As David Blumenthal, MD, sees it, Stage 2 is where the rubber meets the road for the Meaningful Use EHR Incentive Program – the government’s grand scheme to drag the American healthcare system, kicking and screaming, into the 21st Century.

The program’s promise and appeal from the start was that it would move healthcare from an industry stuck in antiquated ways and mired in paper, into a smooth, sleek, efficient digital system, more akin to what consumers experience when banking, or buying a book or refrigerator on Amazon.

Blumenthal, who served as the third national coordinator for health information technology – is often credited as the architect of the meaningful use program.

“I certainly didn’t act alone,” he told Healthcare IT News in a recent interview. While Blumenthal presided over the Office of the National Coordinator at the time the concept of meaningful use was fleshed out, the first regulation was written, and the phased pattern established, he noted, “The actual provisions were very much a group effort – a huge amount of input from our Health IT Policy Advisory Committee at the Office of the National Coordinator.”

Today, having steered smoothly through Stage 1, and the government having spent more than $30 billion on the program, the industry has arrived at Stage 2 – and healthcare providers appear to be lost, unable to find their way. Some have complained that Stage 2 is just too hard, too complex. Others have cited competing projects, such as conversion to ICD-10. Moreover, many EHR vendors had not yet certified their products for Stage 2, making it impossible for providers to meet the Stage 2 attestation deadlines.

The American Hospital Association, the American Medical Association and other professional organizations lobbied for more time to get to Stage 2, and they got it.

CMS and ONC announced last December the government would extend Stage 2 through 2016 and begin Stage 3 in 2017 for providers that have completed at least two years in Stage 2. Even so, by the end of May, only four hospitals and about 50 physicians had attested to having reached Stage 2.

More time to arrive at Stage 2 is likely to help. But, what effect might the delays have on the program – on the vision for healthcare transformation?

“Well, I take a long view,” Blumenthal said. “My belief is that the United States healthcare system was flawed in ways that prevented, or dis-incented the adoption of electronic health records, and that to accelerate that process required government intervention.”

The intervention was not perfect, he acknowledges, but it accomplished the basic goal of accelerating the adoption and use of electronic health records. It means that most Americans’ health information is in digital form.

“The consequences of that digitization of information in a reasonably systematic way, guided by meaningful use, will have enormous, difficult to predict, and generally positive effect on the American health system over a generation to come,” Blumenthal said, “That’s my view of it. I know that physicians find certain aspects of meaningful use problematic. Some find it too aggressive. Some find it not aggressive enough. But, I still think it was a reasonable way to proceed, and we’ll see the results over decades.”

John Halamka, MD, CIO of Beth Israel Deaconess Medical Center in Boston, sees the Stage 2 extension as a positive move, not as a retreat by the federal government from its commitment to the meaningful use program. At the time CMS and ONC announced the extension, he saw the need to explain it.

“This is NOT a delay of Meaningful Use in 2014 (Stage 1 or Stage 2),” he wrote on his Dec. 6, 2013, blog “All 2014 certification and attestation deadlines are still in force,” he added. “This announcement adds another year to Stage 2, delaying Stage 3 to 2017 and making Meaningful Use Stage 2 a three-year cycle.”