The HHS Office of the National Coordinator for HIT (ONC) released its draft National Interoperability Roadmap and associated Standards Advisory today for public comment. The Roadmap builds upon ONC’s past efforts to obtain stakeholder feedback on advancing interoperability and health information exchange. The Standards Advisory is a compilation of current standards ONC identified that could facilitate implementation of the Roadmap.
Public comments are due on the Roadmap by April 3, 2015, and the Standards Advisory by May 1, 2015. Any and all members of the American College of Radiology interested in providing feedback for potential inclusion in ACR’s future comments should please email Michael Peters, ACR Director of Regulatory and Legislative Affairs, at firstname.lastname@example.org.
For additional background information, please visit healthit.gov.
Today, the Centers for Medicare and Medicaid Services (CMS) announced its intent to propose additional regulatory changes via a separate rulemaking from the imminent “Stage 3” EHR Incentive Program (“meaningful use”) rulemaking. The proposals would potentially include allowing a 90-day EHR reporting period in 2015 as well as other revisions to reduce complexity and lessen providers’ reporting burdens.
CMS’ “Stage 3 MU” and the HHS Office of the National Coordinator for HIT’s “2015 Edition EHR Certification Criteria” rulemakings have been under formal regulatory review for about one month. They were likely drafted months before both agencies realized that participation in the physician version of the program was going to be much lower than acceptable based on the small number of additional new participants in 2014 (and not even factoring in all the anticipated drop-offs from previous years). So, this second CMS MU rulemaking in 2015 will be another bite at the regulatory apple.
Timing-wise, we should expect to see the agencies’ Stage 3/2015 Edition proposed rules released for public comment within the next couple of months. Then, likely before those final rules are promulgated later this year, we should see this second CMS rulemaking published for comment around spring/early-summer (and presumably finalized before the end of the year).
Beyond the mechanics and expected timing of the various MU-related rulemakings in the pipeline, today’s announcement was also CMS’ way of signaling to the public that a 90-day EHR reporting period in 2015 is in the works. If all goes well with the rulemaking process, prior MU participants who could not begin their CY 2015 EHR reporting periods on January 1 should get another chance to comply this year. Although the agency had several opportunities to include a shortened 2015 EHR reporting period in various rulemakings in 2014, this “announcement of intent” is better late than never.
A s part of last month’s FY 2015 Consolidated and Further Continuing Appropriations Act efforts, Congress directed the HHS Office of the National Coordinator for HIT (ONC) to decertify products that “proactively block the sharing of information” and to report back to Congress on the extent of the problem, including an estimate of the number of vendors, hospitals, or providers who “block information.” An example of “blocking information” could be when a hospital or EHR vendor prohibits, discourages, or excessively charges for appropriate and secure exchange between referring providers’ systems and those of unaffiliated radiology practices.
The American College of Radiology (ACR) is working with the American Medical Association and other physician groups to collect information to help HHS and Congress understand the scope of the issue. Please contact Michael Peters, ACR Director of Regulatory and Legislative Affairs, at email@example.com by February 4 if you have information about any of the following items:
- Fees charged by EHR vendors, or others, to connect radiologists with ordering providers who use the vendors’ products.
- Interface costs to connect radiologists’ systems with those of referring providers.
- Contractual limits on which parties EHR vendors or providers will exchange information with.
- Contract language that explicitly states EHR vendors own data.
- Interface costs to connect with health information exchange (HIE) networks.
- Monthly or per-transaction costs associated with the use of health information service providers.
- Any other charges/fees (not identified above) required to exchange data.
The American College of Radiology (ACR) recently released “ACR’s Pocket Guide to Meaningful Use (MU) in 2015,” a three-page overview of Medicare EHR Incentive Program requirements for radiologists. This free educational resource will be enhanced over time with new information and links to additional materials.
The 2015 version is the third iteration of this educational tool. The continued goal of the “Pocket Guide” series is to translate the vast, enormously complex regulatory framework of the Medicare EHR Incentive Program for eligible professionals into the shortest and most basic of summaries. Approximately 9 out of 10 questions I get from ACR members regarding Meaningful Use can be answered with this simple document and/or using the links provided within.
Note: Physicians interested in the State/Medicaid version of the program have additional fundamentals to learn beyond those discussed in this Medicare EP-specific resource.
White House Reviewing CMS and ONC Proposed Rules to Update the EHR Incentive Program and HIT Certification Requirements
The HHS Office of the National Coordinator for HIT (ONC) and Centers for Medicare and Medicaid Services (CMS) submitted proposed rules to update the EHR Incentive Program participation and technology certification requirements for White House Office of Management and Budget (OMB) Office of Information and Regulatory Affairs (OIRA) review. OIRA review is one of the final steps in the federal rulemaking process prior to submission to the Government Publishing Office’s (GPO) Office of the Federal Register (OFR). Public stakeholders will be able to access the text of these two Notices of Proposed Rulemaking (NPRMs) for the first time when they are placed on the OFR’s Public Inspection Desk. So, while we know that public release of the NPRMs is imminent (OIRA review could last up to 90 days – usually closer to a month or two), the only information we have about the content at the moment is included in the rough descriptions on OIRA’s website.
The description for CMS’ NRPM, “Electronic Health Record (EHR) Incentive Programs–Stage 3” (RIN: 0938-AS26), indicates that it will propose changes to “the reporting period, timelines, and structure of the program, including providing a single definition of meaningful use.” It goes on to say that “These changes will provide a flexible, yet, clearer framework to ensure future sustainability of the EHR program and reduce confusion stemming from multiple stage requirements.” Hopefully, this means physician participants will be rewarded with a new, much-needed infusion of flexibility this rulemaking cycle.
The description for ONC’s NPRM, “2015 Edition Health Information Technology (Health IT) Certification Criteria, Base Electronic Health Record (EHR) Definition, and ONC Health IT Certification Program Modifications” (RIN 0991-AB93), indicates that, beyond the normal coverage of ONC’s certification criteria rulemakings, it also “proposes a new 2015 Edition Base EHR definition and proposes to modify the ONC Health IT Certification Program to make it more broadly applicable to other types of health IT health care settings and programs that may leverage the ONC Health IT Certification Program.” Some of the proposals from last year’s “2015 Edition EHR Certification Criteria” NPRM—which later evolved into the “2014 Edition Release 2” final rule—indicated the agency’s ambition (despite the lack of an apparent need) to expand the certification program beyond Meaningful Use (MU) applications. Then, there were provisions in a 2014 CMS payment rule that called for certified products in long-term, post-acute care settings. The additional ONC proposals would presumably address the new non-MU certification need in LTPAC settings—or, it could even be more widely applicable. If the latter, the agency would need to be careful about generating undue confusion in a market that needs more MU-ready software.
The HIT Policy Committee (HITPC) and HIT Standards Committee (HITSC) of the Office of the National Coordinator for HIT (ONC) focused on the recently updated Federal HIT Strategic Plan in rare back-to-back meetings December 9 and 10.
The revised Federal HIT Strategic Plan (released Monday) is an ARRA/HITECH-mandated, non-binding document to identify broad milestones over certain periods of time for federal agencies related to health IT, including dozens of agencies outside of HHS (NASA, Bureau of Prisons, DOD, Education, and so on). The update released for comment on Monday was the third version (2008 and 2011 being the priors). Critical to understanding the scope of this document, it does not address private sector/physician/industry activities or goals, but rather what outcomes government actors should strive for over the next 3 and 6 years.
Meanwhile, the anticipated “National Interoperability Roadmap” is expected to be published around January. Most importantly, the proposed rules to update the EHR Incentive Program participation and technology certification requirements are on the horizon for early 2015 (probably/maybe).
Earlier today, the HHS Office of the National Coordinator for HIT (ONC) announced the publication of the ONC Data Brief No. 21, “Physician Motivations for Adoption of Electronic Health Records.” The data brief attempts to explore stakeholder decisions to move forward (or not) with EHR adoption.
Unfortunately, as with all EHR adoption reports based on the Centers for Disease Control and Prevention (CDC) NAMCS survey and supplemental surveys from 2011-2013, a large chunk of the EHR Incentive Program eligible professional (EP) population (nearly 17% if CMS’ EP denominator is to be believed)—anesthesiologists, pathologists, and radiologists—are explicitly not included. Moreover, the CDC/NAMCS concept of an “EHR” is not always aligned with the ONC’s regulatory concept of “certified EHR technology.” So, while the CDC survey data may be useful for some things, it is not particularly helpful for understanding overall physician views of CMS’ EHR Incentive Program.
This is not new. The CDC’s annual surveys have omitted anesthesiology, pathology, and radiology data for years because they are based on a pre-ARRA understanding of the world. This kind of data would be more helpful if the surveyed population aligned with the real makeup of CMS and ONC’s stakeholders and better reflected the current, post-ARRA landscape.