The comment period on the proposed meaningful use rule and the interim standards final rule closed March 15. On March 17, federal officials said they had collected some 2,700 comment letters.

Steve Posnack, a policy analyst with the Office of the National Coordinator for Health Information Technology said ONC received 700 comment letters on the standards interim rule. After reviewing them, ONC found that only 300 of them were "relevant," Posnack said at a March 17 meeting of the HIT Policy Committee.

According to Jodi Daniel, director of the ONC Office of Policy and Research, because the standards rule is an interim final rule, there is very little the government is allowed to change, by law. Recommendations can only be acted upon by ONC if they expand on what is already in the rule.

Tony Trenkle, director of the Centers for Medicare and Medicaid Services' (CMS) Office of E-Health Standards and Services said CMS has so far read almost half of the 2,000 comment letters it received on the meaningful use proposed rule.

Most of the letters were well thought-out, and reflected the need for balance between setting standards high enough for data collection and ease of healthcare IT adoption.

Balance is important, Trenkle said. "We have to [use balance] to get this off the ground and meet the larger policy goals," he added.

Trenkle said CMS would now tease out the high policy issues in the letters, then make a public response to each issue before pulling together final regulations. The government hopes to finish the rules by late spring, but that could change depending on how long it takes to go through the process, he said.

The deadline "could be impacted, depending on whether some of the issues need further clarification," Trenkle said. "For those letters that are looking for a major policy decision, we will try and float it up-ranks to the policymakers," he said.

Trenkle said the comments have revealed several trends so far, including: requests for the government to lower the bar for providers who would qualify for incentives; give additional clarification; allow flexibility in adopting measures for meaningful use; set some measures as core, and some measures as optional; and reduce the number of measures, or the threshold of the measures.

Some comment letters asked the government to scale incentive payments to the level of electronic health records being used, Trenkle said. This is set by statute and isn't something CMS can change, he said.

The Markle Foundation, the Center for American Progress, and the Engelberg Center for Health Care Reform at Brookings joined with healthcare leaders from 56 diverse organizations in commenting on the rules. They urged the federal government to make the meaningful use goals more explicit. The goals should be something simple, like improving medication management or reducing readmissions to hospitals, "so that everyone - including the public - can play a role in contributing to these priorities," they said.