CMS and ONC published an NPRM on May 20 regarding Meaningful Use
An NPRM is a notice of proposed rule making and serves as a public notice issued by law when one of the independent agencies of the United States government wishes to add, remove, or change a rule or regulation as part of the rulemaking process. It includes a period of public comment.
If finalized, the NPRM would:
- Allow providers to meet meaningful use with EHRs certified to the 2011 or the 2014 Edition criteria, or a combination of both Editions in 2014.
- Require providers to report using 2014 Edition CEHRT for 2015 EHR Reporting Period.
- Extend Stage 2 through 2016 (2014, 2015 and 2016).
- Allow Stage 2 providers to attest to the Stage 1 Objectives.
- Probably not become law until September.
If finalized, MediTouch Users would have the following options for Meaningful Use:
- Regardless of what stage you were projected to attest for in 2014, any MediTouch user could attest to the 2014 Definition Stage 1 objectives and 2014 CQMs should this proposed rule become law.
- Stage 2 providers would also have the option of attesting to the 2014 Definition Stage 2 objectives and 2014 CQMs.
- Regardless of Stage the user must attest to 9 CQMs from 3 domains using the 2014 CQM list.
The Confusion: There is a portion of the proposed rule that infers that the provider will need to attest that they could not “fully implement” all of the functionality of 2014 Edition CEHRT in order to attest to Stage 1 if they were projected to be a Stage 2 provider. There are some providers who want to be certain they understand what “fully implement” really means.
In the case of a cloud-based software solution, if the vendor (like MediTouch) has delivered the software via web-based interfaces, is that equivalent to “fully implemented”? Would you lose the flexibility of attesting to Stage 1 because MediTouch was among the first group of EHRs certified to the 2014 standard? We think the answer is no.
Many vendors have been contacted by their clients regarding this issue and in turn those vendors have requested that CMS clarify the confusing “fully implement” clause. CMS has a canned response; they refer all vendors to the NPRM.
Per the NPRM: “…a provider may have certain 2014 Edition CEHRT functionality that, once implemented in a live setting, requires software patches or workflow changes. …..A provider’s ability to fully implement all of the functionality of 2014 Edition CEHRT may be limited by the availability and timing of product installation, deployment of new processes and workflows, and employee training.
Vendors and providers alike are left to interpret the NPRM. It seems that meeting the not “fully implemented” standard should be interpreted as: a provider could not change office workflow or train employees or deploy new processes for Stage 2 in time to meet the deadline. In our recent blogs about why Meaningful Use Stage 2 is a pipedream for most providers, we touch on the new processes that are impossible to deploy because of the lack of a mature “Stage 2 ecosystem.”
Should stage 2 providers feel comfortable checking the “Not able to fully implement stage 2” box when they attest? We think yes, and we hope that when the rule becomes law CMS will remove any remaining ambiguity related to this issue.