Wish there could be a delay of Stage 2 meaningful use? Talk to the Centers for Medicare & Medicaid Services, not the Office of the National Coordinator for Health Information Technology. And don't hold your breath.

Responding to a written, anonymous question from an attendee at the American Medical Informatics Association Annual Symposium, Jodi Daniel, director of ONC Office of Policy Planning, would not explicitly discuss prospects for easing the Stage 2 compliance timeline.

"We are very focused on making Stage 2 work," Daniel said Monday during a town hall-style session with ONC leadership, and said any question of a possible delay should be directed to CMS, which wrote the rules for and administers meaningful use.

"They would have the authority to do that, but it would require a regulatory change," Daniel said. The regulatory process requires a notice of proposed rulemaking, followed by a mandatory public comment period, after which time CMS would review the comments and finalize the rule.

It could take a year or more, so the implication was that changes to Stage 2 are highly unlikely.

Acting national health IT coordinator Jacob Reider, MD, who led the town hall, said ONC is working especially hard to reach the "little folks" – independent community hospitals and small physician practices – that lack inside-the-Beltway contacts and don't "know how to interact with us." ONC is tasked with helping providers of all sizes and stripes achieve meaningful use, with the ultimate goal of producing safer, more effective care at lower cost – otherwise known as the "triple aim."

Reider discussed what he called ONC's "5+1 guiding principles": open, transparent inclusive decision-making; "eye on the prize" (the triple aim); "feet on the ground" (realism, rather than shooting for what Reider likened to "Star Trek"-esque science fiction); fostering market innovation; being open to all, including the "little folks" and – the "plus one" – putting patients and their interests at the center of all activities.

"People sometimes get a little jaded about patients from the physician side," he noted. He suggested clinicians think about the kind of care they want their own mother to have.

"The mom part is a good reminder," said Reider, who took over the ONC reins early last month, following the departure of Farzad Mostashari, MD.

"We're gonna get there," he continued. "We are on that trajectory. We're not there yet. I understand that, but we are gonna get there."

ONC devoted about half of the hourlong session to answering written audience questions. One questioner worried that meaningful use had taken on a life of its own, asking whether the original intent of the incentive program is getting lost as providers struggle to "check off boxes" on the attestation form.

"It's easy to lose sight of why we are implementing things," acknowledged Mat Kendall, director of the Office of Provider Adoption Support.

Kendall said ONC has been educating providers about the triple aim and trying to promote the true spirit of meaningful use by collaborating with other federal agencies. For example, he said, ONC has been working with CMS and the Centers for Disease Control and Prevention (CDC) to align quality measures in meaningful use with the Million Hearts initiative, a CDC-led effort to prevent 1 million heart attacks by 2017. (This, according to acting ONC Chief Medical Officer Amy Helwig, MD, includes a focus on controlling people's cholesterol levels.)

Kendall also was asked how subspecialty surgeons in academic settings would meet the Stage 2 requirement of engaging at least 5 percent of patients via online portals. He said it was really just a matter of making sure patient education is properly integrated into surgical workflows.

Privacy and security seemed top-of-mind for a good chunk of the medical informatics community.

ONC Chief Privacy Officer Joy Pritts said that, based on surveys about health information exchange, people at least want to know where information is being shared and what is being done with their data. "[They want] no surprises," Pritts said. "You don't want to establish a sense of distrust between a healthcare provider and a patient."

Chirs Muir, ONC's liaison to states on HIE, recommended that providers and HIEs make it clear exactly what information is protected when people opt in or out of sharing data.

Pritts also said there has been "a failure of the market somewhat" in terms of smaller healthcare organizations assessing security risks. "I can't overestimate the value of common sense in conducting a security risk assessment," Pritts said.

She added that ONC has been working with the HHS Office for Civil Rights, which enforces HIPAA privacy and security rules, for more than a year trying to develop a free security risk assessment tool for small providers. "It's a bit of a challenge because this is a legal thing that you have to do," Pritts said. Expect this resource to be out sometime in 2014.

[See also: Stage 2 changes may be rude awakening]