The MACRA proposed rule is "an example of regulatory overambition," according to John Halamka, MD, CIO of Beth Israel Deaconess Medical Center in Boston.

Writing in a blog post, Halamka said many of the concepts are good, such as reducing documentation burden, enabling flexbility, focusing on outcomes/quality, engaging patients in novel ways, and emphasizing connectivity/interoperability. However, he questions the use of ONC's 2015 Certification Rule because it will have the following three "bad consequences":

• The burden of certification will consume developer resources that could be used for innovation
• The standards listed in the certification rule have varying degrees of maturity and we'll be setting in concrete some technologies that should not be used
• The certification rule did not envision the kinds of products or services the private sector would develop between 2016 and 2018

"The 2015 Rule is a kitchen sink of standards, many of which are not ready for production deployment," he wrote, calling instead for use of the Standards Advisory concept to provide a constrained list of standards but then let vendors innovate as needed to support the workflows desired by patients, clinicians and hospitals."  

Halamka applauds the focus on outcomes and quality, he wrote. "Meaningful Use has run its course and achieved its goals. It needs to be replaced. Along with replacing Meaningful Use, let's rethink the certification concept too."

He promised a more thorough review of the proposed rule in coming days.