The federal government’s Health IT Policy Committee has adopted additional recommendations on meaningful use and proposed expansion of EHR certification to include 10 to 12 certification panels in addition to the existing Certification Commission for Health Information Technology.
Physicians, activists, vendors and others warned the committee at a meeting on Aug. 14 that it was moving too fast
Updated Recomendations
The panel’s recommendations, which include timelines for development and certification plans, will be used to guide the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare and Medicaid Services as they develop the “meaningful use” requirements providers must fulfill to get their cut of $17 billion in health IT funding from the American Recovery and Reinvestment Act (ARRA).
Eligible providers would have to use CPOE (computerized order entry) for all orders; implement drug-drug, drug-allergy, drug-formulary check; and maintain an up-to-date problem list of current and active diagnoses based on ICD-9 or SNOMED.
Among the quality measures providers would be required to report to CMS in 2011 are percentage of diabetics with A1c under control; percentage of hypertensive patients with blood pressure under control; and percentage of smokers offered smoking cessation programs.
The Health IT Policy Committee plans to hold informational hearings this fall, develop measures in the first quarter of 2010, work on standards in the second quarter of 2010 and hand over its recommendations to CMS in the third quarter of 2010. Providers who want to qualify for ARRA bonuses must have used data meaningfully during 2010 to get bonuses to be paid in 2011.
Expanded Certification
Also in the new recommendations is a plan to open the certification process to the market. Today. the Certification Commission for Health Information Technology (CCHIT), which is under the umbrella of the Department of Healt and Human Services, is the sole certification body. The Meaningful Use Workgroup envisions 10 or 12 more certifying bodies. The federal government would approve the panels, which would be required to adhere to CCHIT certification procedures.
The Health IT Policy Committee also recommended a “gap” certification, or preliminary certification, to be given by HHS to vendors who prepare software in good faith in advance of the meaningful use standards. After the standards are released in 2011, the vendors would add whatever is missing in their programs, facilitating the speed with which providers can be ready to start their meaningful use data collection.
Moving Too Fast
Members of the public complained to the panel at the Aug. 14 meeting that the panel was rushing process and that the public lacked the opportunity to be part of it.
David Blumenthal, national coordinator for health IT, reiterated what he says at every meeting. “We are not in the business of making policy, we are in an advisory role. Ultimately, the decisions will come down to CMS.”
Gayle Harrell, former Florida state legislator and member of the policy committee was concerned about timing and whether CMS would be able to handle its new gap certification role.
Tony Trenkle, director of the CMS Office of e-Health Standards, also a member of the committee, said CMS is working on that now and will include its methods and intentions in its meaningful use proposed rulemaking in December. “We won’t propose something in our rule that we can’t handle in our systems,” he said.
Deborah Peel, MD, founder of Patient Privacy Rights said she feared her coalition’s written concerns, representing more than 10 million Americans, were never considered by the committee. Among other things, she is concerned patients will lose the right to control their data in the process of the meaningful use rulemaking.
Mike Campbell from McKesson Corp., said the new gap certification, to be based on 2008 criteria, will make an un-level playing field for vendors who certified in 2009 under stricter requirements.
Other complaints came from representatives of physicians’ and health disparities groups who said the committee’s recommendations do not take into account the difficulties physicians face in healthcare IT adoption and consequences racial and ethnic groups face in increased disparities caused by lack of support to safety net providers who want to adopt IT.
