If initial reactions are anything to go by, the Centers for Medicare and Medicaid Services hit a home run with its final rule for meaningful use of electronic health records, simultaneously lowering the requirements bar and increasing the likelihood of more healthcare providers participating in the CMS' incentive program and adopting EHRs.
Organizations and health IT experts were broadly positive, and relieved, about the decrease in the number of requirements and their achievement levels, as well as allowing for the choice to delay some measures.
CMS released the final rule July 13 after a period of public comment. The agency received more than 2,000 comments, many of them balking at the original all-or-nothing approach to qualify for incentive payments under the HITECH Act.
Dr. Steven Waldren, director of the Center for Health IT at the American Academy of Family Physicians (AFFP), said small and medium physician practices especially faced significant barriers with the first approach to qualifying for incentives.
Breaking down the criteria into core measures and optional menu, and lowering the performance threshold "will definitely improve physicians' ability to achieve meaningful use and get everyone to the point where they can get on to that escalator" to full EHR adoption, he said.
Many physicians who have considered acquiring an EHR, done the research and "kicked the tires around" have had trouble turning that intellectual decision into a financial one, Waldren said.
"Anything that makes the measures a little more flexible and gives them a little more leeway in the first stage, the less of a risk to them and the more likelihood that they will go ahead and make the investment and move forward," he said.
The final rule takes into account the small physician practice, where the bulk of medicine is practiced in this country, instead of the early adopter, said Dr. Harry Greenspun, chief medical officer for Dell Services.
"Because this will enhance the rate of adoption, we'll see a tipping point or critical mass reached where providers, patients and others begin to see that their life is easier and their care is better when you have a modern system," he said.
Health information will be available at the time it is needed, like the data used in banking and travel.
By the next stage of meaningful use in 2013, "people will see, geographically speaking, that it's much easier to interact with your physician," Greenspun said. "It's more convenient and, at a basic level, information that ought to be there is there."
As physicians go through the learning curve of how to incorporate EHRs into their workflow and get better at it, they'll begin to leverage those capabilities and see care improve, he said.
Consumer groups also weighed in on the final rule. The administration made reasonable concessions and stood firm against the pressure of some to gut the regulation, said Christine Bechtel, vice president of the National Partnership for Women and Families, a consumer advocacy group. Bechtel is also a member of the federal advisory Health IT Policy Committee.
"An end is finally in sight for the days when doctors have to sift through incomplete and incomprehensible handwritten medical records, when patients must tote test results from doctor to doctor, and when family caregivers spend endless time trying to coordinate medications and treatments for those who can't do so for themselves," she said in a statement.
The American Hospital Association (AHA), a major industry group, said it was "pleased" that CMS offered flexibility in its criteria but still protested the fact that individual hospitals within healthcare networks are not eligible for incentives. AHA was also concerned that the rule's provisions may still be difficult for rural hospitals to comply with.
In tandem with CMS' final rule, the Office of the National Coordinator for Health IT (ONC) released its final rule on the standards and certification criteria for EHRs. ONC added detailed and specific implementation guidance for standard formats for patient care summaries, public health laboratory reporting, syndromic surveillance and immunizations, said Dr. John Halamka, chief information officer of Beth Israel Deaconess Medical Center.
"It's a tricky balance to ensure there is enough specificity to test and certify EHRs and modules for interoperability, while at the same time encouraging innovation," Halamka, who is also the co-chairman of the federal advisory Health IT Standards Committee, said on his blog. "The final rule achieves that balance perfectly."
