Fourteen thousand providers have registered for meaningful use incentives, David Blumenthal, MD, National Coordinator for Health Information Technology, told members of the HIT Policy Committee on Wednesday. This is up from the 13,000 announced in January.

Providers who have registered attest to having "meaningfully used" certified electronic health records for at least three months, collecting specific data required under the program. The flooding of registrants comes even as the GOP is considering repealing the law that has set aside billions to reward physicians and hospitals for EHR adoption.

[Read more about the GOP plan to topple the EHR incentive program.]

Blumenthal told the members of the HIT Policy Committee that the the Office of the National Coordiniator for Health Information Technology (ONC) and its advisory committees will have more time in planning the meaningful use of EHRs for State 2 than they did for Stage 1.

"We're at a point where we are planning without the urgency of last year," he said. "It will be important to get feedback from meaningful users in Stage 1 to help lay the groundwork for Stage 2."

Blumenthal also said interoperability will be key to the success of the program and the federal government is "working hard" on it. He was pleased ONC was announcing on Wednesday the launch of two interoperability projects as part of the "Direct Project" pilot.

[Read more about the Direct Pilot project.]

David Lansky, co-chair of the Quality Measures Workgroup, said ONC wants to put into the "refinement pipeline" some of the best suggestions from public comments collected in December on quality measures for Stage 2.

According to Lansky, ONC received comments from 134 respondents, including 112 organizations and 22 individuals not associated with an organization. Lansky said the workgroup wants to narrow the proposed quality measures from 491 to 30 or 40 for its final recommendation.

Lansky said the workgroup's criteria for the selection of quality measures would include:

• evidence that the measures could be built into EHR systems;
• the applicability of measures across multiple types of providers, care settings and conditions;
• evidence that the measure could support potential improvements in population health and reduce the burden of illness;
• the ability of measures to support assessment of patient health risks and assess changes in outcomes;
• and the ability of measures to enable assessment of patient-focused episodes of care.

Lansky said the workgroup considers some of the "most promising measures" to include:

• patients HIT connection with providers;
• lipid control using the Framingham risk score;
• duplicate diagnostic imaging;
• and hospital readmission.

Lansky said the government could not require providers to count duplicate testing unless it first solved the functional requirements needed to collect that information – namely interoperability.

Blumenthal said that in the meantime, providers can still use other methods to convey that tests have been conducted. "We can't hold ourselves to a perfect standard before we work on duplication of tests," he said. "Just having an EHR in a  practice helps a doctor look for what tests have already been done. Doctors don't usually have time to do that with paper records."

For patient safety reasons, it will help oncologists to know how much radiation exposure their patients have had because oncologists routiningly order CT scans on a three-month basis, Blumenthal said.

Blumenthal said ONC will work on pushing the simplest interoperability as an option at first. He said ONC is considering setting a target for Stage 2 that would take into account what is achievable using secure email.

Lansky said the workgroup plans to have the development, testing and validation of the qaulity measures completed by the fourth quarter of this year for Stage 2 and the fourth quarter of 2013 for Stage 3.

"Credible people" have said the measures under consideration are possible to achieve by Stage 3 – at least 60 to 70 percent by State 2, Lansky said.

Some committee members were skeptical, however.

Gayle Harrell, a Republican Florida state representative, was concerned the federal goverment won't have the technology to assess whether providers have achieved meanigful use requirements along with the capability of paying them incentives. "It takes two to tango," she said.

Judith Faulkner of Epic Systems Corporation warned that ONC should only require what's reasonably attainable by most providers, not by a few.