August 27, 2010 - Advocacy Corner

Privacy and Security Recommendations Approved by Committee. The HIT Policy Committee’s Privacy and Security ‘Tiger Team’ presented its recommendations for electronic data exchange at the August 19 meeting. Among recommendations the workgroup called for transparency in healthcare delivery, so patients can make informed decisions about disclosing their person health information. Trust was identified as the key to better relationships between consumers and providers, as well as for successful and secure information exchange. Providers must obtain patient consent before exchanging data with other clinicians, lab testing or HIE networks. However, the team also recommended that providers have the responsibility of maintaining EHRs and “direct exchange” between two providers should not require patient consent. These recommendations are based on the universal set of privacy guidelines called “fair information practices.” The 19-page document produced by the Tiger Team can be downloaded here.

Before voting on the recommendations, Committee members raised a number of questions, including the requirement that healthcare providers offer alternative data exchange models for patient who opt out of a multi-point health data exchange network. There was concern this requirement would place an undue burden on providers. Other perspectives put the responsibility on the health data exchanges for establishing processes to transmit data without storing the information. The committee-approved recommendations must now be submitted to the ONC for final approval.

CHIME Meaningful Use Final Rule Summary Amended. In an effort to provide the latest updates to CHIME members, we include the following information from Health Policy Alternatives (HPA), policy consultants to CHIME and author of the final rule summary on Meaningful Use relating to electronic health records posted on the CHIME website. The paragraphs below describe two changes to the summary.

“First, the text at the bottom of page 24 and the top of page 25 has been revised to accurately reflect CMS’ responses to comments regarding which hospital cost reports would be used in determining preliminary and final incentive payments. In the previous summary, we had inadvertently implied that CMS had adopted as final what it had originally proposed and also correctly indicated the changes that CMS had agreed to in response to public comments.

The second change makes one correction to the table on page 3 of the summary. We have replaced “Stage 2” with “Stage 1” in one cell of the table on page 3 of the summary, the cell for payment year 2014 in the case of eligible professionals (EPs), hospitals and critical access hospitals (CAHs) whose first payment year is 2013. This change is made based on a recent conversation with Elizabeth Holland, the lead CMS staff person on the rule, who stated that “the table in the final rule is correct.” In making this statement, Ms. Holland:

• Was unable to explain why the preamble text in the final rule appears to disagree with the table [The regulation contains the following statement: “We anticipate updating the criteria of meaningful use to Stage 2 in time for the 2013 payment year and therefore anticipate for their second payment year (2014), an EP, eligible hospital, or CAH whose first payment year is 2013 would have to satisfy the Stage 2 criteria of meaningful use to receive the incentive payments.” This statement is obviously not compatible with the information found in Table 1 in the final rule, which implies that an EP or hospital whose first payment year is 2013 would only need to satisfy Stage 1 criteria in 2014];
• Said she would be speaking to the General Counsel’s Office regarding the apparent conflict;
• Emphasized that the final rule generally established policies for 2011 and 2012 and not for future years; and
• Emphasized that Stage 1 criteria in 2013 could differ from Stage 1 criteria for 2011 and 2012.