Under current regulations, Stage 2 meaningful use requirements become effective on Oct. 1, 2013, for eligible hospitals and on Jan. 1, 2014, for eligible professionals.

As these effective dates near, discussions regarding Stage 2 implementation have intensified. During a Senate Finance Committee hearing on July 24, 2013, witnesses representing hospitals, critical access hospitals, and health information technology vendors urged Congress to provide more time for eligible professionals and eligible hospitals to implement Stage 2 meaningful use requirements.

In a recent letter to the Department of Health and Human Services (HHS), the American Medical Association and the American Hospital Association urged delay for Stage 2 requirements for meaningful use and increased flexibility for eligible professionals and hospitals in meeting Stage 2 requirements.

Under the Health Information Technology for Economic and Clinical Health Act, financial incentives are paid to eligible physicians, hospitals, and critical access hospitals who adopt, implement, and demonstrate meaningful use of electronic health records. Payment adjustments for eligible professionals and hospitals not meeting meaningful use requirements will begin in 2015.

Stage 2
Stage 2 is the second of three stages that require successively higher levels of requirements for integrating electronic health records (EHR) into the clinical care provided by hospitals and providers for their patients. Incentive payments for EHR adoption began in May 2011 for eligible professionals and hospitals meeting meaningful use requirements; these incentive payments will continue until 2016 for those participating in the Medicare program. Meaningful use incentive payments for participation in the Medicaid program will continue until 2021.

The Office of the National Coordinator for Health Information Technology (ONC), with the advice of the Health Information Technology Policy Committee (HITPC) and its attendant workgroups, was tasked with providing recommendations to the Centers for Medicare & Medicaid Services (CMS), which is the federal agency responsible for developing and implementing regulations detailing meaningful use requirements through all three stages. According to the ONC, the goal of Stage 2 of meaningful use is to increase patient engagement, care coordination, and health information exchange.

In addition to increasing the number of core and menu objectives and revising some of the objectives required to meet meaningful use, Stage 2 also increases the number of clinical quality measures (CQMs) that must be reported from among the 64 approved CQMs.

HITPC public hearing
On July 23, 2013, the HITPC meaningful use workgroup held a public hearing of invited representatives who presented their views on the meaningful use program. The American Association of Orthopaedic Surgeons (AAOS) was the only medical specialty invited to have a representative as a panelist for the public hearing; John D. Bowman, MD, represented the AAOS in responding to the questions of the workgroup.

Dr. Bowman, the chief medical officer for OrthoVirginia, reinforced the points made in an AAOS comment letter on the HITPC’s draft recommendations for Stage 3 meaningful use. He pointed to the still common problem of data interoperability and the challenges that it poses in exchanging health information. He also noted the need for appropriate and applicable orthopaedic-specific quality measures and iterated the call for meaningful use criteria that reflect surgical specialty practices.

Data interoperability; information exchange
In response to an earlier request for information issued by ONC and CMS on March 3, 2013, the AAOS emphasized the need to require the following:

• EHR vendors must include secure Health Insurance Portability and Accountability Act–compliant professional network communications tools in their platforms as a condition of obtaining and maintaining certification.
• Health information may be provided to beneficiaries in a readily accessible way (such as a PDF document) as a transition step until such time that full interoperability among providers and beneficiaries can be achieved.
• Qualified EHRs should have technology similar to the Department of Veterans Affairs’ Blue Button^® to enable individuals to download their personal health information prior to full health information exchange implementation.

Based on these and other comments, ONC and CMS recently acknowledged the barriers to data interoperability and health information exchange. They also noted that CMS Medicare and Medicaid EHR incentive programs and the ONC health information technology (HIT) certification programs are not enough to achieve the widespread interoperability and health information exchange necessary for delivery and payment reform. However, HHS is committed to an incremental, yet comprehensive and strategic approach to accelerating health information exchange.

As the nation’s healthcare system undergoes the transition to adopting EHRs, the AAOS shares the goal of having all physicians use HIT in a meaningful way and provides tools for members to become meaningful users of EHRs. The AAOS will continue to meet with CMS officials overseeing quality measure reporting programs to ensure that, as the AAOS develops orthopaedic quality measures, such measures will be available to report in programs such as meaningful use.

Kevin Kwon is the senior manager, regulatory and government relations, in the AAOS office of government relations. He can be reached at kwon@aaos.org

Bottom Line

• Stage 2 meaningful use requirements become effective on Oct. 1, 2013, for eligible hospitals and on Jan. 1, 2014, for eligible professionals.
• The goal of Stage 2 of meaningful use is to increase patient engagement, care coordination, and health information exchange.
• Challenges to orthopaedic surgeon participation in meaningful use include a lack of interoperability, a lack of orthopaedic-specific quality measures, and a lack of meaningful use criteria that reflect surgical specialties.

Additional Information

• Senate Finance Committee Meeting Testimony—Health Information Technology: Using it to Improve Care
• HITPC Public Hearing Testimony—Implementation/Usability
• Dr. Bowman’s Testimony
• AAOS Comment Letter on Stage 3 proposed recommendations
• AAOS Comment Letter on Health Information Technology
• Additional AAOS resources on health information technology
• Additional AAOS resources on electronic medical records