CMS, ONC release meaningful use final rules
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Those who joined in the announcement were Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, Donald Berwick, MD, new CMS administrator, David Blumenthal, MD, the national coordinator for health IT and Regina Benjamin, MD, MBA, U.S. surgeon general.
The department published proposed meaningful use requirements on Jan. 16. The proposal prompted some 2,000 comments. Today, the HHS released a final regulation for the first two years (2011 and 2012) of this multiyear incentive program.
“Electronic health records are the foundation of a high performing and high quality health system,” said Sebelius. “When the record is properly designed and implemented, it is a powerful force for increasing physician and patient satisfaction. We hope that other provider groups will embrace these standards.” She noted that only 20 percent of hospitals and 10 percent of physicians use basic EHRs.
The centerpiece of the program begins in 2011, when doctors and providers can receive incentives for the use of IT. “In order to receive these incentives, providers will need to embody these standards, as it was never our goal to use technology for technology’s sake,” Sebelius said.
Likewise, Blumenthal wrote in an editorial that was simultaneously released in the New England Journal of Medicine: “HITECH’s goal is not adoption alone but ‘meaningful use’ of EHRs—that is, their use by providers to achieve significant improvements in care. The legislation ties payments specifically to the achievement of advances in healthcare processes and outcomes.”
In the final regulation is divided into two groups: a set of core objectives that constitute a starting point for meaningful use of EHRs and a separate menu of additional important activities from which providers will choose several to implement in the first two years, Blumenthal explained.
Core objectives
Core objectives comprise basic functions that enable EHRs to support improved healthcare, Blumenthal wrote. As a start, these include the tasks essential to creating any medical record, including the entry of basic data: patients’ vital signs and demographics, active medications and allergies, up-to-date problem lists of current and active diagnoses and smoking status.
Other core objectives include using several software applications to begin to realize the true potential of EHRs to improve the safety, quality and efficiency of care. Blumenthal outlined the features--to qualify for incentive payments, clinicians must start employing clinical decision support tools. They must also start using the capability that undergirds much of the value of EHRs: using records to enter clinical orders and, in particular, medication prescriptions. Only when providers enter orders electronically can the computer help improve decisions by applying clinical logic to those choices in light of all the recorded patient data. And to begin extending the benefits of EHRs to patients themselves, the meaningful use requirements will include providing patients with electronic versions of their health information, he added.
In addition to the core elements, the rule creates a second group: a menu of 10 additional tasks, from which providers can choose any five to implement in 2011–2012. “This gives providers latitude to pick their own path toward full EHR implementation and meaningful use,” wrote Blumenthal.
CMS summarized other changes in the final rule including:
- An objective of providing condition-specific patient education resources for both eligible professionals and eligible hospitals and the objective of recording advance directives for eligible hospitals, in line with recommendations from the Health Information Technology Policy Committee;
- A definition of a hospital-based eligible professional as one who performs substantially all of his or her services in an inpatient hospital setting or emergency room only, which conforms to the Continuing Extension Act of 2010; and
- Expanding the definition of acute care hospital to include Critical Access Hospital (CAH) for the purpose of incentive program eligibility under Medicaid.
CMS’ and ONC’s final rules follow two other recently issued HHS rules. On June 24, ONC published a final rule establishing a temporary certification program for health IT. And on July 8, the Office for Civil Rights announced a proposed rule that would strengthen and expand privacy, security, and enforcement protections under the Health Insurance Portability and Accountability Act of 1996.
As part of this process, HHS said it also is establishing a network of Regional Extension Centers to assist providers in adopting and using certified EHR technology in a meaningful way.