Meaningful Use And EHR Standards: The Final Rule
July 13th, 2010
 by
John Halamka
|
Editor’s Note: For more on electronic health records and meaningul use requirements, see the April issue of Health Affairs, “Health IT: The Road To ‘Meaningful Use’“.
This morning, the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator (ONC) for Health Information Technology released the final rules that will guide electronic health record (EHR) rollouts for the next five years. CMS and ONC released final “meaningful use” requirements, spelling out how hospitals, physicians, and other medical professionals must use EHRs to improve care, in order to be eligible for Medicare and Medicaid financial incentives under the “HITECH” Act. ONC also released final rules governing standards that vendors of EHRs must meet and the process for certification of EHRs.
Key resources include information from the Depeartment of Health and Human Services on the final meaningful use and standards and certification regulations, as well as an overview of the regulations in the New England Journal of Medicine authored by national health IT coordinator David Blumenthal and CMS Principal Deputy Administrator Marilynn Tavenner.
Differences betwen final and proposed regulations. Both the meaningful use regulations and the standards regulations had earlier been issued in proposed form. Here’s my analysis of the key changes between the final and proposed meaningful use rules.
1. HHS has adopted the recommendation of the HIT Policy Committee – a group of private-sector individuals (including me) appointed to advise HHS — to frame meaningful use in terms of core requirements and discretionary requirements. This responds to the concern that the proposed rules had set up an “all or nothing” approach, in which hospitals and professionals who failed to meet any one of the requirements were ineligible for funding.
By adopting a framework of core and discretionary requirements, HHS has reduced the total number of requirements and introduced choice. In the notice of proposed rulemaking (NPRM) there were 25 requirements for Eligible Professionals and 23 for hospitals. In the Final Rule there are 15 core requirements for Eligible Professionals and 14 for hospitals. For both hospitals and professionals, there are 10 discretionary requirements from which five must be chosen.
2. Thresholds have been reduced in many cases. For example, under the NPRM, 80 percent of orders for eligible professionals and 10 percent of orders for hospitals had to utilize computerized physician order entry (CPOE). The language in the final rule focuses on order entry of medications and requires that 30 percent of patients with medication orders have at least one medication order entered electronically. This requirement applies to both eligible professionals and hospitals.
3. Administrative simplification, which addresses formats for the exchange of information among different systems, has been postponed to Stage 2.
4. Only one clinical decision support rule must be included under the final rule, down from five in the proposed rule.
5. Required clinical quality measures have been reduced to 6 for professionals and 15 for hospitals. For professionals, there are 3 core measures required, 3 alternative core measures, and a choice of 3 from a pool of discretionary measures. Reporting by attestation is required in 2011, electronic reporting is required in 2012. Clinical quality measurements for specialists have been eliminated for stage 1. There has been great effort to align meaningful use with the measures tracked through CMS’ Physician Quality Reporting Initiative.
6. The NPRM did not include the recording of advanced directives or a provision for providing patients with educational materials. The final rule includes these as discretionary meaningful use requirements.
Overall, the final rule maintains a balance between the policy objectives sought and the technology changes that are achievable now. There will still be three stages of meaningful use and later stages will be more demanding. All the Stage 1 requirements included in the NPRM will still be part of meaningful use by Stage 2.
In January of 2011, the clinicians may begin the 90 day process of using a certified record per meaningful use requirements. Attestation of this use begins in April 2011. CMS payments will begin May 2011.
Standards and certification. ONC also released the final rule on standards and certification today. They have done a remarkable job of adding detailed implementation guidance specificity for patient care summaries, public health laboratory reporting, syndromic surveillance, and immunizations. It’s a tricky balance to provide enough specificity to test and certify EHRs and modules for interoperability, while at the same time encouraging innovation. The final rule issued today achieves that balance perfectly, ensuring that only mature implementation guides are specified, leaving room for innovation in such areas as how to transport data from point to point via NHIN Direct and other demonstration projects.
Overall, a very good day for ONC, HHS and stakeholders. The final rule ensures meaningful use will be achievable by many. The standards and the process to certify their use are sufficiently specific. I’m impressed.
Email This Post
Print This Post
