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Meaningful Use Stage 3 Priorities

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In my reading, I came across this message of what the priorities for meaningful use stage 3 should be:

To be considered for Stage 3, objectives must support new models of care, address national health priorities, promote advancement, be achievable and widely adopted by 2016, and be reasonable from a products and organizational perspective.

I thought this was a really interesting statement, because there’s always a lot of discussion about what meaningful use should really accomplish. If you ask someone in healthcare IT what meaningful use is suppose to accomplish, I expect you’d get a different answer from every person that you ask. That’s unfortunate, because if we’re going to spend billions of dollars on this you’d think we’d have a clear vision of what we want to accomplish with that money.

At the end of the day, it’s ONC-CMS-HHS that makes the meaningful use rules and so it doesn’t really matter what we think if they don’t think the same way we do. Plus, unfortunately it’s a really sad minority that actually give feedback during the meaningful use process.

I wonder how many doctors actually gave any sort of feedback to ONC during the meaningful use process. I’m not talking doctors who are now working for some company. I’m talking about practicing doctors who took the time to understand the MU regulations and provided comments on it. The same could be said for hospital C-level executives. I heard of some that copied and pasted their response from their EHR vendor, but how many hospital CIO’s really dug into the regulations and provided comment? The answer is not enough (despite significant effort on ONC’s part to hear from them).

The above statement seems to make ONC’s position clear on what they want to accomplish with meaningful use stage 3. In fact, the priorities listed above seem in line with the actions they’ve taken when it comes to meaningful use and other ONC initiatives. Right, wrong, or otherwise, it’s important to understand where ONC is coming from when they make the final meaningful use rules. Everyone else can say what they want, but they’re not making the rules.

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March 22, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and @ehrandhit and Google Plus.

Filed Under: ARRA  EHR  EHR Stimulus  Electronic Health Record  Electronic Medical Record  EMR  Healthcare  HealthCare IT  Meaningful Use
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Meaningful Use Stage 3 Retires Measures that Doctors Don’t Do

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The other day I was spending some time going through the proposed meaningful use stage 3 measures. It’s quite an experience if you haven’t done this already.

As I was going through each of the measures I realized something that could be a little troubling. In a number of cases, they are proposing that certain measures should be retired from the meaningful use attestation process because essentially those measures have reached a percentage in meaningful use stage 2 that they’re fully adopted. I think this is generally a good idea. We don’t need clinics and hospitals reporting information just to report information.

Although, I did find a surprising trend when it came to the measures that were being retired in meaningful use stage 3. Almost all of the measures (possibly all, but I didn’t dig that deep) were measures that were done by someone other than the doctor. A few examples were vitals, smoking status, and demographics. I guess in some cases the doctor might enter these, but you can see how the vitals were likely entered by a nurse or MA and not the doctor.

On the one hand this is a really great thing. That means that in the previous meaningful use stages, the biggest burden was placed on someone other than the doctor while the doctor was only required to have a much smaller percentage. Unfortunately this means that the higher percentages required in meaningful use stage 3 put the burden largely on the backs of physicians.

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February 19, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and @ehrandhit and Google Plus.

Filed Under: ARRA  EHR  EHR Stimulus  Electronic Health Record  Electronic Medical Record  EMR  HITECH  Meaningful Use
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Healthcare Groups Want Meaningful Use Evaluated Before Stage 3

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Though the final rules for Meaningful Use Stage 3 aren’t due to take effect until 2016, ONC has already made the draft rules available for public comment.  And comments, to be sure, the agency is getting.

While various groups have chosen their own details to critique, the general consensus seems to be that ONC is getting ahead of itself and ought to give Meaningful Use Stage 1 and 2 a good hard look first.

Accordng to a nice summary from iHealthBeat, here’s where some of the major healthcare groups stand:

* The American Hospital Association is recommending that ONC fund a comprehensive evaluation of MU generally, and while it does, hold off on finalizing Stage 3 recommendations.

*  CHIME, too, is asking ONC to evaluate the existing Meaningful Use program to decide whether achieving stage 3 is realistically possible by 2016.

* The Federation of American Hospitals is also arguing that ONC needs to evaluate current Meaningful Use requirements.  Also, in its letter to ONC, the group argues that the existing structure of two years per stage doesn’t cut it.

* The AMA weighed in with its own recommendation that ONC evaluate Meaningful Use as is before moving ahead. It also suggested changing some thresholds to  make them more reachable; greater flexibility in program requirements; change the certification process to address usability; and improve HIT’s capability to share patient data.

Personally, I think the idea of doing an extensive Meaningful Use evalulation sounds like a good one, and I hope ONC actually does so.  When you’re setting new standards that affect so many providers, why not gather some data on how existing standards work?

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January 16, 2013 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Filed Under: CCHIT Certification  Certified EHR  EHR  EHR Stimulus  Electronic Health Record  Electronic Medical Record  EMR  HITECH  Hospital EHR  Hospitals  Meaningful Use
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Meaningful Use Potpourri – Meaningful Use Monday

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We’ve been publishing Meaningful Use Monday for exactly two years today. Most of the posts have been written by the wonderful Lynn Scheps from SRSsoft and I think they represent a wonderful asset to those interested in meaningful use. That’s close to hundred posts on the subject of meaningful use and EHR incentive money. Hopefully readers have found it as useful as I have in understanding the complexities of meaningful use.

Considering how much we’ve posted about meaningful use, I think it’s time to move meaningful use out of a featured space on the site. Don’t get me wrong, I’m sure there are many more meaningful use posts to come. In fact, it’s likely a post a week will still be about meaningful use and the EHR incentive money in one way or another. However, I hope that we can also help many doctors move past meaningful use to actually meaningfully using EHR and other healthcare technology. For example, I’m planning a series of posts on the benefits of EHR in the current environment. I expect it to drive some really interesting conversation.

Before I end the Meaningful Use Monday series to a more random assortment of meaningful use posts, I thought I’d provide a potpourri of meaningful use thoughts. I think you’ll find them interesting.


This is an interesting title since the article says that most won’t be able to show meaningful use and then goes on to list the statistics for how many doctors are using EHR. So, they’re using EHR, but they don’t have the capability to show meaningful use? To me EHR adoption is the more important number. I also like that EHR vendors have all applied the same CCD standard for data portability. I’m ok if many doctors forgo meaningful use. Although, we’ll see how that plays out if the penalties indeed go into effect.


This is music to my ears. I’ve been preaching this message for a long time. The odd part is that this article references the same studies and data as the first. What is clear from the numbers is that EHR adoption is up. That’s a good thing for healthcare since we need widespread EHR adoption to take the next step to technology adoption in healthcare.


I don’t think this is true, depending on how you define “apply.” I know very few doctors who have applied to meaningful use and not gotten paid. If you know of stories that say otherwise, I’d love to hear them. This is particularly true in meaningful use stage 1. We might see more meaningful use payment rejections in stage 2 and 3, but so far the money has basically flowed out. I think this is by design. The worst thing for ONC would be many doctors working towards meaningful use and then not getting paid.


Yep, meaningful use stage 2 is still getting tweaked. It’s hard to keep up.


Almost a third of the way there. I love this “shovel ready” part of the ARRA economic stimulus package. Makes me laugh to think about it.

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December 10, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and @ehrandhit and Google Plus.

Filed Under: ARRA  EHR  EHR Stimulus  Electronic Health Record  Electronic Medical Record  EMR  HealthCare IT  HITECH  Meaningful Use
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Meaningful Use Stage 3 Timeline – Meaningful Use Monday

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The big meaningful use news this week was the release of the meaningful use stage 3 recommendations (PDF) that the meaningful use workgroup released to the public. Some on Twitter thought that this was the meaningful use stage 3 rule that could be commented on. This is not open for public comment yet, but should be soon.

In fact, Healthcare IT News listed the following timeline for meaningful use stage 3:

  • Dec. 21, 2012 – RFC deadline
  • January 2013 – ONC to synthesize the RFC comments for HIT Policy committee workgroups to review
  • February 2013 – The workgroups will reconcile RFC comments
  • March 2013 – The workgroups will present a revised draft of Stage 3 requirements to ONC
  • April 2013 – ONC is expected to approve final Stage 3 recommendations
  • May 2013 – ONC will transmit final Stage 3 recommendations to HHS

That’s a pretty aggressive timeline to have meaningful use stage 3 published by May 2013. If my dates are right, meaningful use stage 3 won’t be effective until 2016. I like that ONC wants to get the MU stage 3 out soon so that no one can use not having the meaningful use details as an excuse for not complying. However, I also don’t think ONC should rush the process either. We have to live with meaningful use, good and bad, for a long time to come.

I’d love to hear what you notice in the meaningful use stage 3 proposal (PDF). We’ll be sure to cover it a lot more in the future.

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November 19, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and @ehrandhit and Google Plus.

Filed Under: ARRA  EHR  EHR Stimulus  Electronic Health Record  Electronic Medical Record  EMR  HealthCare IT  HITECH  Meaningful Use
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Planning for Stage 3 is Underway – Meaningful Use Monday

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Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

At the HIT Policy Committee’s meeting on August 1st, the Meaningful Use Workgroup presented its preliminary recommendations for meaningful use Stage 3. Giving plenty of advance warning regarding its intentions for Stage 3, the Policy Committee hopes to avoid the type of timing issues that led to the postponement of Stage 2. The committee plans to send its final recommendations to HHS by May 2013, well in advance of the earliest timeline for Stage 3—2016. In light of this schedule, the initial recommendations are being formulated before we know how Stage 2 will be finalized and before we can fully evaluate Stage 1. Hopefully, as the planning process advances, the committee will have the time to take into account the experience of participating providers. 

As outlined in the preliminary recommendations, Stage 3 would intensify Stage 2’s emphasis on interoperability and patient engagement and expand on care coordination, quality and safety, and population health. It would foster a new model of care that is team-based, outcome-oriented, and geared toward population management. To accomplish this, it would include—among other requirements —expansion of clinical decision support, including tracking of compliance; electronic management of referrals; and enabling patients to update or correct information that is in their chart. 

Lest you think that a plan for Stage 3 means that the end is now in sight, sit back and take a deep breath. The plan envisions a Stage 4!

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August 20, 2012 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

Filed Under: ARRA  EHR  EHR Stimulus  Electronic Health Record  Electronic Medical Record  EMR  HealthCare IT  HITECH  Meaningful Use
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Global eHealth Olympics, LifeArmor, and Meaningful Use Stage 3 Draft: Around HealthCare Scene

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Time to take a quick look at some of the interesting posts happening on the other Healthcare Scene blogs. I think you’ll enjoy many of the posts.

EMR and EHR

Would Meaningful Use Go Away Under a Romney Presidency

With the November presidential election quickly approaching, there are many questions floating around. With Mitt Romney’s desire to repeal ObamaCare, some are wondering if he will try and stop HITECH as well. And if so, what is the fate of Meaningful Use.

Global eHealth Olympics

While the 2012 Olympics in London have been on the minds of many across the world for the past two weeks, Blair Butterfield suggested another sort of Olympics — one comparing the health care of different countries. He asks the question, “What if we compared our healthcare system to those of Europe, Asia and the Middle East in terms of areas like integration, communication and population health? How would the U.S. fare?” This post contains ideas for the different “events” that might occur in an eHealth Olympics, as well as suggestions for the top contenders for each category.

Meaningful Health IT News

Colbert Lampoons Proteus Digital Pill

The Proteus digital pill has gotten a lot of attention since it was announced. Included in that attention was a bit about it on the Colbert Report. It’s a spoof, of course, but somewhat entertaining. As Neil Versel says, “At least Colbert’s version featured a wireless tablet computer.

Smart Phone Health Care

LifeArmor Created for Military Families for Coping with Stress

A mobile app created by the Department of Defense aims to help military families cope with different issues. It addresses 17 topics, including depression and post-traumatic stress. The app takes content from the D0D website, AfterDeployment, and has videos and assessments. The app is free.

Several Pharmacies Offer Online Services for Patients

In-store pharmacies have started offering online services to make re-filling and transferring prescriptions easier than ever. Target and Walgreens are among those stores, and there are positives and negatives to using these services. Have you switched to online management of prescriptions?

Hospital EMR and EHR

Population Health Management is No Fad

Is population health management a fad, or is it here to stay? Anne references a recent column by Information Week by Paul Cerrato, where he states that it is. However, while she agrees that Cerrato’s column was “well-argued,” she disagrees with the suggestion.

Meaningful Use Stage 3 Draft On The Way

Although the MU Stage 2 final draft hasn’t been released yet, the draft regulations for stage 3 are apparently going to be released in August. Healthcare Informatics suggested a list of recommendations that are likely to be in stage 3, such as tracking individual care goals, and track tracks/steps and responsible party.

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August 12, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Filed Under: EHR  EHR Stimulus  Electronic Health Record  EMR  EMR Implementation  EMR Technology  ePrescribing  Healthcare  HealthCare IT  HIE  HITECH  Hospital EHR  Hospitals  Meaningful Use  mHealth  PHR
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Drivers of Healthcare Interoperability – Meaningful Use and ACOs

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Seems like this week must be interoperability week on EMR and HIPAA after my post yesterday about HIE transport in meaningful use stage 2 and my post today on drivers of healthcare data interoperability.

I was looking through some past notes from a meeting at AHIMA that I had with Health Language Inc. It was a fascinating conversation with Brian F. McDonald, Executive VP and CFO and Marc A. Horowitz, Senior VP. I remember that these guys eat, drink and sleep medical terminology. One of the really interesting observations I took from talking with them was:

Meaningful use and ACOs are the drivers of interoperability in healthcare.

Months after first hearing this idea, it rings even more true. In meaningful use stage 2, ONC and CMS have made it very clear that they plan to use meaningful use as a motivating force behind the sharing of healthcare data. This includes sharing of healthcare data doctor to doctor and also doctor to patient. I expect meaningful use stage 3 will find these concepts at their core as well.

As we try and evaluate what an ACO would look like, some form of healthcare data exchange has got to be part of the solution. I don’t believe anyone will find a way to really improve health the way an ACO will need to improve care without an exchange of data between EHR systems. Considering the pay for performance days are short at hand, this will be an encouraging factor for EHR systems to start exchanging data.

I’ve often said the big problem with interoperability of data in healthcare is the financial aspects and the governance (ie. when to share data) aspects. I see ACOs and meaningful use pushing healthcare providers to figure out both problems.

If not these drivers, what else will get healthcare to start sharing data?

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March 20, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and @ehrandhit and Google Plus.

Filed Under: EHR  Electronic Health Record  Electronic Medical Record  EMR  Healthcare Interoperability  HealthCare IT  HIE
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Top Health Industry Issues of 2011 – “Top 10″ Health IT List Series

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Next up in our evaluation of the various end of 2011 Health IT lists series is one that takes a bit of a look back at 2011. In this list, PwC lists what they consider the Top Health Industry Issues of 2011. The list starts with an interesting comment about the health IT spending in 2011:

More than $88.6 billion was spent by providers in 2010 on developing and implementing electronic health records (EHRs), health information exchanges (HIEs) and other initiatives. This surge is a sign of technology’s critical place in health system improvement.

$88.6 billion is a lot of health IT spending and larger than most numbers I’ve seen. Although, most numbers I’ve seen are only the EMR and EHR market and doesn’t include HIE spending and other healthcare IT initiatives. It’s quite clear that the health IT spending is up, and up Big!

Their list of top Health issues isn’t that surprising, except possibly one of them:

Meaningful Use – This has to be topic number one for health IT in 2011. It’s had a trans formative effect on healthcare IT and EMR and EHR as we know them. Pretty much every EHR vendor I’ve talked to basically had to take an entire software development life cycle to meet the meaningful use and certified EHR requirements. This is the dramatic effect of meaningful use on EHR development.

PwC actually focuses on how meaningful use will encourage patient participation in their healthcare or “shared medical decision-making.” To be honest, I’m not sure meaningful use has done much to help this goal, yet(?). Possibly meaningful use stage 2 and meaningful use stage 3 will help to further these goals. MU stage 1 has done little to encourage this. Regardless of the impact of meaningful use, shared medical decision-making is going forward fast and furious.

HIPAA 5010 and ICD-10 – The interesting issue for 5010 and ICD-10 is that they’ve basically been overwhelmed by meaningful use and EHR incentive money. Either of these changes alone would have been a reasonable challenge for a normal year. However, clinical organizations are battling through 5010, ICD-10 and meaningful use all at the same time. Are there any other IT projects going on that don’t involved these three things? I’d say probably very few.

Electronic medical device reporting (eMDR) – I found this point quite interesting. There’s been a lot of movement in 2011 in regards to what constitutes a medical device and who should take care of tracking and collecting the adverse events that occur on these devices. I don’t think we’ve come to a final conclusion on what will be considered a medical device and how we’re going to deal with reporting adverse events, but finally getting electronic reporting of adverse events is a good step in the right direction.

Be sure to read the rest of my Health IT Top 10 as they’re posted.

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December 28, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and @ehrandhit and Google Plus.

Filed Under: ARRA  Certified EHR  EHR  Electronic Health Record  Electronic Medical Record  EMR  Healthcare  HealthCare IT  HITECH  Hospital EHR  ICD-10  Meaningful Use
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Guest Post: The Long Term Fate of CCD

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The following is part of an email interaction I had with an EHR vendor about the future of CCD. Of course, I can never let strong opinions go unpublished. So I asked if I could put this on my site. I have a feeling there will be many people who have a different view of CCD and how these standards will play out. I’d certainly be happy to publish an opposing view as well. My contact page is here. I’m interested to hear other view points on the subject.

Stage 1 MU allowed either CCR or CCD. Stage 2, and the short term efforts will require CCD. The jury is still out on what Stage 3 of MU will focus upon. Many at the ONC can see that the CCD will never have the flexibility to deliver. These are largely the same people that facilitated the Direct Project initiatives.

I still predict that it is inevitable that the data will become uncoupled from unwieldy, anachronistic document structures. That will be the only means to get to true information portability that can deliver patient-centric use of the information. The CCD will still be around for a while to come, just as CD’s are still around for music sharing. For now, we have to have the CCD to preserve legacy, industry-centric control of the information.

John Halamka has a couple of recent posts that do a good job of explaining what is evolving…. http://geekdoctor.blogspot.com/2011/09/september-hit-standards-committee.html and http://geekdoctor.blogspot.com/2011/10/cool-technology-of-week.html . Both of these contain links to some very interesting information. When the ONC proceeded to issue an advanced notice of rulemaking, the industry power elites became enraged. http://www.ihealthbeat.org/articles/2011/9/22/groups-urge-onc-not-to-include-metadata-standards-in-stage-2.aspx

Technology delivering to patients will eventually win out just as the open-platform WWW won out over proprietary CompuServe. http://www.healthdatamanagement.com/news/onc-metadata-ehr-meaningful-use-43021-1.html Once we have a means to truly exchange the content without the overhead associated with the CCD/RIM crap, we will see a revolution in healthcare similar to the social networking phenomenon.

Again, the whole CCD/CDA will stick around to support legacy information needs, but it will eventually be largely eclipsed by more straight-forward solutions that don’t require a team of consultants and IT engineers to implement.

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November 10, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and @ehrandhit and Google Plus.

Filed Under: ARRA  CCR  EHR  Electronic Health Record  Electronic Medical Record  EMR  HealthCare IT  HIE  Meaningful Use
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