Speculation that the proposed rule for Stage 3 of the electronic health records meaningful use program will come out this month is being fueled by a session scheduled on April 13 at the upcoming HIMSS Conference with the giveaway title, “CMS Meaningful Use Stage 3 Requirements.”

Veteran meaningful use policymakers Elisabeth Myers and Robert Anthony in the Centers for Medicare and Medicaid Services expect at HIMSS to lay out the requirements and compare them with previous program criteria.

Whether the rule actually comes out before the session remains a question mark. The proposed Stage 3 rule was sent to the Office of Management and Budget in early January for review. OMB has its own timetable for reviewing rules and is used to federal agencies begging for quick action on their own initiatives.

In 2012 with the HIMSS conference soon to start, CMS pressed hard on OMB to finish its review of the Stage 2 rule and CMS officials then furiously re-wrote parts of the rule so the agency—which wanted the rule out before the conference—could at least present it and give an overview at the conference. CMS and HIMSS attendees were not happy with such a large and major rule being dropped at a conference where everyone already had overloaded schedules.

But, it could happen again. A CMS spokesperson on March 12 told Health Data Management that the agency was still writing the rule. Further clarification could not be obtained; it may be that CMS now is in the process of amending portions of the rule as part of the OMB review process.

Stage 3 is expected to highlight accelerating interoperability and promoting better outcomes. With eligible hospitals, professionals, as well as vendors struggling with Stage 2, the industry pushed for a streamlined and more focused Stage 3. Whether that will happen is a question soon to be answered. However, existing signs indicate overkill on Stage 3 regulations could become an issue.

In March 2014, the Health It Policy Committee approved scaled-down criteria in Stage 3 from 26 to 19 objectives before sending its recommendations to the Department of Health and Human Services, CMS, and the Office of the National Coordinator for Health Information Technology. Two months later during a HITPC workgroup meeting, stakeholders again argued that the scope of Stage 3 remained too broad.

Two initiatives to accelerate interoperability gained steam in 2014 and small steps to begin implementing the initiatives could be part of Stage 3—and could raise more howls of moving too much too fast.

A 2014 study done for ONC by JASON, an independent group of scientists that advise the federal government on science and technology, called for creation of an open and interoperable health data infrastructure based on adoption of public and standardized application programming interfaces to ease a major barrier to interoperability. JASON established credibility for an emerging initiative, as standards development organization Health Level 7 International accelerated development of its Fast Healthcare Interoperability Resources API, known as FHIR, which uses the latest web standards.

In February 2015, Micky Tripathi, CEO of the Massachusetts eHealth Collaborative and a leader in the FHIR initiative, told Health Data Management that FHIR could perhaps be ready for certification in 2016 if the government wants to adopt the standards. Stage 3 starts in 2017.

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