Prospects For Meaningful Use Stage 2 Progress Questioned

Healthcare Innovators

There's little chance the Centers for Medicare & Medicare Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) can inject significant principles from the President’s Council of Advisors on Science and Technology (PCAST) report (pdf) into Stage 2 of its Meaningful Use incentive program. The reason it’s a long shot is the industry lacks a standardized universal exchange language (UEL) message wrapper, according to Stan Huff and Dixie Baker, both members of the PCAST Workgroup, a subgroup of ONC's HIT Policy Committee.

Workgroup Chair Paul Egerman, a retired software entrepreneur, set the tone for the meeting by noting that the group's mandate was to discuss the PCAST report's "implications and feasibility" on Meaningful Use not to "not to criticize the report, if it's good or bad or right or wrong."

Though continually pressed by Egerman -- operating under the charge from both PCAST and National Coordinator David Blumenthal, M.D., that ONC move the nation toward the report's recommendations "boldly and aggressively" -- the duo adamantly resisted the injection of any measures into Stage 2 that would require use of a UEL wrapper.

"My concern is timeframe," said Stanley Huff, M.D., professor of biomedical informatics at the University of Utah College of Medicine and CMIO at Intermountain Healthcare. "If we are talking about this push [of CCD elements] in a UEL wrapper, that implies that in the timeframe for Stage 2, there is a UEL that has been defined, approved, and, hopefully, prototyped -- one that we know is fit for the purpose, and I really question whether that can happen in the timeframe of Stage 2."

Doug Fridsma, M.D., Ph.D., director of ONC's Office of Standards and Interoperability, said that all Stage 2 measures had to be finalized for the Notice of Proposed Rulemaking (NPRM) by September, which would mean everything had to be "completed, vetted, and piloted by July."

In response, Baker, Ph.D. and SVP, CTO, and technical fellow at Science Applications International Corp.'s health and life sciences business, promptly stated, "Then I would agree with Stan. Since we don't have a common metadata UEL model in place, I think it's true a UEL is not feasible by Stage 2."

Baker went on to drive the point home by talking of her nascent work on the Privacy and Security Standards Workgroup. "We are just preparing at end of the month to present recommendations for digital certification standards that will be developed by the Standards and Interoperability Framework Team. I think a better target [for a UEL] is Stage 3."

Huff continued: "The standards are not in place, and there are no implementations in place. This thing has to be locked down so that you have a specification people can start programming against later this year. All of these things are doable, they are wonderful things, but the timeline is just not right for you to have enough public input, have people prototype it, and prove that it works."

But Huff went on to say there was something that could be done to move Meaningful Use in the PCAST direction. "We could say -- and it's implied -- that you have to be able to send a CCD using LOINC and SNOMED to a PHR, that is doable. What isn't doable is when you say UEL wrapper, or moving to a PCAST approach with a UEL, that makes it not doable by July."

At that, a workgroup member commented that if Huff's assessment was accurate, the industry was in a "poor state of affairs."

"It may be a poor state of affairs," retorted Huff, "but I think that's exactly where we are."