HHS defines rules for receiving billions for e-health systems

Google CEO Eric Schmidt and others argued the health IT strategy should emphasize management of data. John Raoux/AP

Recently released government standards for electronic health record systems show what medical professionals must buy to receive some of the nearly $20 billion in stimulus funding set aside to encourage the development of technology, and Web-based technologies that Google and Microsoft developed may be eligible purchases in the future, IT specialists say.

The Health and Human Services Department issued preliminary guidelines on Dec. 30, 2009. Medical professionals who make "meaningful use" of certified electronic health records, as defined by the department, will be eligible for up to $44,000 in Medicare bonus payments during the next five years.

One preliminary rule dictates the types of technologies providers must use to be eligible for the incentives, setting initial standards and criteria for certifying the systems. A separate proposed rule defines meaningful use as complying with specific procedures -- including the reliance on certified technologies -- in ways that enhance the coordination of care, engage patients and families, and ensure privacy.

During the past year, the government asked technical specialists, health care providers, patients and the technology industry what components should be included in an electronic health record system.

Microsoft and Google paid close attention to the crafting of the definition of meaningful use and certification standards, because they argued the government's health IT strategy would not work if funding was tied solely to the adoption of electronic health records, rather than the management of data by clinicians. In August, Eric Schmidt, chairman and chief executive officer of Google, said the administration's plan would result in hospitals and physicians using outmoded databases in an increasingly Web-based world. Google has developed Google Health, an online database that patients can use to store and manage their health records.

The government's plan likely "would not allow Google Health in its current incarnation to be considered a qualified EHR technology, that is, one able to be certified," said David Kibbe, a family physician who consults on professional and consumer technologies in the health care industry. In the future, however, Kibbe said he "could see it being part of an acceptable modular approach," provided security, coding protocols and other standard specifications in the regulations were met.

The new regulations embrace the ASTM continuity-of-care-record standard, he added. ASTM International is a standards development organization. The continuity of care record, which Google supports, synthesizes data through the Web from multiple sources such as records of visits to a patient's various doctors and past lab results.

The 2009 American Recovery and Reinvestment Act allocated about $20 billion to help doctors and hospitals pay for installation of e-records systems by 2014. Last week's rules specify how that money will be distributed during the coming years. The Office of the National Coordinator for Health Information Technology at HHS released an interim final rule that outlines the initial standards, implementation specifications and certification criteria for e-records technology.

The regulations are open to comment for 60 days. Under the Recovery Act, HHS had to adopt an initial set of standards for electronic health records by Dec. 31. So, the interim final rule goes into effect this month, before the period for comment and refinement is over. A final rule will be issued later this year.

The criteria for meaningful use of e-health records will expand during the next few years. Later stages concentrate on encouraging patients to help manage their digital information. The first stage requires providers to electronically capture health information in a coded format to track medical conditions, communicate that data with other professionals to coordinate care and report quality of care statistics.

The next stage would require providers to use the information gleaned from the data to make better clinical decisions, help patients access their health data and measure quality of care. Industry, as well as consumer and privacy advocates, had urged that patients be given control of their health information.

The last stage would focus on improving the quality, safety and efficiency of health care, by helping individuals manage their patient data, among other things.

"Stimulus funding should cause more patient data to be collected and stored electronically, and more data can get back into the hands of the patient via services such as Google Health," a Google spokesman said in a statement. "Google Health is a personal health record designed to empower consumers to collect their own health information. While consumers can choose to share their health information with others including their physicians, Google Health is not designed for health providers, and there is no way for providers to spend stimulus money on the product."

Microsoft has developed its own health record database called Health Vault. Company officials said they were reviewing the standards.