As comments begin to start rolling in to the Centers for Medicare and Medicaid Services (CMS) and the Office of National Coordinator for Health IT (ONC) on the Meaningful Use Stage 2 proposed rule, it is becoming clear that the state of the EHR is currently in flux. Some stakeholders are asking for more time and flexibility in meeting the regulations. Others are suggesting that the government remain steadfast in their approach to upcoming rules and deadlines.

Earlier this week, the Electronic Health Records Association joined a chorus of organizations in asking for the federal government to change the length of the reporting period that will be used by providers to qualify for Meaningful Use Stage 2 incentives.

The EHR Association proposed that using a three-month or six-month reporting period that would give doctors and hospitals more time to install, implement, amend, and embrace their new systems, according to what the co-chair of EHR Association’s public policy leadership workgroup Mark Segal said in an interview with InformationWeek Healthcare.

The ‘more flexibility’ position being taken by the EHR Association is similar to the one being taken by the College of Health Information Management Executives (CHIME). That organization also recommended to CMS that providers have an 18-month window in which to comply with the finalized Stage 2 rule. The CMS current proposed rule is around 12 months for eligible hospitals and 15 months for eligible providers.

Other healthcare IT experts feel the industry is not moving fast enough away from outdated models and practices. Health IT executive Dave Chase wrote a commentary last week in iHealthBeat that said that EHR vendors are still creating systems primarily for the fee-for-service and acute care models. As a result, he said, the industry is currently driven by billions of dollars worth of systems that soon will be obsolete.

“For entirely logical reasons, given the old reimbursement model, their success was measured by their ability to get as big of a bill as possible out as fast as possible,” Chase wrote. “The shift to a value-based model of reimbursement flips provider incentives on their head.”

In addition, he noted that popular EHR systems “have their strength in automating internal workflows of hospitals and other clinical settings.” According to Chase, this model is more attuned to acute care, where providers make the decisions, but not chronic care, which requires heavy patient engagement and decisions.

The Premier healthcare alliance is another organization pushing for CMS to forge ahead with Stage 2 requirements. In its comments to CMS, Premier called for the publishing of the final Stage 2 rule no later than August of this year.

“Failure to publish a final Stage 2 regulation by August 2012 would seriously compromise the ability of the healthcare community to meet Stage 2 requirements beginning in 2014,” the company commented.

In some respects, Premier and CHIME are coming at the necessary timeframe for adoption from different angles. Premier is simply looking to maintain the anticipated August publish date in order to keep the expected 16-month window intact, while the CHIME  approach focuses more on expanding the window itself to 18 months, regardless of when the final rule is published.