Meaningful use will drive payers' EHR integration

March 1, 2010

Providers that have not adopted EHRs that meet the meaningful use standards of the Health Information Technology for Economic and Clinical Health Act by 2015 face a significant decrease in Medicare reimbursement.

Although these regulations are not directly binding on payers, they should be aware that EHRs adopted by hospitals, physicians and other providers will be designed to comply with the federal standards. Payers that want to integrate their EHR, PHR or claim systems with providers will need to prepare for integration with this in mind. If payers have additional criteria not captured by the federal standards, they must work directly with providers to ensure that the systems adopted meet the payers' needs as well.

REQUIREMENTS VERIFIED BY CMS

For Stage 1, providers must electronically capture health information, use that information to track key clinical conditions, communicate that information for care coordination purposes and report clinical quality measures and public health information to federal officials. Providers initially will only have to make an attestation to CMS that they have met these standards, but by 2012 they will be required to report quality measures and demonstrate satisfaction of the standards.

The regulations establish the criteria that any EHR system must satisfy in order to be certified, including some 25 objectives covering a range of healthcare activities including patient care information, exchange of information between providers and payers, and quality control measures.

Key requirements further dictate that providers must be able to use the EHR system to engage in computerized provider order entry, generate and transmit prescriptions electronically, record patient information, and maintain health records regarding patients' clinical care. The EHR system also must be able to check patients' insurance eligibility and submit claims electronically to public and private payers.

Providers also must be able to use their EHR systems to provide patients electronic information regarding their treatment, discharge instructions and reminders for preventive and follow-up care. In addition, the system must be able to exchange clinical information among providers.

Finally, any certified EHR system must have security features to protect electronic health information and must be HIPAA compliant. Additional clarification is expected from the ONC regarding the certification process for EHR systems.

The generous incentive payments and the threat of decreased Medicare reimbursement down the road will inspire widespread implementation of EHR systems among providers, and payers must be prepared to drive their own goals alongside those of their provider counterparts.

This column is written for informational purposes only and should not be construed as legal advice.

Kelly J. Skeat, Esq, is an associate with Calfee, Halter & Griswold LLP.