In its final meaningful rule published today, the Center for Medicare and Medicaid Services has abandoned its original all-or-nothing approach to offering incentives for electronic health record adoption and opted for flexibility.
Healthcare providers will now have various ways of reporting objectives to demonstrate meaningful use of EHRs, and some that are deemed too difficult to achieve by the original 2011 deadline will be delayed a year.
One of the major changes in the final rule now requires providers to meet a "core" group of objectives, such as electronic prescribing, providing patients who request it an electronic copy of their health information and maintaining an active medication list. Physicians must meet 15 of those core requirements, and hospitals must meet 14.
Providers must also choose 10 measures from a "menu set" of procedures they have to meet, but may defer up to five of them to the next stage, said Dr. David Blumenthal, the national health IT coordinator, who worked closely with CMS to set the new scenario for accomplishing meaningful use.
The measures from this "a la carte" set include incorporating clinical lab results in EHRs, creating a summary of care as patient transitions through providers and maintain an up-to-date problems list of diagnoses.
"We want objectives to be ambitious but achievable. The first thing we've done is add flexibility of choice, allowing different providers with different situations to take different pathways to meaningful use," Blumenthal said at a briefing at the Health and Human Services Department.
In its proposed meaningful use rule published in January, CMS required 25 measures of providers and 23 of hospitals to show they were using EHRs to improve healthcare outcomes in order to qualify for incentive payments.
This two-track approach ensures that the most basic elements of meaningful EHR use will be met by all providers qualifying for incentive payments, while allowing latitude in other areas, Blumenthal said.
Meaningful use of EHRs is aimed at improving the health outcomes of patients and the efficiency and quality of U.S. healthcare. The final rule announcement follows a period of public comment after the proposed rule was published in January.
The final rule gives healthcare providers certainty about the steps they must take to qualify for Medicare and Medicaid incentives under the HITECH Act. The incentives could amount to $27 billion over 10 years, HHS said in its announcement.
In addition to flexibility in the objectives that have to be met, the final rule reduces some of the achievement measurement levels that were required in the proposed rule, Blumenthal said.
"We arrived at that by looking at the comments and what was truly attainable," he said.
For example, in the proposed rule physicians had to prescribe 75 percent of their prescriptions electronically, while in the final rule that level is 40 percent. The number of clinical decision support orders also is down to one from five.
Blumenthal said there are other similar changes in threshold levels.
In time, Blumenthal said he believed that physicians and hospitals would "become the leaders of this effort to improve health information systems in the United States.
"Using information is a core clinical competency for professionals in healthcare," he said. "I know that physicians will soon be unwilling to record information into anything other than the most modern and efficient way because that would be consistent with what they view as their core professional responsibilities."
"When that happens, we at the ONC will be able to pass the leadership role, such as it is, from ourselves to the professions of medicines and our major healthcare institutions," he said.
At the same time, the Office of the National Coordinator for Health IT released its final rule for standards and certification of EHRs. ONC also published its interim final rule in January.
With the standards and certification requirements finalized, vendors can be sure that they equip their EHR products with the features and functions necessary for providers to be capable of exchanging information using standard formats and vocabularies to meet meaningful use.
