HIE Workgroup Takes CMS to Task for Proposed Stage 3 Rule

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For the most part, the Health IT Policy Committee’s workgroups agree with the proposed Stage 3 meaningful use rule from the Centers for Medicare and Medicaid Services. However, the one glaring exception is the Interoperability and Health Information Exchange Workgroup which reported to ONC’s advisory committee on Tuesday that it disagrees with the vast majority of Stage 3’s HIE recommendations.

At a May 12 HIT Policy Committee meeting, four workgroups—the Advanced Health Models and Meaningful Use Workgroup, Consumer Workgroup, Interoperability and Health Information Exchange Workgroup, and Privacy and Security Workgroup—presented their assessments of the Stage 3 proposal.

Also See: Stage 3 Rule Seeks to Simplify, Streamline Meaningful Use Program

The Interoperability and Health Information Exchange Workgroup, chaired by Massachusetts eHealth Collaborative president and CEO Micky Tripathi, specifically looked at Stage 3’s objective 7 on HIE which includes three measures, of which providers have to meet only two out of three (but must report on all three):

*Measure 1 calls for sending an electronic summary of care record for 50 percent of outgoing transitions or referrals.

*Measure 2 would require receiving and incorporating an electronic summary of care record for 40 percent of incoming transitions or referrals of new patients.

*Measure 3 would reconcile clinical information for 80 percent of transitions or referrals of new patients.

While Tripathi said the workgroup in general agrees with the direction and goals of the HIE measures, there are concerns about thresholds set unrealistically high.

“Not because we’re opposed to higher thresholds—we very much support higher thresholds—but we don’t want to have to backtrack on the thresholds as has happened with view/download/transmit,” Tripathi told the HIT Policy Committee. “And,we certainly want to motivate providers to ‘own the problem’ so we don’t want to take that off the plate in terms of accountability. On the other hand, we don’t want to be penalizing people for things that are genuinely out of their control.”

He argued that “you can balance thresholds with judicious allowance for exclusions,” adding that “you can set a high threshold as long as you allow some appropriate exclusions along the way, correspondingly if you get rid of all the exclusions then you probably need to lower the threshold in order to accommodate the real-world variation that exists out there.”

In that vein, Tripathi said the workgroup took a look at Stage 2 meaningful use requirements, given that two out of three of the proposed Stage 3 measures (Measure 1 and 3) “have direct connections” to Stage 2. According to Tripathi, Stage 2 experience “suggests that the Stage 3 thresholds are higher compared with performance to dates, and perhaps significantly higher given the small sample results to date.”

As a result, among the workgroup’s recommendations is that Measure 1’s threshold of sending an electronic summary of care record for 50 percent of outgoing transitions or referrals should be lowered to 40 percent. “Stage 2 data suggests that the average provider could be well below 50 percent,” Tripathi said. “We do want to keep the rate high to motivate forward progress, so we’re not saying let’s reduce it down to 20 percent…We felt like we couldn’t come in with a measure that was below the experience from last year. So, that’s why we’re saying 40 percent would be our recommendation rather than 50 percent.”

Likewise, the workgroup recommends that Measure 2’s threshold of receiving and incorporating an electronic summary of care record for 40 percent of incoming transitions or referrals of new patients should be lowered to 25 percent. “Our biggest concern is that this is a brand new measure and novel territory nationwide,” commented Tripathi. “We think that it’s inappropriate to raise [the bar] too high, and 40 percent is such a high bar…By allowing some flexibility in how it’s done through some of the exclusions that we’re suggesting, we think that 25 percent—though it is a high bar for a new measure—is something that can be accomplished.”

Overall, the workgroup disagreed with 14 proposed Stage 3 recommendations, while only agreeing with 8 recommendations.

For its part, the Privacy and Security Workgroup reported to the HIT Policy Committee that it supports the Stage 3 proposal to increase the opportunities for patient access to information through the use of view/download/transmit technologies as well as open application programming interfaces. However, the workgroup also expressed concerns about potential privacy and security risks associated with increasing patient access to health information electronically.

The HIT Policy Committee on May 22 will hold a follow-up virtual meeting to hear the workgroups’ final comments on the proposed Stage 3 rule, at which time the committee will vote on the recommendations. In the meantime, slides from the May 12 workgroup presentations can be found here.

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