The rule that details the requirements for stage 2 of meaningful use will “look a lot like” the measures that the Health IT Policy Committee recently endorsed, said Dr. Farzad Mostashari, the national health IT coordinator. The measures focus on patient-centered, safe and coordinated health care, he added.
The Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare and Medicaid Services (CMS) anticipate releasing their proposed rules on meaningful use of electronic health records (EHRs) and standards and certification criteria by the end of the year or early 2012, accepting public comments about it, and finalizing it next summer.
[Q&A: ONC's Mostashari on the innovation electronic data will spark. See also: Q&A: HHS CTO Todd Park on the bridge between Health Data Initiative and meaningful use.]
“Nobody knows what it’s going to look like. But if past is any indication of the future, it’s going to be ambitious but achievable, and it’s going to look a lot like what the policy committee recommendations said,” Mostashari told a June 27 health IT conference. “It’s not going to be identical, but there’s going to be a lot of deference given to the results of that process.”
Among the proposals of the policy committee, which is comprised of public and private organizations, is that ONC and CMS delay by one year until 2014 the onset of the next stage of meaningful use.
The change would affect only those who are meaningful users in 2011. “Those who do go in 2011, like everybody else, should have a year or more after the final rule comes out before they have to attest for stage 2,” he said, adding that “there should not be disincentive for those organizations who want to be meaningful users in 2011.”
According to the committee, progress needs to be made on some aspects tied to healthcare transformation, such as electronic medication administration that closes the loop from ordering to dispensing meds in hospitals, secure messaging between provider and patient, and the ability of the patient to get a copy, view and download his or her health information, Mostashari said.
Before the proposed rule for stage 2 meaningful use is released, ONC wants feedback about the use of certain types of metadata standards, or elements that describe data, including for patient identity, privacy and provenance or tracing of the source of data so a recipient can know if it is trusted, Mostashari said.
The Health IT Standards Committee endorsed activities by ONC to explore the use of these existing types of metadata standards last week.
[See also: Mostashari says "patients have a right to their records."]
“We’re going to put out a proposed rule for comment to see what the issues are around that and if that can be integrated in some way as part of meaningful use,” he said. ONC will test it and get experience about the use of metadata to inform the meaningful use proposed rule December or January, he said.
ONC is exploring the use of metadata standards in the simplest of scenarios in which a provider supplies a patient with his or her health information.
Last December, the President’s Council of Advisors on Science and Technology (PCAST) said the use of metadata will accelerate more comprehensive health information exchanges. The Health IT Policy and Standards committees have analyzed the PCAST recommendations and how ONC might begin to incorporate them by building on existing health IT.
