By Angela Reed and Paul Rosenbluth

Perhaps the most significant changes to Meaningful Use in Stage 2 are related to health information exchange and access to information. The proposed regulations are putting more emphasis on making information available to the external stakeholder, including patients and other caregivers.

This controversial initiative is reflected in several core objectives, including:

· Ongoing transmission of health data (rather than the previous single test) to immunization registries and public health agencies. There are three separate objectives, one each for immunizations, reportable lab results and syndromic surveillance data. Syndromic surveillance is a menu for eligible professionals (EPs).

· Electronic transmission of a summary of care record to an entity not using the same certified technology

· Providing patients access to health records with the ability to view on-line, download and transmit to a third party

EPs have additional objectives related to the transmission of data, a core objective for secure electronic messaging and menu objectives for identifying and reporting cases to a cancer registry and a “specialized registry other than a cancer registry”.

The Centers for Medicare and Medicaid Service (CMS) clearly states that while the use of physical media, such as USB drives, satisfies the download requirements, it does not satisfy the transmission requirements. There is already much discussion as to how a provider could track or achieve the threshold related to a patient independently transmitting data.

While more information is to be published, it is important to note that CMS is acknowledging the fact that too many entities are currently relying on costly and complex interfaces to achieve transmission of data. At this point in time, hospitals can transmit via any transport standard such as HL7, which is the only acceptable way to transmit the public health measure data, or File Transfer Protocol (FTP) to meet the objectives. However, the intent is to implement a common transport standard and to that end, the Office of the National Coordinator for Health Information Technology (ONC) is proposing certain transmission protocols in the certification criteria for electronic health records.

For the objective related to patient access to health records, the means by which the hospital grants such access is left to the institution’s discretion, such as hosting a portal or contracting with a vendor to host a portal. Many Electronic Medical Record (EMR) vendors include portals as a component of the software.

As procedurally required, CMS has invited public commentary on the proposed rule. However, given the extensive rationales provided, it is not anticipated that there would be significant changes to the final rule.

The biggest issues around this part of the rule revolve around security (specifically encrypting data at rest, which can be very challenging to maintain the needed system performance) and enforcing the use of the data made electronically available for patients. Caregivers have little control over getting patients to use these new mechanisms to access their records.

Expanded and robust strategies for incorporating technology with processes are key to achieving success for these criteria.

The public comment period on the CMS proposed rule and the ONC proposed rule closed on May 7th.

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