The Health IT  Policy Committee, a federal advisory panel, adopted additional recommendations from its Meaningful Use Workgroup on Friday that had  physicians, activists, vendors and others warning that the government was moving too fast.

 Stakeholders including physician groups, health disparities experts, vendors and privacy activists voiced their concerns during the final 10 minutes of the Friday meeting allotted to public comment,  after the committee had already voted to adopt the recommendations.

Updated meaningful use recommendations

The recommendations, which include timelines for development and certification plans, will be used to guide the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare and Medicaid Services as they develop the "meaningful use" requirements providers must fulfill to get their cut of $17 billion in health IT funding from the American Recovery and Reinvestment Act (ARRA).

Eligible providers would have to use CPOE (computerized order entry) for all orders; implement drug-drug, drug allergy, drug-formulary check; and maintain an up-to-date problem list of current and active diagnoses based on ICD-9 or SNOMED.

Among the quality measures providers would be required to report to CMS in 2011 are: percentage of diabetics with A1c under control; percentage of hypertensive patients with blood pressure under control; and percentage of smokers offered smoking cessation programs.

 The timeline adopted as part of Friday's recommendation included holding informational hearings this fall, development of measures in the first quarter of 2010, work on standards in the second quarter of 2010, handing over those recommendations to CMS in the third quarter of 2010. Providers who want to qualify for ARRA bonuses must have used data meaningfully during 2010 to get bonuses to be paid out 2011.

Expanded certification process proposed

Also in the new recommendations is a plan to open the certification process to the market. Right now the Certification Commission for Health Information Technology (CCHIT) is the only certification body. The Meaningful Use Workgroup envisions 10 or 12 more certifying bodies. These bodies would first be approved by the federal government to have uniform certification procedures to that of CCHIT.

Another key aspect of the Friday recommendations was the inclusion of a "gap" certification, or preliminary certification,  to be given by HHS to vendors who prepare software in good faith in advance of the meaningful use standards. After the standards are released in 2011, the vendors would supply whatever  is missing in their programs, facilitating the speed with which providers can be ready to start their meaningful use data collection.

Stakeholders: Feds moving too fast

A clear theme in the complaints from the public centered on the rushing of the process and lack of opportunity to be a part of it. Congress set a steep pace for the advance of health IT in ARRA, passed in February. The Health IT policy committee seems to be caught between hearing from the public and making its recommendations on time.

David Blumenthal,  national coordinator for health IT, reiterated what he says at every meeting. "We are not in the business of making policy, we are in an advisory role. Ultimately,  the decisions will come down to CMS."

Gayle Harrell, former Florida state legislator and member of the policy committee was concerned about timing and whether CMS would be able to handle its new gap certification role.

Tony Trenkle, director of the CMS Office of e-Health Standards, also a member of the committee, said CMS is working on that now and will include its methods and intentions in its meaningful use proposed rulemaking in December. "We won't propose something in our rule that we can't handle in our systems," he said.

Deborah Peel, MD, founder of Patient Privacy Rights said she feared her coalition's written concerns, representing more than 10 million Americans, were never considered by the committee.  Among other things, she is concerned patients will lose the right to control their data in the process of the meaningful use rulemaking.

Mike Campbell from McKesson Corp., said the new gap certification, to be based on 2008 criteria, will make an unlevel playing field for vendors who certified in 2009 under stricter requirements.

Other complaints came from representatives of physicians' and health disparities groups who said the committee's recommendations do not take into account the difficulties physicians face in healthcare IT adoption and consequences racial and ethnic groups face in increased disparities caused by lack of support to safety net providers who want to adopt IT.