Ask the Expert

Final Rule for Meaningful Use Adds Flexibility for 2014, but Implementation Still a Stretch

September 17, 2014 09:07 am David Mitchell
[Steve Waldren, M.D., mug shot]

Steven Waldren, M.D.

Steven Waldren, M.D., director of the AAFP's Alliance for eHealth Innovation, is a nationally recognized expert in health information technology. Waldren came to the AAFP in May 2004 with a wealth of knowledge in design and management of health information systems, computer science, and medical informatics. Before joining the Academy, he was a National Library of Medicine Medical Informatics Postdoctoral Fellow at the University of Missouri, where he earned a Master's degree in Medical Informatics. Waldren, a residency-trained family physician, also participates in many national health care informatics initiatives, including serving as vice chair of the ASTM (formerly known as the American Society for Testing and Materials) International E31 Health Information Standards Committee and commissioner of the Medicaid and Children's Health Insurance Access and Payment Commission.

AAFP News recently sat down with Waldren to ask him about the final rule( CMS and the Office of the National Coordinator for Health Information Technology (ONC) recently released that modifies the timeline for attesting to meaningful use of electronic health records (EHRs), as well as the definition of certified EHR technology (CEHRT) to allow options in using CEHRT for the EHR reporting period in 2014.

Q: Now that the 25-page rule is finalized, family physicians likely will have more questions about what it all means. What do FPs need to know?

A: The new rule gives physicians more flexibility in how they can attest to being a meaningful user in 2014. That flexibility is needed because of the lack of availability of 2014 edition CEHRT. Under the old rules, all physicians attesting to meaningful use in 2014 were required to use a 2014 edition CEHRT regardless of the stage of meaningful use to which they were attesting. CMS and ONC recognized -- thanks to feedback from the AAFP and other stakeholders -- that the EHR market was not ready to meet the requirements of the 2014 certification requirements. If a practice had trouble fully implementing 2014 edition CEHRT in 2014 because of a lack of availability of a 2014 edition CEHRT, there are now new options for doing so.

Q: What do you mean by "lack of availability?"

A: By that, I mean that a vendor was unable to get 2014 edition CEHRT installed/upgraded in a timely fashion. As stated in the final rule, "delay in 2014 Edition CEHRT availability must be attributable to the issues related to software development, certification, implementation, testing, or release of the product by the EHR vendor which affected 2014 CEHRT availability, which then results in the inability for a practice to fully implement 2014 Edition CEHRT." If, on the other hand, a practice waited for financial reasons or other issues within the practice, that would not constitute a "lack of availability." Practices will be required to attest that they had a lack of availability when they attest to meaningful use. It does not appear there will be a documentation requirement at that time, but there are the potential for audits. For this reason, it would be a good idea to create documentation as to what constituted the "lack of availability."

[Meaningful Use Attestation Options for 2014 for Eligible Professionals]

Q: What do you mean by "fully implement?"

A: Even if a practice was able to get 2014 edition CEHRT installed or upgraded, it may still not have been able to fully implement it. If the lack of availability led to not being able to get the necessary training for staff or the system testing needed to ensure safe and reliable use, or to make needed changes to workflow, then it was not able to fully implement 2014 edition CEHRT.

With the exception of the summary-of-care transition measure, the final rule stated that "issues related to the meaningful use objectives and measures do not constitute an inability to fully implement." If colleagues and health organizations to which physicians refer patients are unable to fully implement a 2014 edition CEHRT, those physicians may not be able to meet this measure. Therefore, "[a] referring provider under this circumstance may attest to the 2014 Stage 1 objectives and measures for the EHR reporting period in 2014. However, the referring provider must retain documentation clearly demonstrating that they were unable to meet the 10 percent threshold for the measure to provide an electronic summary-of-care document for a transition or referral for the reasons previously stated."

Q: What are a practice's options if it had a lack of availability to fully implement a 2014 edition CEHRT?

A: Options depend on when a practice first started attesting to meaningful use. The figure above illustrates options based on the first year a practice attested to meaningful use.

Q: What about 2015?

A: The 2015 reporting requirement remains unchanged:

  • If a practice started attesting to meaningful use in 2011-2013, it is required to start a reporting period as of Jan. 1, and it must use a 2014 edition CEHRT to attest to stage two of meaningful use. Stage three will not be required until 2017.
  • If a practice started attesting to meaningful use in 2014, it is required to start a reporting period as of Jan. 1, and it must use a 2014 edition CEHRT to attest to 2014 edition stage one of meaningful use.
  • If a practice starts in 2015, it must use a 2014 edition CEHRT to attest to the 2014 edition of stage one of meaningful use during a 90-consecutive day period.

The AAFP has articulated to CMS and ONC that not changing the 2015 reporting requirements means this is still a large stretch for many physicians.

Q: Any final thoughts?

A: If members have additional questions, I invite them to use the comments field below to voice their queries, and we will work to get them answered.

Related AAFP News Coverage
ONC Final Rule Seeks to Simplify Health IT Certification
Rule Incorporates AAFP's Input