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January 04, 2010

iHealthBeat

Officials Announce 'Meaningful Use,' EHR Certification Criteria

Last week, CMS released proposed regulations defining the "meaningful use" of electronic health records, Reuters reports (Wutkowski/Heavey, Reuters, 12/31/09).

In addition, the Office of the National Coordinator for Health IT released an interim final rule describing the required certification standards for EHR technology (Simmons, HealthLeaders Media, 12/31/09).

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHRs will qualify for incentive payments through Medicaid and Medicare.

Officials will offer a 60-day public comment period after both regulations are published in the Federal Register on Jan. 13. The interim final rule on EHR certification is scheduled to take effect 30 days after publication (Goedert, Health Data Management, 12/30/09).

Phased Approach to Meaningful Use

CMS' plan proposes phasing in meaningful use requirements over three stages between now and 2013.

The first stage of the meaningful use criteria emphasizes:

  • Collecting electronic health data in coded formats;
  • Implementing clinical decision support tools;
  • Reporting clinical quality measures and public health data; and
  • Using EHR data to track conditions and coordinate care (Monegain, Healthcare IT News, 12/30/09).

The criteria call for physicians to submit at least 80% of their orders electronically and for hospitals to submit at least 10% of orders electronically. The proposed rules also call for health care providers to use EHRs to check for potential drug interactions (Perrone, AP/San Francisco Chronicle, 12/30/09).

In addition, the rule requires health care providers to provide patients with electronic copies of their medical records within 48 hours of a request (Hensley, "Shots," NPR, 12/31/09).

A list of Stage 1 criteria for physicians and a list of Stage 1 criteria for hospitals are available from Healthcare IT News (Healthcare IT News, 12/30/09).

The Stage 2 criteria are expected to focus on structured data exchange and continuous quality improvement. CMS is scheduled to release the second phase criteria by the end of 2011.

The Stage 3 criteria are expected to center on advanced decision support and population health. CMS is scheduled to publish the third phase criteria by the end of 2013.

Certification Criteria for EHRs

ONC's interim final rule outlines the technical standards and features that EHR systems must include to receive certification for meaningful use.

The rule includes:

  • Standard formats for clinical summaries and prescriptions;
  • Standard terms to describe clinical problems, laboratory tests, medications and procedures; and
  • Standards for secure transmission of online data.

The rule focuses solely on standards for certified EHRs. Later in 2010, ONC is scheduled to release additional guidance on the process for EHR certification.

Reduced Budget for Incentive Payments

When federal officials released the two new regulations, they also announced that the government might distribute less money than anticipated for the incentive payment program.

Initially, the Congressional Budget Office estimated that total federal incentive payouts could reach $34 billion (Mosquera, Government Health IT, 12/30/09).

However, officials last week said the outlays are likely to range from $14.1 billion to $27.3 billion.

They added that the government might pursue further budget revisions after evaluating the popularity of the incentive payment program (Schulte/Schwartz, Huffington Post Investigative Fund, 12/30/09).

Reaction to Regulations

Advocacy organizations, medical associations and other stakeholders offered mixed feedback on the proposed meaningful use criteria. Several groups' reactions are provided below.

  • American Hospital Association: AHA expressed concern that the rules will reward only facilities that have achieved advanced EHR functionality. AHA suggested that officials also offer incentive payments to hospitals that are making progress toward EHR adoption (Simmons, HealthLeaders Media, 1/4).
  • Healthcare Information and Management Systems Society: HIMSS officials praised the rules for helping to create a path toward greater EHR adoption nationwide. The group said the rules contain "much more to applaud than criticize."
  • Medical Group Management Association: MGMA said the new rules are overly complicated and could discourage physicians from adopting EHRs and participating in the incentive program. MGMA urged officials to make additional changes to allow for greater flexibility for meaningful use.
  • Patient Privacy Rights: Deborah Peel, founder and chair of PPR, criticized the rules for not including sufficient patient privacy protections. Peel said the regulations should ensure that consumers have control over their personal health information (Manos, Healthcare IT News, 1/4).