Officials defend meaningful use standards as a work in progress

Standards that define what constitutes an official electronic health record aren't strict enough to justify the billions of dollars in incentives the government plans to pay physicians and hospitals to install the systems, Republican lawmakers said on Tuesday.

In a hearing of the House Ways and Means Health Subcommittee, officials from the Health and Human Services Department defended the recently released standards, which are known as meaningful use and are requirements and expectations that health providers must meet when applying for funding to pay for the adoption of the e-records. The regulations were designed to accommodate diverse communities looking to move away from paper-based records systems, they said.

The Office of the National Coordinator for Health Information Technology announced in June a temporary certification program for electronic health records programs, and the Centers for Medicare and Medicaid Services issued on July 13 a final rule setting standards for health care providers that want incentive payments for adopting EHR systems. CMS will offer eligible professionals up to $44,000 for five years through Medicare and as much as $63,750 for six years through Medicaid.

Some lawmakers expressed concern that the final rule watered down the meaningful use requirements. The regulations represent a missed opportunity to improve patient care and reduce waste because the standards are lower than expected, said Rep. Wally Herger, R-Calif. He said he expected a better return on the $36 billion investment in incentive payments to providers.

For example, lawmakers said health care providers aren't required to electronically record lab test results, nor are they asked to exchange data. They also questioned whether physicians would create electronic records only for simple cases to meet minimum use standards and ignore e-records for more vulnerable patients.

According to David Blumenthal, national coordinator for health IT, HHS will place higher demands on providers in the future. The recent standards are the first in a series of rules and apply only to incentives payments before 2013. Two additional stages for rolling out electronic records will be released, and will have stricter requirements, he said.

"We set the bar where we felt it was appropriate and also signaled for future stages that we would be setting the bar much higher," said Tony Trenkle, director of the Office of E-Health Standards and Services at CMS. "We're going along with ways we can modify to reflect real-life experiences we hit once the program begins."

Witnesses agreed the expected outcome of electronic records adoption is to improve the quality and efficiency of care, but were unable to estimate how much it would cost Medicare and Medicaid. The technology is only one way to reduce waste and must be combined with other activities, they said.

Blumenthal said the incentive payments mandated in the Recovery Act are important to build technical and policy infrastructure and to help providers cover the cost of the systems. But he added they are just one way to encourage electronic records use.

"Much more important than incentives will be a professional sense of obligation," Blumenthal said.

"The whole purpose of the [Health Information Technology for Economic and Clinical Health] Act is to push providers to do more with health IT and do it faster," said Rep. Pete Stark, D-Calif. "The standards are aggressive but set realistic goals."