"Steve Posnack from ONC declared today IT Bonanza Day," wrote Beth Israel Deaconess CIO John Halamka, MD, on his blog Tuesday evening.

Indeed, with CMS and ONC dropping much-awaited final meaningful use rules, EHR certification criteria and a final interoperability roadmap, all with National Health IT Week in full swing, there was perhaps more federal activity in single day than since the heady post-HITECH days of of the early 2010s.

As they settled in to read hundreds of pages of regulations, Halamka and industry leaders offered early reactions.

Many of the specifics yesterday came as little surprise, having been hinted at in recent months or appearing in earlier proposed rules. One of the more notable bits of news, though, was CMS' plans for a 60-day public comment period to gain more feedback about meaningful use going forward -- especially with regard to its relationship with the Medicare Access and CHIP Reauthorization Act of 2015, especially its Merit-based Incentive Payment System, and the consolidation of certain quality measurement and incentive programs into a more workable framework.

Halamka's take? "It remains to be seen how the comment period on the EHR Incentive Programs final rule will be used to align the Meaningful Use program with the (MACRA) effort," he wrote. "It would not surprise me that the CMS final rules are not really final."

In general, he noted that the final MU rules "are not substantially different than the proposed rules, but the thresholds have been reduced" – a good thing, from most providers' perspectives.

But the fact that "existing certified EHRs were created to support the previous Stage 2 thresholds" means vendors will most likely "have to modify code to support the changes," he wrote.

Halamka promised a deeper dive in the days ahead, but noted that "CMS and ONC have incorporated many of the changes requested by professional organizations and expert commentators, which is a good thing."

For its part, HIMSS applauded CMS and ONC's "continued efforts" to hone the rules into a more simple and more flexible framework. "We support the confirmation of the 90-day reporting period for 2015," said Carla Smith, executive vice president of HIMSS North America in a statement. "Further, we support the emphasis placed on January 1, 2018 – the start of the period where providers are required to meet Stage 3 objectives and measures.

HIMSS has consisentely made the case that there should be at least a year and a half  between the publication of a new meaningful use rule and the start of a new stage's reporting period, she said, and "the 27 months provided in this final rule appears to address this issue."

Ensuring those reasonable timelines, said Smith, "enable(s) providers to continue their participation in the program, thus supporting a positively transformed health system."

CHIME agreed. Its CIO membership was thankful that the "752-page rule grants flexibility for providers who are doing their best to not only meet the intent of the federal program, but also ensure the adoption of health information technology that improves patient care," according to CHIME Board Chair Charles E. Christian.

Key to that, of course, is the 90-day reporting period, which was reduced from 365 days. But while "several members are positioned to take advantage of this shorter period, others will be challenged to meet it since there are fewer than 90 days remaining in the year," Christian wrote.

"We urge CMS to implement a hardship exemption for those unable to meet this timeframe."

CHIME also cheered Stage 2's reduced patient access requirements, which now requires only that, for 2015 and 2016, one patient discharged from a hospital view, download or transmit their electronic record.

As for Stage 3, "the extra comment period will enable providers, CMS and other stakeholders to ensure that the next stage of Meaningful Use advances interoperability and takes into account new payment models being advanced by Medicare," said Christian.

Meanwhile, the American Medical Association – which has recently launched a campaign, Break the Red Tape, where physicians frustrated with "EHR designs (focused) on meeting government-imposed MU objectives" can share their stories – had muted praise for the new rules.

"In particular, the agency addressed the delay in issuing the modifications rule by allowing a hardship exemption for physicians who are unable to attest this year" -- something AMA had called for within the past week -- "providing needed relief for those uncertain about the 2015 program requirements.  We also acknowledge that the agency is working to improve patient engagement by ensuring that patients can access portals while still providing flexibility in the measure requirements," according to AMA President Steven J. Stack, MD.

As for Stage 3, AMA still thinks the rule needs "significant changes" to be workable, and urged CMS to use the public comment period "to further improve the program and consider changes related to the Medicare Access and CHIP Reauthorization Act, which was signed into law earlier this year."



And with regard to ONC's volumnious certification criteria, "we also want to make sure that EHR vendors have the time they need to further test products for interoperability, usability, safety and security," said Stack, in a press statement. "We hope that health IT certification is nimble enough to accommodate future technology innovations and that the program not seen as final at this time."

The American Hosptial Association, too, found a "mixed bag" in all the rulemaking coming out of D.C. on Tuesday, according to AHA President and CEO Rick Pollack.

On the one hand, he said, "we are pleased that CMS released the long-awaited modifications rule, which will allow hospitals a 90-day reporting period in 2015 along with other flexibilities in response to AHA concerns. Hospitals will finally have the clarity they need to take steps to ensure they meet the revised requirements."

On the other, however, "the simultaneous release of the final rule implementing Stage 3, which will be required beginning January 1, 2018, is deeply disappointing," said Pollack.

"Despite the urging of hospitals, physicians and Congress, the Stage 3 final rule includes many new and more challenging requirements. More than 60 percent of hospitals and about 90 percent of physicians have yet to attest to Stage 2. The Stage 3 rule is too much too soon."

Earlier on Tuesday, ONC also put out the final version of its shared nationwide interoperability roadmap, a path forward toward a data-rich learning health system that within the next decade will put "the person at the center of a system that can continuously improve care, public health and science through real-time data access."

HIMSS declared its strong support for "the four critical pathways identified in the Roadmap that focus on using consensus-based standards, enabling the shift in payment policies from fee-for-service to value-based models, and aligning federal and state privacy and security requirements that enable interoperability."

The Premier healthcare alliance also put out statement in support of the roadmap, saying it represents "a significant leap forward in the national effort driving toward interoperability.


"We strongly believe that this roadmap will provide important guidance that will help improve consumer access to health data and the sharing of electronic health information among providers," said Blair Childs, Premier's senior vice president of public affairs. "We also support the roadmap's recommendations for broader, governmental action to promote consistent, national interoperability standards, including the use of open source application programming interfaces to support the secure transfer of information between and among different HIT platforms."