The ONC’s Meaningful Use Workgroup is submitting draft recommendations for Stage 3 of the Meaningful Use EHR Incentive Program to the Health IT Policy Committee on Feb. 14. So far, the workgroup has developed a number of ideas that have consensus, but clinical quality measures may not be as easy to include in digital systems as previously thought, and Congress may end up stepping in.

While health IT stakeholders consider the potential challenges of Stage 3 over the next year, Congress may end up coming back into the process with new ideas — and redesign the entire system for how Medicare pays and provides incentives for  physicians.

Provisions being floated for the new Medicare doc payment reform legislation would create a Merit-Based Incentive Payment System to streamline current incentive programs in 2018, gradually offering increases and incentives for entering altnernative payment models and also ending Medicare penalties, including those for not participating in meaningful use, in 2017. Different components of the existing incentive program might continue, though, such as EHR certification.

[See also: Consumers now call for meaningful use.]

In March, the HIT Policy Committee, headed by Karen DeSalvo, MD, will be approving Stage 3 recommendations and by this time next year HHS will be working on final rules.

The Meaningful Use Workgroup, chaired by Paul Tang, MD, chief innovation and technology officer at Sutter Health's Palo Alto Medical Foundation, has nurtured a variety of policy ideas across more than 100 different stakeholder calls on Stage 3 over the past two years.

[See also: The Meaningful Use Workgroup recommendations.]

One proposal that’s emerged would have physicians and hospitals use clinical decision support interventions based on four of six national priority areas: preventive care, chronic disease management, appropriateness of lab/rad orders, medication-related decision support, improvement of problem, medication and allergy lists, and drug-drug and drug-allergy checks.

The Meaningful Use Workgroup is also proposing new certification criteria for EHRs, bringing them evermore into the Internet economy: a requirement to offer patients “an easy way to request an amendment to their record online.”

Among the main goals for meaningful use Stage 3 are supporting new models of care and addressing national health priorities, such as the Million Hearts cardiovascular disease prevention campaign. To support that, the workgroup said the program needs to fix “key gaps in EHR functionality that the market will not drive alone, but are essential for all providers,” and also guide the development of “mature standards” that could be widely adopted by 2017.

For health systems and physicians that are the furthest along in health IT and demonstrating high-quality clinical outcomes, the workgroup is considering an optional “deeming” approach to attestation that could reduce some of the administrative burden.

Though, that option would come with a challenge; “a lack of broadly applicable” e-clinical quality measures, Tang said. “Not all outcome measures are HIT sensitive” and outcomes-oriented eCQMs are not yet available.