HHS issues final rule on meaningful use for e-health records

The Health and Human Services Department issued its final regulation Tuesday on what doctors and hospitals should do to get a share of funding to help in the adoption of electronic medical records, saying it made numerous changes to address concerns that the proposed rule was too rigid.

The Health Information Technology for Economic and Clinical Health Act, which was adopted as part of the 2009 economic stimulus package, included incentive payments through Medicare and Medicaid for doctors and hospitals to encourage the use of electronic health records, which supporters say will improve health care delivery, reduce costs and provide patients with more information about their care.

Up to $27 billion will be available during 10 years for the incentive payments, allowing health professionals to obtain as much as $44,000 under Medicare and $64,700 under Medicaid, while hospitals could receive millions of dollars to help with the implementation and use of certified electronic health professionals.

"In the original proposal, we identified a broad set of objectives, all of which would need to be met. This included 23 objectives for hospitals and 25 for clinicians," National Health Information Technology Coordinator David Blumenthal and Marilyn Tavenner, principal deputy administrator of the Centers for Medicare and Medicaid Services, wrote in summarizing the new rule on Tuesday in the New England Journal of Medicine. HHS "received many comments that this approach was too demanding and inflexible, an all-or-nothing test that too few providers would be likely to pass."

The final rule defining meaningful use of electronic health records will give physicians more flexibility in meeting the objectives, the department said. HHS has divided its objectives into two groups including a core set of objectives doctors and hospitals will have to meet. Doctors and hospitals will then be able to choose which five out of an additional 10 objectives they will comply with over the next two years, while deferring compliance with the remaining items, Blumenthal said during a news conference announcing the rule.

Blumenthal and Tavenner said the core objectives "comprise basic functions that enable [electronic health records] to support improved health care. 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."

Blumenthal said HHS also "loosened some of the achievement levels" in the proposed rule. For example, one of the core objectives called on providers to prescribe prescriptions electronically. The proposed rule would have required up to 75 percent of a providers' prescriptions to be done electronically, while the final rule has lowered that to 40 percent.

HHS also announced a second rule outlining the standards and criteria for the certification of electronic health records technology.

"The final rule is very similar to the interim final rule. However, in response to public comments, the final rule clarifies or revises certain standards and certification criteria," the department said. "As noted in the final rule, some of the adopted certification criteria were revised to realign with changes to the Medicare and Medicaid [electronic health record] incentive programs final rule."

Patti Dodgen, chief executive officer of the health IT consulting firm Hielix, said the final meaningful use rule addressed many of the concerns expressed about the interim rule. "They did a great job in coming up with a solution that looked pretty intractable," she said. "It's aggressive but achievable."