Medical organizations are closely examining the long-awaited, proposed “meaningful use” criteria developed by the Department of Health and Human Services.
The final criteria, to be phased in starting in 2011, will be crucial for providers interested in receiving bonuses of up to $64,000 for installing or upgrading electronic health record (EHR) systems.
“We've tried to build in flexibility in these standards and certification criteria, as well as providing necessary guidance,” Dr. David Blumenthal, HHS's national coordinator for health information technology, said in a conference call.
He emphasized that the proposed regulations are open for public comment until March 15. “We'll carefully consider any comments about them and change the rule if we think it's required, based on those comments.”
The American College of Physicians is “very supportive of the goals articulated by the proposed rules,” said Dr. Michael S. Barr, the ACP's vice president for practice advocacy and improvement.
In a written statement, Dr. Barr told
The ACP will address three questions:
▸ Will the process for certifying EHR technology help ACP members identify the appropriate solution for their practice needs as well as help practices maximize the benefit of the EHR incentive program for patient care?
▸ Are the measures selected for reporting clinically relevant, evidence-based, and truly associated with meaningful use of health information technology?
▸ Do the processes required for collecting data to document and report on meaningful use minimize administrative and financial burdens for practices?
Under the Health Information Technology for Economic and Clinical Health Act (HITECH), a part of 2009's federal stimulus law, physicians who treat Medicare patients can get up to $44,000 over 5 years for the meaningful use of a certified health information system. Physicians whose patient populations are made up of at least 30% Medicaid patients can earn up to $64,000 in incentive payments for their use of the technology. The regulations include a definition of meaningful use and outline other criteria for obtaining the full incentive payments.
The HHS issued a rule that outlines proposed provisions governing the incentive programs, as well as an interim final regulation that sets initial standards, implementation specifications, and certification criteria for EHR technology.
“We hope we've provided a pathway toward more uniform standards over time, while at the same time making it possible in 2011 for well-intended providers and health professionals who want to become meaningful users to become so, and for the industry to create technology that will support that,” Dr. Blumenthal said.
The meaningful use criteria start with minimum requirements in 2011 and build gradually, with more requirements added each year. For stage 1, which begins in 2011, the requirements include:
▸ Use of computerized entry for 80% of all patient orders.
▸ Use of electronic prescribing for 75% of all permissible prescriptions.
▸ Maintenance of active medication and medication-allergy lists as part of the EHR for at least 80% of patients.
▸ Inclusion of demographic data (language, gender, ethnicity, insurance type, and date of birth) in the EHR of at least 80% of patients.
▸ Inclusion in the EHR of at least 50% of the lab results that can be recorded as either positive or negative or can be recorded with numerical data.
Other requirements deal with reporting quality data, filing claims electronically, encouraging patients to be active in their care, improving care coordination, and protecting the privacy of health records.
In 2012, the rules tighten for submitting quality data. Although providers are allowed to report quality data to the Centers for Medicare and Medicaid Services (CMS) through attestation in stage 1, data must be reported directly through certified EHR technology in stage 2.
“For clinical quality reporting to become routine, the administrative burden of reporting must be reduced,” CMS said. That goal can be achieved “by using certified EHR technology to report information on clinical quality measures electronically to a health information network, a state, CMS, or a registry.”
The American Medical Association responded cautiously to the proposed regulations. “We want physicians in all practice sizes and specialties to be able to take advantage of the stimulus incentives and adopt new technologies that can improve patient care and physician workflow,” Dr. Steven Stack, a member of the association's board of directors, said in a statement. “We have provided ongoing input this year on standards for the use of EHRs and have stressed the importance of realistic timeframes for adoption, the removal of extraneous requirements that would delay successful adoption, and reasonable reporting requirements.”
The Medical Group Management Association (MGMA), however, maintained that the proposed criteria “are overly complex and … medical groups will confront significant challenges trying to meet the program requirements.” In a statement, the group cited among its objections “unreasonable thresholds” for some criteria, including CPOE and electronic claims submission, “potentially difficult meaningful use attestation after the first year,” and a requirement that physician offices provide patients and others with electronic copies of medical records.