In the innovative style of this ONC we had a new first today, a dramatic reading from a federal regulation.
One of the concessions to comments in the final rule for stage 2 meaningful use was eviscerating a criterion that required that 10% of transitions of care must be accompanied by electronic transmission of structured data across vendor boundaries. The final rule still requires 10% transmissions but eliminates the requirement for transmission across vendor boundaries. There is an added requirement that a single transition of care be sent across vendor boundaries or to a test EHR operated by CMS for the purpose of receiving and validating these transactions.
In commenting on this part of the final rules, Farzad gave an eloquent statement on the continued intent to find find policy levers to avoid vendor-built “walled gardens” of interoperability. You can listen to a one-minute excerpt of his statement here. I highly recommend it. It includes the aforementioned dramatic reading.
In the end, are ONC and CMS trying to stop the tides? I don’t think so. I can’t imagine that inter-vendor transmission of clinical data will ever match what can be accomplished between two well-run healthcare organizations that have the same product implemented well. But the stage 2 regulatory approach involves setting a minimum bar for the data elements that must be exchanged rather than implying that all the data in document must be compatible on a structured basis. This enables the government to set a base-level bar and raise it over time. Inter-vendor exchange at the base level is a realizable target.
It is a concern that you can’t manage what you can’t measure. Meaningful use might have convenient, but it’s not the only ruler in the toolbox.
Neither is it the only hammer.