The Centers for Medicare and Medicaid Services (CMS) recently released proposed rules for Stage 3 of the EHR meaningful use program. The Office of the National Coordinator for Health Information Technology (ONC) concurrently released proposed certification criteria for EHR technology.  The full text of the ONC proposal can be found here.

According to CMS, the Stage 3 rules are intended to build upon the groundwork laid by Stages 1 and 2. The rules aim to increase the interoperable health data sharing among providers and focus on the advanced use of EHR technology.  CMS has streamlined the attestation requirement in the Stage 3 proposed rules.  The proposed rules set forth eight objectives that providers must successfully attest to beginning in 2017 in order to receive an incentive.  To satisfy a given objective however, providers would only be required to complete a specified portion of the objective’s associated measures. In this way, providers have the flexibility to choose the associated measures most relevant to their unique practice setting.

The Stage 3 proposed rules would also establish a single, aligned reporting period for all providers.  Beginning in 2017, the reporting period for all providers will be the full calendar year, with a limited exception for Medicaid EHR incentive program providers.  Medicaid eligible professionals, eligible hospitals and Critical Access Hospitals (CAHs) demonstrating meaningful use for the first time in 2017 will continue to be subject to a 90-day EHR reporting period.  According to the American Hospital Association and the American College of Cardiology, the one-year reporting period is the most challenging aspect of the meaningful use program and does not allow providers sufficient time to implement a carefully planned EHR system.

The Stage 3 proposed rules have also made significant changes to the patient engagement requirements.  Stage 3 proposes to expand the options through which providers may engage with patients, and has allowed for the use of application program interfaces (APIs).  APIs would enable a patient, through a third-party application, to access and retrieve their health information from a care provider, and allow a diverse group of care team members to communicate directly and efficiently with the patient.  However, the proposed rules would also require providers to prove that 25 percent of their patients viewed, downloaded or transmitted their health records – an increase from Stage 2’s five percent requirement.  According to Roger Neal, vice president and CIO at Duncan Regional Medical Center, providers are already struggling to meet the five percent patient engagement threshold in Stage 2.  Other critics agree, arguing that a 25 percent benchmark for 2017 is unrealistic and that the level of patient engagement is up to the patients, not the provider.

Eligible professionals will be required to comply with the Stage 3 meaningful use requirements by 2018, regardless of their prior participation in the program.  Stage 3 will be optional for providers in 2017.  The CBO estimates that eligible professionals will have to pay approximately $4,500 to purchase and implement a certified EHR, and $10,000 annually for ongoing maintenance.  The stage 3 proposed rules are open for public comment until May 29.  A full text of the proposed rules can be found here.