HHS Sustains Paper Cuts

The federal government this week acknowledged critics who accused it of being overzealous in pushing to replace paper medical files with electronic medical records.

On Tuesday the Health and Human Services Department announced that it would be easier for doctors and hospitals to qualify for incentive funds--as much as $27 billion over 10 years--set aside by Congress to entice health providers to go electronic.

Rather than requiring doctors to comply with 25 standards (23 for hospitals) of meaningful use to receive incentive funds in 2011 and 2012, HHS will use a two-track system to govern eligibility in the first two years of the program. Meaningful users must meet 15 core objectives and five of 10 additional objectives.

The final rules modify proposed requirements that have generated 2,000 comments since January, including many submitted by aggrieved parties that found the original rules "too demanding and inflexible, an all-or-nothing test that too few providers would be likely to pass," wrote David Blumenthal, the national coordinator for health information technology at HHS, and Marilyn Tavenner, the principal deputy administrator of the Centers for Medicare and Medicaid Services, in a piece published Tuesday by the New England Journal of Medicine.

Core objectives include "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," according to the NEJM piece.

Other core objectives include using decision-support software to avoid preventable errors, physician order entry, electronic prescriptions, and providing patients with electronic versions of their health information.

A la carte objectives call for incorporating laboratory results into EHRs, alerting patients of preventive or follow-up care and electronically recording advance directives, among other desired outcomes.

Doctors may receive up to $44,000 through Medicare or $63,750 through Medicaid. Hospitals that demonstrate meaningful use of electronic medical records will be eligible for millions of dollars each through Medicare and Medicaid.

The final rule includes formulas for calculating incentive payments as well as penalties (in the form of reduced Medicare and Medicaid benefits) that will apply to providers who do not demonstrate meaningful use by 2015. According to the HHS news release, additional requirements will "raise the bar for performance on IT and quality objectives" after 2012.