The Health IT Policy Committee, an advisory panel to the federal government, is divided over the start date for Stage 2 meaningful use requirements, voting 12-5 June 8 to delay Stage 2 by one year – from 2013 to 2014.

Since its inception in 2009 under the American Recovery and Reinvestment Act, the EHR incentive program has been fraught with controversy over timing, which some claim has been too difficult a hurdle for most healthcare providers to achieve, despite one extension already granted.

[See also: Vendors air reservations about Stage 2.]

The American Hospital Association and other groups have called on the committee to delay Stage 2 until results of Stage 1 have been adequately assessed.

The Centers for Medicare and Medicaid Services (CMS) has only just begun to mail out checks -- some $75 million by the end of May-- to  qualified doctors and hospitals for the use of certified EHRs according to Stage 1 criteria.

As Stage 1 incentives are underway, the committee has been scrambling to pull together a rough draft of recommendations to guide the Office of the National Coordinator for Health Information Technology (ONC) and CMS on what to include for Stage 2.

Committee member Marc Probst, CIO of Salt Lake City-based Intermountain Healthcare, was one who voted for more time. "Much more time," he said. Probst would like to see Stage 2 delayed later than the proposed recommendation of  2014.

Intermountain Healthcare is one of the front-runners in the nation to use EHRs to successfully improve population health. 

Probst said he suspects most of the providers who received the incentives have been using EHRs for 10 years. All they had to do was "a little tweaking" to qualify for Stage 1 meaningful use, he said.

"Essentially, we have people in a ski race who were three-quarters of the way down the hill," Probst said. "We have to help people at the top of the hill. It's going to be difficult to get people [to EHR adoption]," he said. "It just is."

Judith Faulkner, founder and CEO of Madison, Wisc.-based Epic Systems Corporation had reservations over proposed 2014 start date. "If we don't know how long it will take vendors to do the work, we don't know how long it will take for providers to get up and running," she said.

For Stage 1, federal advisors relied on "giving signals" to vendors throughout the planning process. This was intended to help vendors get underway with what would be needed in EHR products, so they could be ready for providers when the time came.

But some of the signals didn't end up in the final regulations. Faulkner said signals that ended up being false cost vendors thousands of dollars to correct later. "We might be feeling good about giving signals, but those receiving aren't so good with that," she cautioned.

Faulkner also had concerns over the amount of time it would take doctors to meet the proposed requirements in the course of their day. Doctors are already challenged to find enough time to spend with patients, she said.

Neil Calman, MD, president and CEO of the Institute for Family Health was adament about moving forward as planned. "This program is not a subsidy program. It doesn't subsidize HIT adoption," he said. "We have a responsibility to use these funds as incentive dollars. If we're not accelerating the process, then we don't need to put all these dollars on the table."

Calman said the market is, of its own accord, moving rapidly toward EHR adoption, fueled by patient expectations. Time is of the essence, he warned. Too many medical errors are taking patients' lives for lack of EHRs.

Paul Tang, MD, chair of the committee's Meaningful Use Workgroup, and vice president and CIO at the Palo Alto Medical Foundation, said the group's recommendations are merely advice. The federal government will ultimately decide on the timing and criteria of Stage 2.

Tang said he would like to see the group get started as soon as possible on Stage 3 recommendations, expected to begin in 2015, but with no specified start date. In addition, the federal government could create a Stage 4 for meaningful use incentives, should it choose to do so, Tang said.

ONC released a draft proposal for Stage 2 criteria in mid-January of this year and accepted public comments through Feb. 25. The advisory committee is making changes based on those comments and expects to issue final recommendations this summer. CMS will issue a final rule on Stage 2 meaningful use by June 2012.

A grid with the draft criteria for Stage 2 can be found on ONC's website here. The HIT Policy Committee is tweaking some of the proposed requirements.

[See also: CIOs call for delaying move to Stage 2 meaningful use.]

Follow Diana Manos on Twitter @DManos_IT_News. 

This story was updated on June 10.