Meaningful Use of Health IT Timeline

UPDATE JUNE 17th - Although I was the lone voice on the blog circut and twitter just as I predicted the workgroup recommendations were not only sent back for more work at yesterdays meeting but they won't be binding on CMS and this is far from a one time event.

The ONC policy committee recommendations on meaningful use will not be binding, Blumenthal said. The Centers for Medicare and Medicare Services will be the final word on meaningful use and how it applies to incentives for physicians and hospitals using healthcare IT under the Medicare and Medicaid program.

"It's up to your readers on what to read into the discussions today on meaningful use," Blumenthal said. However, the definition of meaningful use is likely to come in stages, year by year.

According to Tony Trenkle, director of the CMS Office of e-Health Standards and Services, CMS will consider the ONC policy committee recommendations when they are complete, to help its rulemaking process. CMS expects to have a proposed final rule on payment issues – including the definition of meaningful use – by the end of the year. A 60-day comment period will follow that proposal before CMS will issue a final rule.

Although it is true; according to John Glaser, that a workgroup of the HIT Policy Committee on June 16 will unveil its recommendations on the definition of "meaningful use" of electronic health records other bloggers are not quite accurate in implying that is going to "ONC on June 16th" as any sort of finished draft and in fact the next step is to hand it off the HIT Standards Committee Clinical Quality Workgroup and it is just the very first (but important) draft in a multiple step process.

This is just a workgroup reporting up to the HIT Policy Committee and there are quite a few other steps in the process both in the next 2 months and between now and the end of the year. The HIT Policy Committee is an advisory group (that includes David Blumenthal ONC Coordinator) but it is helpful to know that ONC also has an internal workgroup working on the meaningful use as well. From their first meeting David says,

So this group, I think, needs to pick up where the NCVHS left off and think about the concept of meaningful use. And we have an internal group in the office of the National Coordinator that is working with other representatives of other agencies in the Federal Government trying very hard to think about the topic and it awaits your advice

The recommendations from the Policy and Standards Committee could have a large impact on the final rules of course, but tomorrow is just the very first step in a 6 month or longer process

According to David Blumenthall the head of ONC at the May 11th Policy meeting

We are working very hard to arrive at a set of recommendations on meaningful use. And we're going to be doing that over the next month. Having a -- this group review that and make its recommendation would be very helpful to us, especially if we could present our thoughts to you when we're ready to go public with them.

He goes on to say,

The Secretary, or the Department of Health and Human Services, has to post by interim rule making a set of standards necessary to achieve meaningful use by the end of this calendar year. So, fortunately they're not final standards, they're interim standards.

What is the group that is making the recommendations responsible for?

HIT Standards Committee - Clinical Quality Workgroup is charged with making recommendations to the entire HIT Standards Committee on specific quality measures that should be included in the definition of Meaningful Use for 2011 within two (2) months of the workgroup’s first meeting

Remember there are two committees 1) Standards and 2) Policy and both of them have workgroups

According to John Halamaka's blog who sits on the HIT Standards Committee here are their next steps:

1. June 16, 2009 HIT Policy Committee will discuss a matrix of meaningful use, standards, certification criteria, and meaningful use measures at their June 16th meeting
2. June 16th HIT Standards Committee Clinical Quality Workgroup will receive meaningful use guidance from the HIT Policy Committee. We'll work hard over the following week and will present our strawman standards, implementation guidance, and certification criteria at the June 23rd public meeting of the HIT Standards Workgroup
3. June 23rd HIT Standards Committee Clinical Quality Workgroup Receive strawman standards from Clinical Quality Workgroup
4. July - August HIT Standards Committee Clinical Quality Workgroup We'll continue to refine the matrix in July and complete our work in August
5. This will then go to ONC as an advisory and ONC will then combine it with their own internal workgroup. It will then be posted in the Federal Registrar by December of this year and be open for feedback

Just as an aside, in researching this (reading the entire meeting transcripts ) it is clear these committees are tying to move very quickly but most of their members seem unaware of the tremendous work that has happened over the past few years and the consumer voice is almost silent. It also appears based on the laborious discussions at their meetings that they haven't read the existing ONC strategic plan that very elegantly lays our a matrix that ONC developed with 2 primary goals of Patient-Centered Health Care and Population Health which underpin four recurring themes Interoperability, Adoption, Privacy and Security, and Collaborative Governance)