Modifications to "Meaningful Use" Stages 1 & 2 - Did CMS heed public health?

On October 16, 2015, the Centers for Medicare and Medicaid Services (CMS) published a final rule that modifies Stages 1 & 2 of the CMS EHR Incentive Program; a.k.a, Meaningful Use. The modifications are based on public comments CMS received earlier this year to a Notice of Proposed Rule Making. JPHIT, as a unified voice of the public health community on informatics matters, was among the many groups that commented on CMS's NPRM.

JPHIT’s position is to ensure that any modifications would not unintentionally stall progress on the flow of health data vital to public health and to ensure that population-level health outcomes are prioritized appropriately. Overall, JPHIT applauds CMS for continuing to support the needs of public health and fostering the capabilities needed to improve the speed and quality in which critical data gets to and is useful to public health agencies at the local, state and national levels. Here’s our opinion on what made it in to the interim final rule. For an exhaustive list of of JPHIT’s comments, check out the complete details here.

Which comments made it in?

Bidirectional data exchange with immunization registries was not adopted for Stages 1 & 2

JPHIT suggested that, while bidirectional data exchange with IIS is needed, requiring this for Stages 1 & 2 may be too burdensome. CMS agreed to JPHIT’s suggestion that bidirectional data exchange be included in Stage 3.

Measure 5, clinical data registry (CDR) reporting, not adopted for Stages 1 & 2

JPHIT expressed concerns that allowing CDR for Stages 1 & 2 would make it possible to decrease or eliminate engagement of public health agencies by eligible providers/hospitals. This would be detrimental to the gains made to population health through the original Stage 1 & 2 requirements. CMS did not adopt the modification and acted in accord with JPHIT’s suggestion.

Was CMS responsive to public health?

JPHIT represents the unified voice of the public health community, so did CMS heed public health’s voice when it comes to considering how modifications to Stages 1 & 2 would impact us?

Sort of.

JPHIT’s concerns were to ensure that CMS’s expectations of public health readiness in the modification of Stages 1 & 2 were in line with reality, and their decisions to not adopt certain modifications (like those listed above) align with our concern. When the interim final rule was published, JPHIT took a collective sigh of relief to see that some of the proposed modification were not adopted. However, some of our suggestions did not appear to be heard. For example,

·      Clarifying the definition of active engagement of public health agencies

·      Phased approach to adopting electronic case reporting for Stages 1 & 2

·      Including vital records systems in the measure for public health reporting

·      Clarifying the role of public health agencies in regards to public health reporting

JPHIT plans to reiterate our concerns since there is still time for comments to this interim final rule. We will be posting our reaction to the interim final rule to Stage 3 and the official final rule of ONC’s 2015 Edition Health Information Technology (Health IT) Certification Criteria, 2015 Edition Base Electronic Health Record (EHR) definition, and ONC Health IT Certification Program Modifications in the next few weeks.