Farzad Mostashari, M.D.Among the advances that have been made, Mostashari said, have been greater understanding of meaningful use overall, a growing comprehension of how meaningful use and healthcare reform goals dovetail, and of course, significant numbers of patient care organizations and some physicians attesting to stage 1 this spring and summer.“We are now in an incredible position” to leverage clinical information to meet important national goals for care quality and effectiveness improvement, Mostashari continued, saying that “we are moving away from a fee-for-service model comfortably faster than we had even anticipated it. And as a country I think we are increasingly focused on the practical aspect of implementation,” citing a statistic he did not reference that “57 percent of hospitals have said that achieving meaningful use is their top priority, and 92 percent have said that it’s one of their top two issues.”Mostashari went on to cite as signs of progress the fact that “We now have 454 certified, complete EHR systems—386 ambulatory, 68 inpatient,” plus “over 400 modular products.” And he predicted that “In a couple of years from now, we’ll have more than 80 percent of primary care providers on the e-health record. That,” he said, “will be a primary change in healthcare.”Mostashari also felt the need to clarify and contextualize comments he had made in the past month around stage 2 requirements for early-attesting organizations and individuals, given the controversy in that area that has preoccupied many in healthcare this year. “Let me talk about the recent discussions that got translated as [supporting] ‘delay’ in the stage 2 transition,” he said. “Here’s how I see it and would explain it. The health IT policy committee looked at the national health IT policy and said, there are some big things that need to get done. And stage 1 provided a really good framework, roadmap. But there are a few things that are going to be challenging, including with quality measures development, and the current schedule allowed for little room for products to get upgraded and rolled out across the country… meaning that we would be severely limited in how robust stage 2 would be. And the committee said, by giving the early movers one extra year, we can continue to [advance progress]… They will have more time setting up for stage 2, so they’re incented to not rush for anybody who is ready to go. So I would characterize the shift as leading to a more robust stage 2 and also saying that there is no reason for delay on stage 1 work.”Following Mostashari’s speech and question-and-answer session, three officials from the federal Centers for Medicare and Medicaid Services (CMS) discussed timelines around the Medicare and Medicaid EHR incentive programs, and answered numerous audience questions revolving around practical concerns over meaningful use, including concerns over how hospitals can help physicians attest to meaningful use.Some industry experts looked a bit askance at certain comments made by the CMS officials. “One of the obvious takeaways that this morning’s session with CMIOs emphasized is that CMS, in the meaningful use process, has failed to recognize how much aggregation of providers and hospitals into large health systems has occurred over the last decade. Whereas other CMS requirements have provided the means for a large entity to efficiently such processes, meaningful use has not yet done so,” said Vi Shaffer, research vice president for healthcare at Gartner, Stamford, Conn. “They really should develop a means to help these entities report on behalf of sometimes 1,000 or more providers in an organization.” Shaffer noted that the ACO model under healthcare reform further encourages provider aggregation.Bria’s and Mostashari’s comments initiated the formal part of the Symposium program (following an opening reception Tuesday evening). The conference will continue through midday Friday.