Electronic Health Records

Adoption & Implementation News

ONC Considers Meaningful Use Requirements, Patient Engagement

By Vera Gruessner

Today at the HIMSS15 Annual Conference and Exhibition, Karen B. DeSalvo, National Coordinator for Health Information Technology, answered the public’s questions at the media briefing for the Office of the National Coordinator for Health IT (ONC). A variety of information was dispersed and new changes to Stage 2 Meaningful Use requirements were further clarified.

EHR certification criteria was also discussed and ONC explained that modified test procedures have now become more streamlined. Product developers were asked to provide more feedback about the EHR certification program.

Many questions revolved around patient engagement and meaningful use requirements. For example, DeSalvo was asked to address ONC’s response to patient safety issues including any new standards that may be created.

The proposed rule centering on modifications to Stage 2 Meaningful Use requirements and the EHR certification program include incorporating proactive surveillance, which is based on tracking a random sampling of EHR use.

“The surveillance is tied to the certification programs. It’s about surveillance of the functionality that is certified. It is limited to the functionality that we have,” DeSalvo stated.

Specifically, criteria related to EHR and health IT interoperability is an important change for the proposed surveillance objectives of the EHR certification program. There was also comments and questions regarding ONC’s latest information blocking report.

“Regarding information blocking, ONC doesn’t have the authority to go out and do investigations and enforce practices that we’ve identified in the information blocking report,” DeSalvo stated. “There may be other agencies that have some authority there and we have talked with the Federal Trade Commission (FTC) and CMS with respect to fraud abuse. There are other agencies that do investigation and have some specific authorities but that isn’t something that ONC currently would do.”

“We are working in close collaboration with FTC. We’re actually sharing information. They do investigations but only with respect to their legal authority,” DeSalvo continued.  “We’re working very closely with the Federal Trade Commission [to address information blocking].”

A discussion regarding the expanded language of the latest meaningful use proposed rulings – such as the distinction between health IT certification and EHR certification – also ensued at the ONC media briefing.

“Our authority is around health information technology. The conceptual model of the EHR as the modern major driver in advancing better care brought about some of the language and approach six years ago when this began,” DeSalvo explained. “The world has continued to advance and evolve. It’s clear that the ecosystem is much broader than EHRs. It’s clear that to really provide person-centered care, you need a person-centered data model.”

“This is going to require information that isn’t only from episodic visits and a slice of healthcare,” DeSalvo went on. “It’s really meant to make certain that we’re allowing for technology to evolve and being able to protect consumers and their information instead of being focused on EHRs because they are only one part of the story.”

One of the most interesting questions regarding patient engagement modifications in the latest Stage 2 Meaningful Use proposed ruling was inquiring as to why ONC changed the 5 percent threshold of patients downloading, viewing, and transmitting their electronic health data to a total of just one patient.

“Our commitment to consumers and free access to their health information is unwavering,” DeSalvo stated. “It is thematic and central for me as a doctor and as a person that the control is meaningful and that they are able to be engaged not just by looking but by having bi-directional engagement with the record.”

“What’s really exciting about the last few days is the dialogue that’s ensued and what’s going to be essential is that advocacy representatives for consumers sit down and talk with providers to understand technology and cultural challenges,” said DeSalvo. “What we need to do is to find some shared solutions and they probably exist technologically today. Some of this is also about culture. The dialogue is good and I think it’s gotten a lot of important attention. We need to find out the right path for it.”

ONC representatives went on to explain the importance of improving dialogue between patients and providers as well as offer multiple resources and education tools for patients to become more fully engaged with their own health. Patient engagement continues to be an important aspect of meaningful use requirements and the EHR certification program.

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