Deven McGraw knows a thing or two about the Meaningful Use program. A member of the Health Information Technology Policy Committee, McGraw chairs the Privacy and Security workgroup and is liaison to the Interoperability workgroup, and has served on the Meaningful Use workgroup as well.

No longer with the Center for Democracy & Technology, where she was the director of the Health Privacy Project, McGraw is now a partner in the healthcare practice of Washington, D.C. law firm Manatt, Phelps & Phillips, providing legal, regulatory and strategic policy and business counsel to healthcare providers, payers and other healthcare organizations with respect to the adoption and implementation of health IT and health information exchange.

Health Data Management spoke to her about MU Stage 3 and what stakeholders can expect from the proposed rule that has been sent to the Office of Management and Budget for review.

HDM: Any idea when the proposed Stage 3 MU rule will be released?

McGraw: I’m totally speculating here. But, given that the Office of the National Coordinator is expected to release its draft Interoperability Roadmap in February at a joint Health IT Policy Committee and Standards Committee meeting, I would be surprised if the rule was released before that because one would assume that they are following similar trajectories and there’s probably a desire not to have one trump the other.

HDM: Currently, eligible hospitals and professionals are struggling with attesting to Stage 2 MU and with Stage 3 MU not slated to begin until 2017 it’s difficult for providers to get their heads around Stage 3 when Stage 2 is such a challenge.

McGraw: I hear from providers on this. One of the advantages of the new role that I’m in is that I actually have clients who are dealing with this, which was not the case when I was at the Center for Democracy & Technology and the input I received came from the associations that represent providers. It is a unique lens when you are trying to work with a provider who’s really struggling because the technology is not working for them in the way that it needs to in order for them to be able to attest.

There have been significant challenges to achieving Stage 2 objectives and a lot of them are technology and interoperability related. That’s why I think ONC’s Interoperability Roadmap will help to make the changes that are going to be critical to achievement of the higher level exchange and outcome-based objectives that Stage 3 was always supposed to be about. In many respects, the Interoperability Roadmap and Stage 3 should really be seen as a package.

HDM: Is that what we should expect from the Stage 3 rule—a focus on advanced use of EHR technology to promote improved outcomes for patients and increased interoperability?

McGraw: That was always what was envisioned for Stage 3. Stage 1 was supposed to be about populating records. Stage 2 was supposed to be about exchanging data. And, Stage 3 was supposed to be about taking our foot off the gas pedal on incremental objectives and moving more towards achievement of outcomes. I think it’s an open question as to whether industry is really ready for that. I think they are certainly ready for some relief on the incremental objectives—we certainly heard that loud and clear on the Health IT Policy Committee from industry—but which objectives to give up in service of instead relying on outcome measures, which we don’t have as many of as we would like, is a closer question and it’s one that frankly the Health IT Policy Committee could not come to consensus on.

HDM: The submission to OMB for Stage 3 proposes changes to the reporting period, timelines, and structure of the program to provide a “flexible, yet, clearer framework to ensure future sustainability of the EHR program and reduce confusion stemming from multiple stage requirements.” But, perhaps most significantly, the rule is said to also include a “single definition of Meaningful Use.” 

McGraw: It’s not clear what that single definition of Meaningful Use would mean. There’s a lot of ways you could interpret that. It could mean to say that there are not two pieces to the Meaningful Use program—objectives and the quality measures—but there is one. It also could mean that we are going to measure hospitals and ambulatory providers the same way. It’s just not clear as to what is meant by single definition, but those are two potential ways to cut it.

HDM: In March 2014, the Health IT Policy Committee approved scaled-down recommendations on criteria for Stage 3, going from 26 objectives in an earlier version to 19 objectives for providers to comply with. Do you see that as progress in and of itself?

McGraw: Absolutely. Having sat through those deliberations, it was incredibly difficult to figure out what to cut and what to keep. For some people, that sort of goes to the notion of which of your children are you going to favor. The measures were all seen as important but there was universally a sense that we needed to move from an incremental objective approach to one that was less prescriptive about how providers achieve good outcomes and concentrated more on good outcomes. It was really hard to come to consensus on that

HDM: The Health IT Standards and Policy Committees’ JASON Task Force recommended that Meaningful Use Stage 3 should serve as a pivot point from current interoperability approaches that are functionally limited to gradually replacing them with more comprehensive open API-based models. Do you think we’ll see that reflected in the Stage 3 rule?

McGraw: Maybe I’m biased because I sat on the task force, but I thought the task force did a great job in evaluating the JASON report and making thoughtful recommendations about how to progress to the next level of interoperability. I thought that was a tremendous piece of work and I am expecting ONC’s Interoperability Roadmap and Meaningful Use Stage 3 to reflect some of those recommendations.  

HDM: Anything else you are specifically looking for in the proposed Stage 3 rule?

McGraw: The piece I’m going to be looking for first, because it’s near and dear to my heart having spent six years at the Center for Democracy & Technology, is what’s going to be happen to the provisions around exchanging data with patients—either through the view/download/transmit capability or the secure email pieces of it. Those provisions were the subject of a lot of comment from industry about the difficulty in achieving those measures, particularly where they were being measured for what patients were doing and not just making the technology available. ONC has certainly emphasized in public comments the importance of getting patients access to their data and facilitating interoperability with patients. But, given industry concerns about being measured for what patients do in terms of accessing data, it will be very interesting to see how CMS and ONC thread that needle in Stage 3.

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