OMB Reviewing Final Rules to Update Meaningful Use and HIT Certification Criteria

In this month’s post, we take a look at an article posted on Radiology and HIT Blog on September 11, 2015 which discusses the next round of final rules which are currently under review.

Earlier this month, the HHS Office of the National Coordinator for HIT (ONC) and Centers for Medicare and Medicaid Services (CMS) submitted final rules to update the EHR Incentive Program participation and technology certification requirements for White House Office of Management and Budget (OMB) regulatory review. OMB regulatory review is one of the final closed steps prior to public release, and the process typically takes 30 to 90 days.

There are two CMS final rules (2015-2017 and Stage 3) and one ONC final rule (2015 Edition HIT certification criteria) under review. We should expect at least the main final rule on meaningful use (MU) modifications for 2015-2017 to be published before October to enable 90-day reporting periods to commence on October 1. The Stage 3 final rule also includes “modifications for 2015-2017” in the title, which could mean pieces of the MU fix are divided between some sort of expedited “modifications” final rule and a lengthier “Stage 3” final rule to be published later. However, it is equally possible that all three CMS and ONC final rules will be published simultaneously given that all three were submitted for OMB review on the same September 3 date.


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Flex-IT 2 Act Provides Relief to Physicians, Hospitals and Healthcare Providers Facing Tough Health IT Mandates

In this months post, we take a look at a recent post on on July 30, 2015 that introduces legislation that would delay CMS promulgation of the Stage 3 MU Final Rule and mandate a 90-day EHR reporting period every year, among other updates.

Congresswoman Renee Ellmers (R-NC-02) introduced H.R. 3309 – the Further Flexibility in HIT Reporting and Advancing Interoperability Act or Flex-IT 2 Act on July 30, 2015.

According to the post, there continues to be a need for healthcare providers to have flexibility in meeting CMS’ rigid deadlines: only 19 percent of providers and 48 percent of hospitals have met Stage 2 of the Meaningful Use. To address mounting concerns among healthcare providers, Rep. Ellmers has introduced the Flex-IT 2 Act to address concerns with CMS’ proposed rules for Meaningful Use Stage 3 rules for the Medicare and Medicaid EHRs Incentive Programs.

This robust legislation encompasses 5 measures:

(1) Delay Stage 3 Rulemaking until at least 2017, or MIPS final rules or at least 75 percent of doctors and hospitals are successful in meeting Stage 2 requirements.
(2) Harmonize reporting requirements (MU, PQRS, IQR) to remove duplicative measurement and streamline requirements from CMS.
(3) Institutes a 90-day reporting period for each year, regardless of stage or program experience
(4) Encourages interoperability among EHR systems
(5) Expands hardship exemptions, as they are very narrowly defined under current regulations

View H.R. 3309 – the Further Flexibility in HIT Reporting and Advancing Interoperability Act (Flex-IT 2 Act): click here.

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The last mile of meaningful use — value

In this months post, we take a look at an article written by, Bob Cooke, Vice President, Marketing, National Decision Support Company.

The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator (ONC) for Health IT took a leap forward with their recent releases of the Stage 3 Proposed Rule and HIT certification criteria, respectively. At the highest level, a key requirement derived from these proposed program updates is that providers will need to comply with a revised set of requirements in order to receive future value-based reimbursements.

The Stage 3 Proposed Rule focuses on the exchange of data across episodes of care as opposed to whether or not providers “see patients,” “have office visits,” or fall under others terms that don’t really apply to radiologists. It’s not that radiologists don’t conduct “office visits,” or “see patients,” it’s just that to apply these definitions against a radiologist’s compliance with Meaningful Use, and more importantly, extracting value from participation by imaging is practically impossible. Collecting this data is not enough for radiology.

Take smoking status for example, a fairly simple piece of data. For most of the radiologists in the country, this simple piece of data is not available as part of the interpretation process. Collecting it when you see a patient is one thing, but for a radiologist to see it when they interpret an exam for the patient, it can mean everything, as Brigham and Women’s Hospital found out when a jury awarded a patient $16.7 million for a missed cancer diagnosis on a simple CXR for a patient. It turns out the radiologist did not have access to the patients history, which included a family history of lung cancer and a 30 year habit. The exchange of this kind of data is critical to healthcare providers and consumers alike.

Exchanging data across episodes of care (e.g. a radiology encounter) has tremendous benefits to radiology as it enables practices to capture relevant clinical information and apply it towards value-based workflows using widely available, and established, implementation standards. Furthermore, this same exchange mechanism transports coded radiology results, updated medications (for interventional exams) and vitals as appropriate, as the Stage 3 Proposed Rule formally defines the radiology report as part of the Clinical Document Architecture (CDA).

Another key component of Meaningful Use is Clinical Decision Support (CDS). And, the Stage 3 Proposed Rule encompasses the implementation of CDS for recording clinical quality measures and to align incentives with the Physician Quality Reporting System (PQRS). Furthermore, the Protecting Access to Medicare Act of 2014 (PAMA) requires physicians to consult CDS in order to receive payments for Medicare claims.

All in all, radiology has an opportunity to leverage these proposed program updates to deeply embed themselves into the patient care cycle and measure and improve their value in delivering more cost effective and higher quality patient care.

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ONC 2015 Edition Certification Criteria Proposed Rule

In this month’s post, we take a look at the ONC 2015 Edition Proposed Rule.

The 2015 Edition Proposed Rule introduces the beginning of the Office of National Coordinator for Health Information Technology’s (ONC’s) more frequent approach to health information technology certification regulations. Under this approach, ONC intends to update certification criteria editions every 12 to 18 months in order to provide smaller, more incremental regulatory changes and policy proposals. This approach gives stakeholders greater and earlier visibility into our regulatory direction before compliance is required, provides more time for public input on policy proposals under consideration for future rulemakings, and enables our certification processes to more quickly adopt newer industry standards that can enhance interoperability.

The 2015 Edition EHR certification criteria proposed in this rule would be voluntary. No EHR technology developer who has certified its EHR technology to the 2014 Edition would need to recertify to the 2015 Edition in order for its customers to participate in the EHR Incentive Program. Furthermore, eligible professionals, eligible hospitals, and critical access hospitals that participate in the EHR Incentive Programs would not need to “upgrade” to EHR technology certified to 2015 Edition in order to have EHR technology that meets the Certified EHR Technology (CEHRT) definition. Instead, the 2015 Edition EHR certification criteria would accomplish three policy objectives:

  • Enable a more efficient and effective response to stakeholder feedback
  • Incorporate ”bug fixes” to improve on 2014 Edition EHR certification criteria in ways designed to make our rules clearer and easier to implement
  • Reference newer standards and implementation specifications that reflect our commitment to promoting innovation and enhancing interoperability

The proposed rule was published in the Federal Register on February 26, 2014. ONC will accept comments on the proposed rule through April 28, 2014 via A voluntary public comment template offers a simple and organized way to submit comments on the proposed certification criteria and associated standards and implementation specifications, and respond to specific questions posed in the preamble of the proposed rule. The final rule is expected to be issued in summer 2014.

Proposed Rule (Federal Register):

Public Comment Template:

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