment period to pertain just to stage 3, that isn't precisely true. Because ONC and CMS issued a single final rule covering both stage 3 and its amendments to stage 2 in the years 2015, 2016, and 2017, the public has the right to comment on anything in the final rule, says Liz Johnson, CIO of acute care hospitals and applied clinical informatics at Tenet Healthcare, the for-profit hospital operator headquartered in Dallas.

The second big date is February 29, 2016, which is both the starting day of next year's HIMSS conference and the day that all providers receiving Medicare must complete their attestation to their meaningful use of certified EHR software in 2015.

Considering that the final rules amending stage 2 came out nearly a week into the newly shortened 90-day reporting period for 2015, CIOs had to do some fancy footwork to make sure that they were gathering the necessary data starting October 1.

Among the lingering questions are challenges in meeting the public health reporting requirements in the newly modified stage 2, which will vary from state to state. Within the CHIME organization, board member Johnson is one of two experts on this devilish detail. The other is Pam McNutt, senior vice president and CIO of Methodist Health System in Dallas.

My October 7 news story on the final rule could only hit some highlights of these voluminous documents. At CHIME, McNutt celebrated the fact that the modified stage 2 rules removed the 50% measure for providing a summary of care record by any means, as well as relaxation of requirements for manual transmission, to better allow providers to tailor the contents of the summary of care document to the transport mechanism, rather than constraining transport to a certified HIE or Direct message.

The final rule "gives you more flexibility on what could be defined as a secure electronic message to your providers, and that is good news," McNutt said. "I know many people were struggling, didn't have an HIE that was functional to get to 10% of your referrals. … So this will give you some latitude to maybe be creative. However, I will tell you we're scrambling with this one ourselves right now, because the reporting period has in fact started, and if you don't have your numbers up to 10%, you've got to scramble."

McNutt and Johnson also cautioned CIOs to be prepared for the final rule's planned jumps in stage 2 patient engagement and e-prescribing metrics in 2017.

On the second morning of the CHIME conference, ONC chief health information officer Michael McCoy, MD, told attendees that alignment of financial incentives of healthcare—through value-based purchasing and ACOs—would make health IT interoperability a reality.

"Go to your board and suggest that the data should flow," McCoy said. "We should compete on our service, on our caring, and how well we score, but we shouldn't compete on the data flowing."

One questioner then asked what the most effective path would be to attain useful data exchange between providers.

The answer is Consolidated Clinical Document Architecture (CCDA), McCoy says. "The CCDA is the right path. There are revisions now coming. The challenge we have had with CCDAs is they have been branded as unusable. I have to respectfully push back and disagree. What has been lost in the [EHR] certification rules and the intent over the years is that certification is a floor for the vendors and developers to achieve, not a ceiling. As an example, transmitting information as a CCD [Continuity of Care Document] to whomever … as the sending individual, you probably don't have all the knowledge of what is desired by the receiving individual …. What's missing from the usability side is the receiver should be able to filter what's coming through, and that's more explicit, called out in the 2015 CEHRT rules …. Specialty societies have to be involved in setting some of those defaults."

I got the impression that very few CIOs so far have even begun to read those 2015 CEHRT (Certified EHR Technology) rules, which themselves delineate meaningful use's final stage. With the aforementioned comment period ending December 15, at this point providers could use a good crowdsourcing effort to fully understand and parse those 550 pages, and help an already beleaguered health IT industry catch the next wave of regulation even as the previous wave washes over it.

Wouldn't it be cool if technology could help us with that?