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CMS Issues Proposed Rule on Stage 3 of Meaningful Use

On March 20, 2015, the Center for Medicare and Medicaid Services ("CMS") and the Office of the National Coordinator for Health Information Technology ("ONC") each released their much-anticipated proposed rules for Stage 3 of the Meaningful Use program and the 2015 Certification Criteria for EHR Vendors, respectively.

The proposed rules are born out of the Health Information Technology for Economic and Clinical Growth (HITECH) Act. A primary objective of the HITECH Act is to encourage sophisticated use of electronic health records ("EHRs").  To accomplish this, the Act adopts a two-pronged approach. One prong establishes a Meaningful Use program that seeks  to spur the use of certified EHRs by eligible professionals, hospitals and critical access hospitals ("CAHs") by using carrots and sticks; meaningful users of certified EHR technology are eligible to receive incentive payments under the EHR Incentive Program while non-meaningful users may be subject to a reduction in their reimbursement. The other prong of the HITECH Act establishes technical requirements for those certified EHRs utilized in the Meaningful Use program.

The Meaningful Use program has adopted an incremental approach to achieving its goals by breaking them up into consecutive stages. CMS's proposed rule, which can be found here, addresses Stage 3 of the Meaningful Use program. In the proposed rule, CMS responds to criticism from the health care industry over the rigidity of the Meaningful Use program's previous two stages by, for example,  providing greater flexibility in terms of reporting requirements. The proposed rule also provides some flexibility in terms of timing: whereas providers were originally required to be compliant with Stage 3 in 2017, the proposed rule makes compliance with Stage 3 optional until 2018, at which point all providers must be compliant with Stage 3.

CMS also attempted to simplify Stage 3 by  establishing a single set of eight objectives that would apply to eligible professionals, hospitals and CAHs, alike.  These eight objectives focus on:

  1. Protecting patient health information
  2. Electronic prescribing
  3. Clinical decision support
  4. Computerized physician order entries
  5. Patient access
  6. Coordination of care through patient engagement
  7. Exchange of health information
  8. Public health and clinical data registry reporting

Two of these objectives have garnered the most attention, namely, those related to patient access and patient engagement (#5 and #6, above).

The patient access objective would require that providers give more than 80% of their patients access to view, download or transmit their health information, or retrieve their health information through an application programming interface (API) that can be used by a third party application or device, within 24 hours of its availability.

The patient engagement objective would require the eligible provider, hospital or CAH to meet two of the following three requirements:

  1. More than 25% of patients must actively engage with the provider’s EHR (or access their information through a certified API from other applications or devices).
  2. 35% of patients must receive secure messages.
  3. Patient-generated data or data from a non-clinical setting is incorporated into the EHR for more than 15% of all unique patients.

The reference to third party applications and devices in the two objectives described above demonstrates CMS's continued belief that consumer devices and online services will play an important role in how patients interact with and create their health information.

While it is true that CMS reduced the number of total objectives in an effort to simplify the process, some are questioning whether this simplicity has been overshadowed by the objectives' unrealistic goals. In comments made to, John Halamka, Chief Information Officer of Beth Israel Deaconess Medical Center, questioned whether the new thresholds are appropriate under the current Meaningful Use program.  "If Meaningful Use was converted from a stimulus/penalty program to a pay-for-performance program without penalty, then these thresholds would be more appropriate." Physicians are also skeptical of some of these changes. In a survey designed by Healthcare Informatics and conducted by QuantiaMD, more than half (53.3 percent) cited the patient engagement objective as the objective that would be most difficult to satisfy.

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