Hospitals and medical professionals planning to take advantage of electronic health record (EHR) incentives created under the American Recovery and Reinvestment Act of 2009 (last year’s federal stimulus package) now have a clearer idea of what they will have to accomplish to qualify for the incentives with recent rules issued by the feds. The Recovery Act authorizes the Centers for Medicare & Medicaid Services (CMS) to provide reimbursement incentives for hospitals and eligible professionals who become “meaningful users” of certified EHR technology. On January 13, 2010, the federal government published standards for the EHR incentive program. CMS’ proposed rules include a draft definition of the core concept of “meaningful use,” offering a detailed framework for determining how challenging a task demonstrating meaningful use of EHR technology will likely be.

The proposed meaningful use criteria are based upon a series of specific objectives, each of which is linked to a proposed measure that all hospitals and eligible providers must meet in order to demonstrate that they are meaningful users. These objectives and measures include use of EHR technology in a way that improves quality, safety and efficiency of health care delivery; reduces health care disparities; engages patients and families; improves care coordination; improves population and public health; and ensures adequate privacy and security protections for personal health information. The first payment year for which hospitals and eligible medical professionals can qualify for EHR incentives is 2011.

The current plan is to implement the meaningful use criteria in stages. The initial stage of criteria will focus on collecting health information electronically in coded formats, using EHR data to track key clinical conditions and coordinate care, implementing clinical decision support tools, and reporting clinical quality measures and public health data. For Stage 1, which begins in the 2011 payment year, CMS proposes approximately two dozen objectives/measures that hospitals and eligible professionals must meet to qualify to receive EHR incentives. The proposed criteria call for hospitals to submit at least 10% of orders electronically, and for eligible physicians to submit at least 80% of their orders electronically. In 2011, hospitals would report results for all objectives/measures, including clinical quality measures to CMS, or for Medicaid hospitals to the States, through attestation.

The second stage of meaningful use criteria would be proposed by the end of 2011. Stage 2 criteria will focus on structured information exchange and continuous quality improvement. Finally Stage 3, which will focus on decision support for “national high-priority conditions” and population health, would come out in 2013. CMS is urging interested stakeholders to comment on its first comprehensive attempt at framing the EHR incentive program, to help inform its development of the final meaningful use criteria.

In addition to CMS’ proposed rules addressing meaningful use and other aspects of the EHR incentive program, the Office of the National Coordinator for Health Information Technology (ONC) released a closely linked interim final rule that outlines the standards, implementation specifications and certification criteria that must be met by certified EHR technology to exchange health care information among providers and between providers and patients. The objective is to define a common language to ensure accurate and secure exchange of health information across different EHR systems. The details spelled out in the EHR certification rule include standard formats for clinical summaries and prescriptions; standard terms to describe clinical problems, procedures, lab tests, medications and allergies; and standards for the secure transmission of this information over the Internet. This interim final rule will go into effect 30 days after publication, with an opportunity for public comment and refinement during the 60-day period after publication.

Both the CMS and ONC rules, which were published in the Federal Register on January 13, 2010, are open for public comment through March 15, 2010.

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