The proposed rule defining meaningful use of electronic health records could actually make it more difficult for providers to adopt EHRs, according to early reaction from the Medical Group Management Association and the American Hospital Association.

The government on Dec. 30 released for a proposed rule defining meaningful use of EHRs and an interim final rule that sets initial standards, implementation specifications and certification criteria for EHR technology. Both rules are available for viewing in a draft format at They will be published in the Federal Register on Jan. 13 with a 60-day comment period effective at that time.

The meaningful use rule includes about two-dozen requirements that eligible providers and hospitals must meet to qualify for incentives. "Overly burdensome requirements and needlessly complex administration will only discourage physician participation in the program and the implementation of EHRs," contended William Jessee, M.D., CEO and president of the Medical Group Management Association in a written response.

The following is a statement from the Rick Pollack, executive vice president of the AHA, expressing a number of serious concerns with the rules:

"America's hospitals have serious concerns that the new health information technology rules severely limit hospitals' ability to access federal financing for health information technology that is used to improve patient care.  Moving toward broader adoption of electronic health records (EHRs) is an important goal and helping hospitals, doctors, nurses and other caregivers is essential in getting us there.  While health information technology holds great promise in improving care, widespread efforts toward adoption will be hindered unless key provisions in these rules are addressed.

"Under the American Recovery and Reinvestment Act of 2009, only hospitals that are considered 'meaningful users' of EHRs can receive much-needed financial assistance.  America's hospitals believe the proposed definition of 'meaningful use' is a worthy goal, but it should be a destination point, not a starting point.  Today, many hospitals are using clinical systems that reduce medication errors, track quality and outcome measures, and collect basic patient health information using computer technology.  The intent behind the stimulus funds was to recognize the important efforts hospitals and physicians have undertaken to improve care and to stimulate greater use of health information technology and EHRs.  However, the rules released yesterday create a stringent definition of 'meaningful use' that doesn't recognize these important efforts and would unfairly penalize many hospitals.  A more commonsense approach would reward the progress hospitals and physicians already have made toward adopting EHRs.

"In addition, the 'meaningful use' rule also fails to recognize how modern hospitals are organized and how care is delivered.  Simply put, the eligibility requirements for hospitals and physicians are too restrictive.  For example, health information technology payment incentives unfairly exclude physicians who practice in outpatient centers and clinics owned by a hospital.  An alternate approach that recognizes all non-hospital physicians and the myriad of physician-hospital relationships would go a long way toward ensuring patient care is better coordinated and adoption of health information technology is rewarded.

"America's hospitals strongly embrace health information technology and want to accelerate its use to improve care.  However, as proposed, the current regulations may actually make it more difficult for hospitals and doctors to adopt health information technology.  Unless significant changes are made and timelines reexamined, it is unlikely that the vast majority of hospitals can meet the proposed standards, making them ineligible for this important funding, and also subject to penalties for not being in compliance.  We urge CMS to make changes to these regulations that would advance the adoption and use of clinical information technology to improve care for patients and communities."

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