HHS rules on electronic health records have broad impact

The Health and Human Services Department’s proposed regulations for distributing $17 billion in electronic health records incentives may broaden the gap between early and late adopters, ignore lab data, increase fragmentation in health care and impose administrative burdens, according to panelists who have analyzed the regulations.

There is a “risk of an unintended consequence of a widened digital divide between early adopters and those without significant resources,” Dr. Karen Bell, senior vice president for health IT services at the Masspro state quality improvement organization, said during the eHealth Initiative online seminar Jan. 9. The eHealth Initiative is a nonprofit group that promotes health IT adoption.

HHS officials on Dec. 30 published two sets of regulations related to the economic stimulus law incentive payments for eligible users of the health record systems. One of the regulations defines certification of the systems, and the other defines how doctors and hospitals can qualify for the payments by becoming meaningful users of the technology. The regulations take effect in March.

Speakers praised the HHS provisions that require meaningful users to collect and share certain types of clinical data in their practices or hospitals — such as what percentage of their patients are smokers. The regulations include 25 measures, of which 17 may be attested to and eight require data submission and exchange. Payments are offered in stages.

Dr. Neil Calman, president of the Institute for Family Medicine, said HHS struck a balance between promoting health data exchange and recognizing that few such exchanges are currently in existence.

The regulations will bring positive change because they are aligned with recommended priorities for improving health outcomes, Bell said.

However, she added that 27 percent of physicians are likely to not be eligible for the incentive payments, there is too much paperwork, not enough guidance and “overemphasis on premature reporting” of data.

Furthermore, the structure of the payments to individual physicians reinforces “fragmentation” and “undermines the value of interoperable health IT as a support for teams of providers coordinating patient-centered care,” Bell said.

Micky Tripathi, president of the Massachusetts eHealth Collaborative, said the new regulations do not address lab resources except for public health data.

Labs are “the Achilles' heel of meaningful use,” Tripathi said. The HHS proposed rule “does not solve main barriers to adoption and undermines quality measurement capabilities.”

Glen Tullman, chief executive of Allscripts, a health IT vendor, noted the strong points of the HHS proposals, including that the certification criteria are clear and based on existing standards whenever possible. Taken together, the reporting requirements “push the industry in the right direction,” even though they are vague in many places, he said.