NPRM for Stage 2 of Meaningful Use

The Department of Health and Human Services has sent to the Federal Register two notices of proposed rulemaking for Stage 2 of the electronic health records meaningful use program. The rules will be available on Feb. 23 on the Federal Register Public Inspection Desk, and within days officially published. The proposed rules have a 60-day public comment period following publication. Federal officials hope to publish final rules in mid-summer.

One rule sets the policies and criteria for achieving Stage 2 meaningful use; the other rule would adopt standards, implementation specifications and certification criteria to ensure EHRs support Stage 2 objectives. National HIT Coordinator Farzad Mostashari, M.D., says the main message in Stage 2 proposed rules is “stay the course.” Much of the meaningful use objectives in Stage 2 are familiar, as the Office of the National Coordinator adopted recommendations of the HIT Policy and Standards advisory committees “in very very large part,” he notes. But there are significant changes and new flexibility in the proposed rules, compared with the Stage 1 meaningful use program. Stage 2 includes specific emphasis on data exchange, Mostashari says. “We can’t wait five years to get standards-based exchange.” That goal, he adds, will be reached when the next phase of meaningful use starts in October 2013 for hospitals and January 2014 for eligible professionals. The proposed rules require use of the Direct Project protocols for secure e-mail, although optional certification of the SOAP approach is permitted. There are specific standards--no longer a menu of options--for lab results and vocabulary.