Monday, March 15, 2010

HIMSS Comments on NPRM and IFR

The HIMSS Electronic Health Record Association (EHR Association) has submitted its detailed responses on two major regulations that implement healthcare IT incentive provisions of the American Recovery and Reinvestment Act of 2009 (ARRA). One comment addressed the Office of the National Coordinator for Health IT (ONC) Interim Final Rule (IFR) on EHR certification criteria and standards. The other commented on the Center for Medicare and Medicaid (CMS) Notice of Proposed Rule-Making (NPRM) on meaningful use criteria and associated payment policies.

"This collaboration engaged more of our member companies than anything we've done in our five year history," said Justin Barnes of Greenway Medical Technologies and Association Chairman. "The breadth of experience and differing perspectives, including input from our customers, that went into developing our positions make our comments and recommendations a very strong complement to input from individual companies," Barnes went on to say.

In preparing this collaborative response, the Association relied on its workgroup structure, which ensures that representation from both larger, enterprise-focused companies and ambulatory-only EHR suppliers is balanced. Sixty-three individuals from 28 member companies worked intensively from the time the IFR and NPRM were made public in late December 2009 through early March to develop and refine comments on behalf of the EHR Association.

Mark Segal, Ph.D., of GE Healthcare and Vice-Chair of the Association noted some of the important points the group made in its letters to ONC and CMS. "CMS and ONC should reconsider their proposals in the context of Congress' intent for incentives that truly encourage adoption and use of interoperable EHRs. The sheer number of requirements, and their complexity, could cause a provider that is doing everything right to miss the incentives based on small oversights or elements beyond their control."

Segal noted the group's general concern regarding quality measure data collection. "The initial meaningful use and quality measures must be more pragmatic, as many providers will be using EHRs extensively for the first time and may not be ready to collect and report on the number of complex indicators called for in the NPRM. And both EHR suppliers and healthcare providers need more lead time for software development, testing, training and deployment. With the starting dates for meaningful use rapidly approaching, we believe that no additional meaningful use requirements should be added in the Final Rule to be issued by CMS this spring."

Barnes added, "In our comments to ONC, we asked for clarification and enhancements on a number of certification criteria as well as strengthening the recommended standards for health information exchange and security to accelerate interoperability for Stage 1 and Stage 2 of meaningful use. We strongly encourage use of robust, harmonized standards, including use of proven HITSP-recommended standards for exchange of clinical documents. We are concerned that allowing two options for document standards as proposed, rather than focusing on the CDA/CCD standard, will add costly rework and unnecessary overhead when we move to a single standard for Stage 2 meaningful use."

"The EHR Association has been a strong and early supporter of EHR certification, standards for interoperability and, of course, the meaningful use of our products toward a more efficient, effective healthcare system," Segal said. "We appreciate the opportunity to engage in the important process of making sure ARRA incentives encourage EHR adoption. Fundamentally, we are optimistic that CMS and ONC will respond thoughtfully to the many comments received and make the changes needed to ensure that the ARRA incentives achieve their intended objectives."

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