The Department of Health and Human Services has released the final rule establishing Medicare and Medicaid incentive programs for the meaningful use of electronic health records. The rule is available for download now at ofr.gov/inspection.aspx, and will be officially published July 28 in the Federal Register, effective 60 days later. Also released was an accompanying final rule to establish initial data standards, implementation specifications and certification criteria for EHRs.

Meaningful use criteria in the final rule are substantially relaxed from what was previously proposed, but still comprehensive and a challenge to meet. David Blumenthal, M.D., national coordinator for health information technology in recent months has said federal officials heard "loud and clear" that the proposed criteria were too ambitious. The final rule represents that the message was received, as the criteria no longer is the "all or nothing" approach that was proposed. "We very much want well-intentioned providers to become meaningful users of electronic health records," Blumenthal said during a media conference call on July 13.

Blumenthal in an interview said federal officials got the feeling that they pushed "a little too far" with the proposed rule. "We're trying to do what makes sense. We wanted to make it possible for every willing provider to have a good shot at meeting meaningful use."

For instance, the proposed rule's Stage 1 meaningful use criteria had 25 objectives that eligible professionals had to meet, with 23 objectives for hospitals. Now, there are 15 "core" objectives for eligible professionals and 14 for hospitals. Eligible professionals and hospitals each in the final rule have 10 other objectives in a "menu set" from which they select and comply with five objectives. All of the "menu set" objectives likely will become core objectives in Stage 2 meaningful use criteria in 2013.

The threshold for meeting Stage 1 objectives also has been reduced in multiple ways. For example, the proposed rule required use of CPOE for medication, laboratory and diagnostic imaging orders. Stage 1 final criteria requires only CPOE for medication orders, with a lower threshold: More than 30% of unique patients with at least one medication in their medication list seen by the eligible provider or admitted to a hospital's inpatient or emergency department must have at least one medication order entered using CPOE. The final rule states that the 30% CPOE threshold will rise to 60% in Stage 2. This is the only threshold in the rule where a definitive criterion for Stage 2 in 2013 is listed.

The percentage of permissible prescriptions generated and transmitted electronically for eligible professionals falls from 75 percent as proposed to 40 percent in the final rule. Also, the final rule requires one clinical decision support rule to be used, compared with five as proposed.

The final rule defers to Stage 2 a proposed requirement to submit claims and eligibility transactions electronically. HHS in the rule makes clear that with forthcoming HIPAA 5010 and ICD-10 adoption and creation of operating rules to make HIPAA standards more uniform, that more transactions processing criteria are coming in 2013. "In order to meet these and other administrative simplification provisions, most providers will have to upgrade their practice management systems or implement new ones."

The final rule significantly decreased the number of clinical quality measures that must be met to demonstrate meaningful use. The proposed rule listed 90 measures, of which eligible providers had to select and comply with three general measures and three specialty-specific measures. The final rule lists 44 measures with a requirement to comply with six, with no requirement to meet specialty-specific measures. Hospital clinical quality measures have been reduced from 35 to 15, with all being met.

HHS cut the clinical quality measures to reduce the burden on electronic health records vendors to meet the criteria, according to Blumenthal.

--Joseph Goedert

 

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