MU Pressure Eases; ICD-10 Uncertainty Continues

The good news is that CMS intends to relax the Meaningful Use reporting period for 2015 to 90 days. The bad news is that although the ICD-10 implementation deadline is on the horizon, the head of CHIME says he "wouldn't say it's 100% by any means."

Three perennial hot topics in healthcare IT were in play late last week, and for a change, there was some good news for providers.

First, CMS announced in a blog post that it intends to relax the Meaningful Use reporting period for 2015 to 90 days, as had been requested by CHIME for several months. This proposal must be submitted as a notice of proposed rulemaking (NPRM) and go through public comment, but there is every reason to believe it will survive the proposal stage and be rapidly finalized.

Second, as expected, ONC published its Interoperability Roadmap Version 1.0, which started sketching the outlines of some "rules of the road" needed to get providers and vendors on the same page regarding the work remaining to exchange basic clinical data, in part by defining sufficient structure to allow sending, receiving and using shared records.

ONC Unveils HIT Interoperability Roadmap

Third, looming in the background, CIOs were working to sign contracts for the coming year's work on ICD-10, not knowing for certain whether once again, Congress will act to delay implementation from its current date of October 1, 2015.

On the first development, CHIME president Russell P. Branzell told me Monday that CMS's willingness to move from a 365-day reporting period to 90 days indicates a willingness to fix the Meaningful Use program in light of some preliminarily low attestation rates for stage 2, and sets the stage for a more realistic stage 3 requirement set. CMS submitted details about stage 3 recently to the Office and Management Budget.

While no one yet knows exactly what is in stage 3—it was originally going to be the stage where outcomes were produced after EHR interoperability happened in stage 2—there is clearly less urgency about mandating all the original aspirations for stage 3 in the same way they were before former ONC chief Farzad Mostashari departed and current head Karen DeSalvo assumed his role.

It was Mostashari who had announced ONC's decision to let non-governmental entities have their chance to define interoperability rules of the road. But Branzell sees something more akin to the rules of the electrical industry emerging. "There's no clear government mandate that our light sockets and our electrical sockets look like they do," he says.

Clarity of Direction
"That was actually a public/private partnership that they did along the way, and I think we can do the same thing now that there's a clear direction that we will have a clear list down, hopefully to a detailed level of standards that we can all agree upon."

Branzell says the Interoperability Roadmap, itself open to public comment until April 3, gives the healthcare IT industry a new clarity of direction, and will flesh out some requirements in Meaningful Use stage 2 that were just too vague.

As an example, he offered the laboratory data exchange standard, LOINC.

"It says in there you have to use LOINC," Branzell says. "But lots of people will say, I use LOINC, but I still can't exchange lab data. Well, maybe if we get to LOINC with defined detail and requirements such as 'you must be able to transfer a complete CBC from one record to another based on the LOINC standard,' that's a little different than saying LOINC is a standard. That's what we're hoping will occur through an adoption of a clear requirements book. I don't want LOINC listed on one line. I want a chapter on LOINC in that book."

The public comment period on the roadmap will be lively. For instance, Branzell says one big unsolved problem is the persistent lack of a way to identify and match patient IDs across systems. John Halamka, CIO of Beth Israel Deaconess Medical Center, is concerned that the proposed roadmap's quality measures, in ONC's new standards guidance document, released at the same time last week, prematurely prescribes quality measures before such measures are mature enough.

"Don't Keep Doing This to Us Every Year"
As far as ICD-10, Branzell says, "right now we're still hearing everything is go ahead, it's going to happen, but I wouldn't say it's 100% by any means. Regardless, it's January, and people have to put these systems in place and buy the solutions and get the consultants and get the coders and the abstractors and all that stuff in place."

But although Branzell doesn't foresee a standalone bill in Congress that could delay ICD-10 again, there are other opportunities for such language to be inserted in the continuing resolution Congress will have to pass by October 1 to keep the government operating, or even, to have its implementation once again tied to the SGR "doc fix."

With that, Branzell made what is becoming a perennial plea to ICD-10 opponents. "Every year you're costing us millions and millions and millions of dollars of rework, so either do it, or don't delay it for another 12 months," he says. "That's crazy. Either delay it for five years or just take it off the table, but don't keep doing this to us every year."

Don't count CHIME out on this next skirmish. Fresh from the organization's victory on relaxing the Meaningful Use reporting requirements, it just could be that Washington is listening to providers with fresh ears. As unlikely as it seems.