Frustration Flares In ONC's Meaningful Use Workgroup Debate

Health IT Boosts Patient Care, Safety

The HIT Policy Committee's Meaningful Use Workgroup struggled to reach consensus on key Stage 2 requirements, with some accusing the group of being timid in certain areas, and others characterizing the proposed requirements as unrealistic in the given timeframe.

Specifically in the area of providing patients with electronic access to their hospital visit summaries through a Web-based portal, tempers flared at the April 5 meeting of the HIT Policy Committee, convened by the Office of the National Coordinator for Health Information Technology.

Arguing that the workgroup seemed willing to add requirements around provider-to-provider electronic transmission, yet balked at those dealing with provider-to-patient transmission, Christine Bechtel, vice president of the National Partnership for Women and Families, said, "We have to be careful about our tendency to raise the bar [to receive our endorsement] with anything around patients and families, and to question them in a way we don't question things for providers. We have to find a way to do this in Stage 2, in 2013, when everyone else and their mother can communicate over the Internet."

James Figge, M.D., medical director, New York State Department of Health, Office of Health Insurance Programs, responded, "Well, it depends on how secure you want to be. If you want to be really secure, that's not easy to do." Figge explained that creating the capability for patients to access their records through hospital-provided portals would be "an enormous undertaking, a really big deal. The authentication of users over the Internet is not trivial."

Marty Fattig, CEO at the Nemaha County Hospital, agreed. "I think this is going to be a huge thing because we have to do this in a very secure manner. It's an operational issue. I'm for it -- I just want to do it correctly."

Charlene Underwood, director of government and industry affairs at Siemens Medical Solutions, echoed Figge and Fattig. "This is one big step up for Stage 2, to put the infrastructure and authentication in place. We are trying to improve the discharge with the exchange of summary information. Access by the patients is good, but another means to go after readmission rates is by making them available to the primary care provider through a health information exchange." To which, Bechtel asked, "Doctor-to-doctor communication is delightful, but what about for patients and caregivers?"

Deven McGraw, director of the Health Privacy Project at the Center for Democracy and Technology, cautioned against adding every patient's information to any portal, which would be theoretically more susceptible to a security breach. "What about people who don't want their information in portals," she asked. "I don't know if I'm comfortable with requiring that portals be established for people who don't want to use them." Group members clarified that the portal option would be "per patient preference," perhaps further complicating its operationalization.

As the workgroup went line-by-line through its proposed Stage 2 requirements, patient and privacy advocates seemed to line up for a higher bar, while those on the provider side preferred more moderate measures.

Interestingly, the workgroup was clearly operating with more flexibility than a thumbs up or down approach to each proposed measure. The group had "signaled" to the industry that Stage 1 Menu items (those items that providers could select from, rather than having to comply with them all) would become "core" in Stage 2. They seemed to favor the same dynamic for Stage 2, perhaps expanding the core set to include new items, while putting others in menu. Some items that seemed out of reach for Stage 2 -- perhaps because they required new EHR functionality and, thus, time for vendor development and product recertification -- were relegated to Stage 3.

Another dynamic of the meeting was the desire of vendors, particularly Underwood of Siemens, to have exact standards for any new proposed measures, especially those that would necessitate a change in software. She repeatedly asked members proposing new measures what the standards in that area were, or informed them that, currently, there were no vendors could build to.

For some proposed measures that seemed to lack standards, such as how to record and display family medical history, Paul Tang, M.D., VP and CMIO at Palo Alto Medical Foundation and chair of the Meaningful Use workgroup, said he would confer with the HIT Standards Committee to see if something could be developed within the group's tight timeframe.

That timeframe calls for the workgroup to present its Stage 2 measures to the full HIT Policy Committee on April 13. On May 2, Tang said the workgroup would convene to discuss the feedback it had received from the Policy Committee, refining its Stage 2 proposals. On May 11, the workgroup will present its Stage 2 "package" to the Policy Committee for a second review. "We will then finalize our proposal after that meeting in preparation for a presentation at the June 8 Policy Committee meeting, when we will ask for approval."