TMA Comments on HIT Rules


TMA's Ad Hoc Committee on Health Information Technology has let federal officials know how they can improve the government's programs on meaningful use and electronic health records (EHR) certification standards scheduled to take effect in 2014. The committee submitted comments on proposed rules governing those programs earlier this month. 

In a letter to Acting Centers for Medicare & Medicaid Services (CMS) Director Marilyn Tavenner, committee Chair Joseph Schneider, MD, said CMS should:

  • Carefully align Stage 2 meaningful use goals with market ability because hastily developed systems lead to patient safety issues. (EHR vendors are hastily preparing their systems to meet meaningful use, and there is not enough time for alpha and beta testing to ensure a seamless deployment. This can lead to patient safety issues.)
  • Offer adequate exclusions so that specialists and focused generalists (e.g., pediatricians and obstetrician-gynecologists) can fully participate in the program. (For Stage 1, of the 25 meaningful use criteria, there are 13 exclusions for physicians. They can claim an exclusion and not have to comply with that measure. This recognizes that much of the criteria are for primary care. This way, specialists can participate without being required to do things they are not capable of. For example, a physician who does not prescribe can be excluded from the e-prescribing criterion.)
  • Give physicians who are forced to switch EHRs because, for example, a vendor discontinues a product, a way to participate in Medicare meaningful use without losing a year of incentives during the transition.

Regarding EHR certification, Dr. Schneider wrote Health and Human Services Secretary Kathleen Sebelius that TMA is concerned the government has not given physicians, hospitals, and vendors enough time to safely incorporate Stage 2 requirements into EHRs. "Assuming that a final rule is issued in the fall of 2012, our experience is that vendors need about 18 months to put the requirements into their systems and to get them certified," he wrote. "Physicians and hospitals then need time to fit these into their budget cycles and obtain vendor support for upgrades. At least a year must be allowed after vendor release for this process. This totals over two years from the time of issuance of the final rule, which makes January 2015 the earliest that Stage 2 could be required for ambulatory EHRs."

In addition, TMA joined the American Medical Association and other medical societies in sending a letter to federal officials telling them that the proposed new meaningful use rules for Stage 2 of the Medicare and Medicaid EHR incentive programs are too aggressive.

TMA continues to recommend that physicians use the federal regional extension programs (RECs) for help with EHR adoption, implementation, and achievement of meaningful use criteria to ensure eligibility for the incentive programs. Interested physicians should visit TMA's REC Resource Center. You can direct questions regarding health information technology (HIT) to TMA's HIT Department by telephone at (800) 880-5720 or by email.

Action, May 15, 2012