Less than three weeks ago, I reported from the American Medical Informatics Association Annual Symposium in Washington that officials from the Office of the National Coordinator for Healthcare Information Technology were publicly saying it was unlikely there would be a delay to Stage 2 of Meaningful Use.
In October, noting that the federal rule-making process can be arduous, former national health IT coordinator Dr. Farzad Mostashari said, “I think folks should assume that the timelines stick.” He was speaking to the College of Healthcare Information Management Executives a week after leaving government service.
Today, we find out that they knew something we didn’t. The Centers for Medicare and Medicaid Services proposed extending Stage 2 to 2016 and delaying the start of Stage 3 to 2017.
Under the revised timeline, Stage 2 will be extended through 2016 and Stage 3 will begin in 2017 for those providers that have completed at least two years in Stage 2. The goal of this change is two-fold: first, to allow CMS and ONC to focus efforts on the successful implementation of the enhanced patient engagement, interoperability and health information exchange requirements in Stage 2; and second, to utilize data from Stage 2 participation to inform policy decisions for Stage 3.
The phased approach to program participation helps providers move from creating information in Stage 1, to exchanging health information in Stage 2, to focusing on improved outcomes in Stage 3. This approach has allowed us to support an aggressive yet smart transition for providers.
The delay to Stage 3 was likely. As I exclusively reported in June, ONC’s deputy national coordinator for programs and policy, Judy Murphy, dropped a strong hint that Stage 3 would not start until 2017, saying, “2016 would be a problem.” By pushing back the start of the third stage, we would automatically get an extension to Stage 2, making it a three-year program instead of two.
The start of Stage 2 already had been pushed back a year from the original plan of 2013. From my reading, what CMS is proposing today is not another delay to the beginning of Stage 2. Hospitals that have begun their attestation periods since Oct. 1 may continue and physicians are allowed to start Jan. 1.
CMS said to expect proposed Stage 3 regulations, as well as proposed ONC EHR certification rules for Stage 3, in the fall of 2014.
What strikes me as odd is that this announcement came late on a Friday afternoon. There is no time stamp on the ONC blog post, but CMS’ Travis Broome tweeted this at 4:05 pm EST:
— Travis Broome (@Travis_Broome) December 6, 2013
Late Friday is typically when government agencies take steps they don’t want plastered all over the news. I don’t see anything here that is surprising or controversial, and it could be argued that ONC didn’t mislead people with earlier statements because the start dates for Stage 2 are not changing. Did I miss something?
UPDATE: CMS held a webcast about this that started at 1 p.m. EST. That’s still Friday afternoon, but not so late that it looks like they’re trying to bury the news.
A couple of weeks ago while I was in Washington for the U.S. News & World Report Hospital of Tomorrow conference, I stopped by the headquarters of the American Telemedicine Association to record a videocast with ATA CEO Jonathan Linkous. We discussed some of my predictions for 2014 in the fields of mobile health and telehealth:
I’m going to try to embed the video here. If not, here’s the ATA’s link.
Healthcare Scene, the blog network of John Lynn and of which this site is a part, has purchased job-finder site Healthcare IT Central and the related Healthcare IT Today blog, founded by Gwen Darling. I don’t think this transaction will directly affect my blog, but John offers this on his EMR and HIPAA blog: “If you asked me a month ago what I could do for organizations looking for healthcare IT talent or individuals seeking healthcare IT jobs, I wouldn’t have much to offer beyond advertising. Today, that all changes.”
We all know about the high demand for health IT jobs and the shortage of qualified people to fill all the jobs available. Healthcare IT Central features:
WASHINGTON—I’ve just finished 2 1/2 days of helping US News and World Report cover its inaugural Hospital of Tomorrow conference. My assignment was to sit in on four of the breakout sessions, take notes, then write up a summary as quickly as possible, ostensibly for the benefit of attendees who had to pick from four options during each time slot and might have missed something they were interested in. Of course, it’s posted on a public site, so you didn’t have to be there to read the stories.
Here’s what I cranked out from Tuesday and Wednesday:
Session 202: A Close-Up Look at EHRs — ‘Taking a Close Look at Electronic Health Records”
Session 303: The Future of Academic Medical Centers — “Academic Medical Centers ‘Must Become More Nimble’”
Session 305: Preventing and Coping With Infections — “How Hospitals Can Better Prevent and Cope With Infections”
Session 401: Provider and Patient Engagement — “Hospitals Grapple With Patient Engagement”
The one on infection control was particularly interesting, in large part due to the panel, which included HCA Chief Medical Officer and former head of the Veterans Health Administration Jonathan Perlin, M.D., Johns Hopkins quality guru Peter Pronovost, M.D., and Denise Murphy, R.N., vice president for quality and patient safety at Main Line Health in suburban Philadelphia.
The session on patient engagement was kind of a follow-on to my first US News feature in September.
If you want to read more about the whole conference, including US News’ live blog, visit usnews.com/hospitaloftomorrow
Two weeks ago, I picked apart a terribly misleading, ideologically steeped Fox News story that wrongly linked the initial failure of the healthcare.gov Affordable Care Act insurance exchange to the Meaningful Use EHR incentive program. Among my many criticisms was the reporter’s apparent confusion between an actual EHR and My Medical Records, the untethered PHR offered by MMRGlobal.
In that post, I said, “I haven’t seen a whole lot of evidence that MMRGlobal isn’t much more than a patent troll.”
Bob Lorsch, CEO of that company, posted in the comments that I should put my money where my mouth is and interview him. (I had interviewed Lorsch before, but never wrote a story because of my longstanding policy of not paying attention to untethered PHRs since none that I know of has gained any market traction, despite years of hype.)
As this podcast demonstrates, I took Lorsch up on his offer. It was at times contentious, in part because I challenged many of his statements in the Fox story and to me, and in part because he challenged some of mine.
He asked me a pointed question, whether I still thought he was a patent troll. Based on the fact that MMR actually earned patents on a product it actively markets and didn’t just purchase someone else’s patents for the point of suing others, it’s hard to conclude that he is a patent troll.
Investopedia defines patent troll as:
A derogatory term used to describe people or companies that misuse patents as a business strategy. A patent troll obtains the patents being sold at auctions by bankrupt companies attempting to liquidate their assets, or by doing just enough research to prove they had the idea first. They can then launch lawsuits against infringing companies, or simply hold the patent without planning to practise the idea in an attempt to keep other companies productivity at a standstill.
By that definition, MMR is not. I still don’t think an untethered PHR is a good business model, a belief supported by the fact that publicly traded MMR is a penny stock, currently trading at less than 3 cents per share. I have said that patient engagement, called for on a small scale by Meaningful Use Stage 2 rules, could change the landscape for PHRs—with a better chance in pediatrics than for adult populations—but it certainly will take a few years.
I stand by my original statement that the Fox News story did health IT a huge disservice by latching onto one problem and trying to tie it to an unrelated issue simply because it fits an ideological narrative. As for MMR, well, take a listen and then judge for yourself. It’s a long podcast, but I went through the trouble of breaking it down by discussion point so you can skip around as necessary.
2:03 About My Medical Records
3:26 Why he believes his product is better than traditional EHRs
5:00 My skepticism of untethered PHRs
6:28 Lorsch’s interview with HIStalk from February
6:40 MMR’s user base
8:00 Why he thinks MMR could facilitate health information exchange
9:40 Health information exchanges vs. health insurance exchanges
10:15 Patient-centered HIE as an alternative to multiple patient portals
12:20 Physician trust of patient-supplied data, and other workflow issues
15:05 Emergency use case
15:50 How MMR is different from other PHRs
16:32 “Last mile” of connectivity
18:17 His assertion in Fox story that patients lose control of health information and privacy under ACA, despite HIPAA
24:15 MMR carries cyber liability insurance
25:00 Scope of MMR’s patents
26:45 “Likely” infringement of patents
27:45 Lawsuits and licensing
29:30 Patent troll?
31:10 Negotiations with WebMD and others
33:00 MMR’s reputation
35:00 “We build and sell what we have intellectual property rights to.”
36:25 Other vendors ignoring patients?
36:50 Standardization in health IT
38:38 MMR’s low stock price
39:20 Patient engagement boosting PHR use?
42:00 Interest from WellPoint
42:48 Payers building trust with PHRs
44:18 Other features of MMR’s PHR
46:45 Segmentation of sensitive parts of medical records
49:08 Putting me on the spot
50:35 His objective in asserting patent rights
51:15 MMR’s issue with Walgreens
52:25 Revenue sharing vs. licensing