Rule proposed for defining "meaningful use" of electronic health records

The Centers for Medicare & Medicare Services (CMS) has issued a proposed rule defining “meaningful use” of electronic health records (EHR), a definition awaited by many healthcare providers before taking advantage of federal incentives for investing in the technology.

The American Recovery and Reinvestment Act of 2009 established programs to provide incentive payments to eligible physicians and hospitals participating in Medicare and Medicaid that adopt and make “meaningful use” of certified EHR technology. Incentive payments may begin as soon as October 2010 to eligible hospitals and to eligible physicians and other providers in January 2011.

Eligible physicians, including those in solo or small practices, can receive up to $44,000 over five years under Medicare or $63,750 over six years under Medicaid for being meaningful users of certified HER, according to David Blumenthal, National Coordinator for Health Information Technology. He said hospitals could receive up to four years of financial incentive payments under Medicare beginning in 2011, and up to six years of incentive payments under Medicaid beginning in October 2010.

“Widespread adoption of electronic health records holds great promise for improving health care quality, efficiency, and patient safety,” said Blumenthal. “Over time, we believe the EHR incentive program under Medicare and Medicaid will accelerate and facilitate health information technology adoption by more individual providers and organizations throughout the health care system.”

However, in addition to tighter controls over patient information, the Health Information Technology for Economic and Clinical Health Act (HITECH) taking effect in February threatens penalties for failure to adopt EHR. Physicians who are not using EHRs meaningfully by 2015 will lose 1% of their Medicare fees, then 2% in 2016, and 3% in 2017. Hospitals also face penalties for nonadoption as of 2015.

The proposed rule issued by CMS on December 30 outlines proposed provisions governing the EHR incentive programs. At the same time, an interim final regulation issued by the Office of the National Coordinator for Health Information Technology (ONC) sets initial standards, implementation specifications, and certification criteria for EHR technology. Both regulations are open to public comment.

The interim final regulation issued by ONC describes the standards that must be met by certified EHR technology to exchange healthcare information among providers and between providers and patients. This initial set of standards begins to define a common language to ensure accurate and secure health information exchange across different EHR systems. The interim final regulation describes standard formats for clinical summaries and prescriptions; standard terms to describe clinical problems, procedures, laboratory tests, medications and allergies; and standards for the secure transportation of this information using the Internet.

The interim final regulation calls for the industry to standardize the way in which EHR information is exchanged between organizations, and sets forth criteria required for an EHR technology to be certified. These standards will support meaningful use and data exchange among providers who must use certified EHR technology to qualify for the Medicare and Medicaid incentives.

The proposed rule would define the term "meaningful EHR user" as an eligible professional or eligible hospital that, during the specified reporting period, demonstrates meaningful use of certified EHR technology in a form and manner consistent with certain objectives and measures presented in the regulation. These objectives and measures would include use of certified EHR technology in a manner that improves quality, safety, and efficiency of health care delivery, reduces health care disparities, engages patients and families, improves care coordination, improves population and public health, and ensures adequate privacy and security protections for personal health information.

The proposed rule would define meaningful use for the Medicare EHR incentive programs. It proposes one definition that would apply to eligible professionals participating in the Medicare fee-for-service and the Medicare Advantage EHR incentive programs as well as a proposed definition that would apply to eligible hospitals and critical access hospitals. These definitions also would serve as the minimum standard for eligible professionals and eligible hospitals participating in the Medicaid EHR incentive program. The rule proposes that states could request CMS approval to implement additional meaningful use measures, as appropriate, but could not request approval of fewer or less rigorous meaningful use measures than required by the rule.

This rule proposes a phased approach to implement the proposed requirements for demonstrating meaningful use. This approach would initially establish reasonable criteria for meaningful use based on currently available technological capabilities and providers’ practice experience. CMS will establish stricter and more extensive criteria for demonstrating meaningful use over time, as anticipated developments in technology and providers’ capabilities occur.

The CMS proposed rule and fact sheets may be viewed at:

http://www.cms.hhs.gov/Recovery/11_HealthIT.asp

ONC’s interim final rule may be viewed at:

http://healthit.hhs.gov/standardsandcertification

Additional details about incentive payments to eligible physicians, hospitals and other healthcare providers are included in an April 9 article by Blumenthal published in The New England Journal of Medicine:

http://content.nejm.org/cgi/content/full/360/15/1477)