ONC Steps Up MU Stage 2 PreparationONC Steps Up MU Stage 2 Preparation

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With seven months to go before Meaningful Use Stage 2 kicks in, the Office of the National Coordinator of Health IT (ONC) has taken several steps to ensure that providers understand the MU interoperability criteria and that they have the ability to meet those requirements.

Among other things, ONC has released new guidelines for implementing Direct secure messaging; it has begun urging health information service providers (HISPs), which convey Direct messages between clinicians, to get accredited through DirectTrust, a nonprofit trade organization; and it has released a suite of electronic training tools to help providers prepare for interoperability.

The five Web-based training modules are designed for use by regional extension centers (RECs), Beacon Communities, state health information exchanges, and other EHR implementers assisting hospitals and providers in achieving Meaningful Use Stage 2, according to an ONC fact sheet. The first module presents an overview of interoperability basics. The other four courses address interoperability in transitions of care, lab exchange with EHRs, patient and family engagement and public health.

Trainers and providers can access the modules on an ONC website or through the national health IT REC site if they have user accounts. The courses are available to mobile users on computer tablets, including the Galaxy and iPad 2 and 3.

[ Do EHRs impede doctor-patient communications? They don't have to. Read EHRs, Communication Can Co-Exist For Doctors, AMA Says. ]

The interoperability basics module uses a storytelling approach to explain the fundamentals of health information exchange. The top level of this course seems to be oriented to providers and the general public. Trainers can drill down to documents that provide more in-depth information.

The new guidelines for Direct messaging, which update protocols released last year, "provide recommended policies and practices for health information service providers (HISPs), trust communities and accrediting bodies, such as DirectTrust," ONC states in its guideline document. ONC strongly urges HISPs providing services to eligible professionals and hospitals in Meaningful Use Stage 2 to adopt these protocols and participate in accreditation programs such as that of DirectTrust, which recently received a grant from ONC.

The guidelines cover Security and Trust Agents (STAs) that may be operated by a healthcare entity, or more commonly, by a HISP. They also cover Registration Authorities, which establish the identities of certificate subjects, and Certificate Authorities, which issue certificates to HISPs and other organizations that convey Direct messages. The functions of an RA and a CA may be performed by a single entity or by multiple entities.

The document notes that many HISPs "are employing Direct in a way that proactively enables exchange with a given HISP's boundaries while not offering mechanisms or supporting policies that enable exchange with other HISPs. Such limitations effectively block providers using different HISPs from exchanging patient information" and could hamper care coordination and the ability to meet the MU Stage 2 requirements.

"[The new guidelines are designed] to ensure Direct is being implemented in a way that will support vendor-to-vendor exchange and interoperability across geographic, organizational and vendor-related boundaries," said Claudia Williams, director of ONC's state health information exchange program, in a blog post.

Williams noted that DirectTrust will incorporate the new implementation guidelines into its accreditation process. In another blog post, Kory Mertz, ONC's challenge grant director, went even further in endorsing DirectTrust as ONC's unofficial accreditation body for HISPs: "We encourage HISPs to get accredited by DirectTrust and add their anchor certificates to its trust bundle to ensure the providers using their services are able to change information across vendor and organizational boundaries."

While Direct is not the only permissible method of exchanging information in MU Stage 2, ONC requires EHRs to include Direct messaging capability as part of its 2014 certification requirements. Providers must use certified EHRs to show Meaningful Use in the federal EHR incentive program.