LAS VEGAS -- Doctors now have an extra nine months to prove to the federal government that they've accomplished the early stages of "meaningful use" of health information technology (IT), National Coordinator for Health IT Farzad Mostashari announced Thursday.
The 34,000 health IT experts -- including hospitals, doctors, and IT companies -- who are here for the annual Healthcare Information and Management Systems Society (HIMSS) conference have been buzzing all week about the release of the "Stage 2" meaningful use guidelines. After much anticipation, the 455-page proposed rule for Stage 2 meaningful use was Thursday, where it will be open for comment for 60 days.
"Meaningful use" refers to provisions in the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, which authorized incentive payments through Medicare and Medicaid to clinicians and hospitals that use electronic health records (EHRs) in a meaningful way that significantly improves clinical care.
Broadly, in order to be clinicians must show their EHR is capable of e-prescribing; exchanging health information with other doctors, patients, and the Centers for Medicare and Medicaid Services (CMS); and submitting clinical quality and other measures for analysis.
There will be three different stages of meaningful use requirements under which providers will have to progressively increase their use of EHRs. The Stage 1 requirements were issued in 2010; they largely dealt with doctors and hospitals just getting an EHR system in place.
The criteria proposed Thursday for Stage 2 focus on capturing health information in a more structured format and on increasing the exchange of information between providers, according to CMS.
Providers must prove their EHR system is capable of meeting a list of specific objectives outlined by CMS, such as having the capability of exchanging a patient's notes, medication list, allergies, and diagnostic test results.
Under the proposed Stage 2 rule, providers who haven't proven they've met the Stage 1 requirements of meaningful use by Oct. 3, 2014 face a 1% cut in Medicare Part B pay starting in 2015, and the percentage is expected to increase a percentage point each year thereafter for at least a couple of years.
That deadline for meeting the Stage 1 requirements is nine months later than the original deadline of Dec. 31, 2013.
According to a survey presented here Tuesday of 302 hospital IT executives, more than one-quarter said they had already proven to CMS that they have met the government's standard for the first stage of meaningful use of health IT. That essentially means they have shown they have the baseline capabilities in their CMS-approved health IT system to collect and submit data.
Stage 2 also deals with security of exchanging patient information electronically, particularly the risk of a doctor leaving his laptop or iPad somewhere accessible to the public.
"A huge, huge, huge portion of all breaches don't occur because someone hacked into the system; they occur because people left their laptop on the train and they didn't encrypt it," Mostashari said.
The Stage 2 rule strongly encourages -- although doesn't require -- that all patient information be encrypted on all devices if sensitive information is stored on the device, he said.
The federal government will provide incentive payments of up to $44,000 per clinician over five years through Medicare and $63,750 per clinician over five years through Medicaid to providers who are meaningful users.