Agencies Issue Final Rules that Define, Support 'Meaningful Use' of EHRs

A July 13 press conference hosted by HHS Secretary Kathleen Sebelius set the stage for the release of two final rules that define and support the "meaningful use" of electronic health records, or EHRs.

One rule, issued by the Office of the National Coordinator for Health Information Technology, identifies the standards and certification criteria for the certification of EHR technology so that hospitals and physicians will know that the EHRs in which they invest can perform the required functions.

A companion rule, issued by CMS, defines the minimum EHR meaningful use objectives that physicians and other professionals must meet to qualify for bonus programs enacted under the American Recovery and Reinvestment Act of 2009.

According to a July 13 HHS news release, CMS estimates that it may pay out $27 million in incentive payments during the next 10 years. Physicians and other health care professionals can choose to participate in the Medicare bonus program -- potentially earning as much as $44,000 in additional income -- or they can choose to earn Medicaid incentives of as much as $63,750.

In the news release, David Blumenthal, M.D., national coordinator for health information technology, or health IT, called the regulations "a turning point for electronic health records in America and for improved quality and effectiveness in health care."

He said the federal government received extensive input from the health care community, and he added, "We have drawn on their experience and wisdom to produce objectives that are both ambitious and achievable."

CMS received more than 2,000 comments -- including comments from the AAFP -- on the proposed meaningful use rule that was issued on Jan. 13.

According to Steven Waldren, M.D., director of the AAFP's Center for Health IT, CMS thoughtfully reviewed the comments it received and made significant changes to the regulations.

"CMS has addressed the Academy's biggest concerns, and many of the changes they have made will benefit family physicians," said Waldren.

For example, in its Feb. 26 comment letter to CMS (7-page PDF; About PDFs), the AAFP suggested that CMS abandon its "all-or-nothing" approach to achieving meaningful use of EHRs and, instead, increase physician participation by offering partial incentives.

Waldren pointed out that the final rule grants physicians greater flexibility in meeting and reporting certain objectives for demonstrating meaningful use. The final regulation states that physicians initially must meet 15 core measures but then can choose from a subset of additional objectives to work on in 2011-12.

"CMS also significantly reduced the threshold for some of the measures that the AAFP deemed particularly onerous for physicians," said Waldren. For example, the threshold for an electronic prescribing measure that originally called for 75 percent of all permissible prescriptions to be transmitted electronically has been reduced to 40 percent.

Another priority issue for the Academy was CMS' measure on computerized provider order entry that called for transmitting at least 80 percent of all orders electronically. That percentage now applies to medication orders only, and the threshold for electronic transmission of other types of orders has been reduced, said Waldren.

"During the next few days, the Center for Health IT staff will carefully analyze the meaningful use rule and the certification rule to make sure that we understand what members have to do to qualify," said Waldren.

"We'll look for those areas that we know are still going to present a challenge for family physicians -- especially our solo and small-practice physicians -- so that the Academy can develop appropriate resources to help," he added.