The Centers for Medicare and Medicaid Services on Dec. 30 posted a proposed--and long awaited--rule defining "meaningful use" of electronic health records to qualify for the Medicare and Medicaid incentive payments authorized under the American Recovery and Reinvestment Act. Also posted was an interim final rule from the Office of the National Coordinator for Health Information Technology that sets initial standards, implementation specifications and certification criteria for EHR technology.

Both rules are available for viewing in a draft format at, and will be published in the Federal Register on Jan. 13, with a 60-day comment period effective at that time. The interim final rule will become effective 30 days after publication.

Under the proposed rule, CMS will define meaningful use in three stages with more expansive requirements for 2013 and 2015. The first stage covers initial criteria for 2011 and 2012.

The Stage 1 criteria for eligible professionals and hospitals contain many of the requirements in the "matrix" that the HIT Policy Committee recommended last summer, with some modifications. These include use of CPOE, implementing drug interaction and formulary checks, maintaining an updated problem list, recording specific demographic data and vital signs, incorporating lab results in the EHR as structured data, and implementing five clinical decision support rules, among other requirements.
Also among the criteria is a requirement to check insurance eligibility electronically from public and private payers, and to submit claims electronically to public and private payers. If finalized, this would be a major enhancement of the HIPAA administrative simplification provisions.

Requirements recommended by the HIT Policy Committee, but not adopted in Stage 1 include documenting a progress note for each encounter, recording of advanced directives and providing access to patient-specific education resources upon request.

But the selected criteria for Stage 1, covering both eligible professionals and hospitals, are as confusing as the committee's matrix was. In the proposed rule, CMS states criteria, and then often explains nuances to the criteria directly below. But some nuances, such as exactly what "Use CPOE" means, aren't explained until 10 to 20 pages later.

--Joseph Goedert

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