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The Healthcare Information Management and Systems Society has released two definitions for "meaningful use" of certified electronic health records technology under the American Recovery and Reinvestment Act.

The definitions cover meaningful use in hospitals and physician practices. Chicago-based HIMSS has sent its definitions to the Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health Information Technology for consideration as the government develops the formal definitions.

In both definitions, HIMSS recommends adopting the Certification Commission for Healthcare Information Technology as the certifying body for electronic health records. For both hospitals and physicians, the organization recommends three phases of definitions, for a minimum of two years each, starting in fiscal year 2011.

For example, HIMSS recommends that hospital use of computerized physician order entry system not be an initial requirement in the first phase of definitions. But the second phase should require at least 51% of medical orders be electronically entered by physicians via CPOE, rising to 85% in the third phase. "Exceptions will always exist," according to the recommendations. "Setting a requirement of 100% is both unrealistic and unachievable."

For physicians, HIMSS recommends in the first phase an EHR infrastructure that includes clinical data display and CPOE with "independent licensed practitioners" entering the order. "The vast majority of orders emanating from an ambulatory practice are medications, laboratory testing or consultative requests," according to the recommendations. "For electronic prescribing, CPOE must be operational within the EHR."

In the second phase, the physician's CPOE must be supported by clinical decision support, according to HIMSS' recommendations. The third phase would require for the first time electronic exchange of patient summary information via the Continuity of Care Document standard. "This means that not only must the information be transmitted via the CCD; it also means that receiving entities must be able to use the CCD as a source of information to input and/or update information in their version of the record."

For full text of HIMSS' recommendations and the letter to federal agencies, click here.

--Joseph Goedert