The US Department of Health and Human Service announced yesterday a final ruling on what will be considered meaningful in applying electronic health records (EHR) to patient care. Alongside the over 800-page final MU ruling, HHS announced two companion final rules and launched a new website at http://healthit.hhs.gov/meaningfuluse.
Since first passed in early 2009, much debate and controversy surrounded provisions within the Health Information Technology for Economic and Clinical Health (HITECH) Act dealing with how health care professionals and hospitals can qualify for billions of dollars when adopting EHRs. Later that same year, vendors like Accenture, EDS (now HP Enterprise Services), IBM, Microsoft, Lockheed Martin, Perot Services (now Dell Services) joined a cadre of traditional health IT and EHR companies in aligning themselves for this emerging $27 billion market. Most if not all of them promised implementations that would eventually be “certified EHRs”.
According to funding streams outline in the economic stimulus package, $27 billion will be paid out as incentive payments over the next ten years, allowing health professionals to tap $44,000 under Medicare and $64,700 under Medicaid. Hospitals stand to obtain millions of federal funds to help with implementation of meaningful EHRs. An interim rule, which many health IT experts called too strict, was passed by Centers for Medicare & Medicaid Services (CMS) in 2010 – outlining 25 requirements for receiving federal incentive payments. It required hospitals who implement EHRs in 2012 or 2013, to be responsible for attaining the standards of 2011 criteria. Furthermore, hospitals have a little more leeway under the new terms, mandating that only 10% of orders be entered through an authorized process of electronic, or computerized, physician order entry (CPOE). The final CMS rule, along with a final ruling from ONC on technical standards and certifications, is more flexible, officials claim.
“This is a turning point for electronic health records in America, and for improved quality and effectiveness in health care,” David Blumenthal, M.D., National Coordinator for Health Information Technology, said in a statement. Mr. Blumenthal said his team sought “extensive input from the health care community,” to strike the balance between ambitious and achievable.
The final CMS rules divides the 25 prior requirements into a “core” group of requirements that must be met, plus an additional “menu” of procedures from which providers may choose, HHS officials explained. The approach ensures, they said, that the most basic elements of meaningful EHR use will be met by all providers qualifying for incentive payments, while at the same time allowing latitude in other areas to reflect providers’ needs and their individual path to full EHR use.
To help hospitals and health care providers understand and adopt the new rules for EHR technology, HHS is standing up a network of Regional Extension Centers with the help of over $500 million in federal funds. HHS has also launched a , to provide information for consumers and providers on meaningful use, CMS and ONC rulings.
According to an HHS press release, other key changes in the final CMS rule include:
- Greater flexibility with respect to eligible professionals and hospitals in meeting and reporting certain objectives for demonstrating meaningful use. The final rule divides the objectives into a “core” group of required objectives and a “menu set” of procedures from which providers may choose any five to defer in 2011-2012. This gives providers latitude to pick their own path toward full EHR implementation and meaningful use.
- An objective of providing condition-specific patient education resources for both EPs and eligible hospitals and the objective of recording advance directives for eligible hospitals, in line with recommendations from the Health Information Technology Policy Committee.
- A definition of a hospital-based EP as one who performs substantially all of his or her services in an inpatient hospital setting or emergency room only, which conforms to the Continuing Extension Act of 2010.
- CAHs within the definition of acute care hospital for the purpose of incentive program eligibility under Medicaid.
“Health care is finally making the technology advances that other sectors of our economy began to undertake years ago,” Dr. Blumenthal said.