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Briefing: The meaningful use final rule

Now that the meaningful use final rule is out, it’s time to get to work. This briefing traces the evolution of meaningful use and what it will take for providers to get there.

The Centers for Medicare & Medicaid Services (CMS) released its final rule for Stage 1 of the meaningful use of electronic health record (EHR) technology on July 13. As stated in the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was passed as part of the stimulus bill in 2009, health care providers will have to demonstrate meaningful use by 2015 to avoid financial penalties in the form of reduced Medicare reimbursements. Organizations that demonstrate meaningful use before 2015 are eligible for financial incentives, which top out at $44,000 for individual providers and millions of dollars for hospitals, depending on how many patients they see per year.

This guide refers to news, tips and best practices that will introduce health care CIOs to the meaningful use requirements and explain what it will take for hospitals and providers to get there.


Where did meaningful use come from?

Under the HITECH Act, which was signed into law Feb. 17, 2009, health care providers were given financial incentives to show the meaningful use of EHR systems. Providers may comply as soon as 2011 to receive the most money and must comply by 2015 to avoid penalties. Additional stimulus funding was set aside to develop regional extension centers (RECs), which would help solo and small practices select an EHR system, and to form health information exchanges, which would help providers share patient records based on common data standards.

It should be noted that meaningful use is but one of several HITECH Act rules applicable to health care organizations. Others include updates to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), a new EHR certification program and new regulations for electronically prescribing controlled substances.

Learn more in "How does meaningful use affect health care IT?" Also:

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How has meaningful use evolved?

The CMS released a notice of proposed rulemaking (NPRM) for meaningful use on Dec. 30. Here, meaningful use consisted of three stages, which had to be reached by 2011, 2013 and 2015, respectively, for organizations to receive the maximum federal reimbursement. Stage 1 consisted of more than two dozen requirements for hospitals and eligible providers. Stages 2 and 3 were to be defined at a later date, focusing on increasingly advanced implementations of clinical decision support, patient access to health data and quality measurement. (Work has since begun on writing Stage 2 of meaningful use.)

During the 60-day comment period that followed the release of the NPRM, CMS received more than 2,000 comments. Given the low adoption rate of electronic prescribing, computerized physician order entry (CPOE) and even EHR technology itself, many comments suggested that a more flexible approach to meaningful use was needed. This was reflected in the meaningful use final rule, which reduced the number of mandatory criteria, made numerous criteria optional and relaxed the requirements for using technology such as CPOE and e-prescribing. The final rule also made no mention of Stage 3, beyond indicating that it would need additional review.

Amendments to the HITECH Act have also expanded eligibility for reimbursement. Legislation passed in April allowed meaningful use eligibility for hospital-based physicians. In addition, H.R. 5025, a bill proposed in April, would extend meaningful use to behavioral, mental health and substance abuse treatment providers.

Find out more in "Final rule on meaningful use criteria days away. " Also:

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What are the meaningful use criteria?

The final rule divides the meaningful use criteria into a core set and a menu set.

  • The core set of criteria is mandatory and includes (but is not limited to) using a CPOE system, recording vital signs and demographic data, providing patients with electronic copies of health information and discharge instructions, and testing EHR systems for clinical data exchange.
  • With the menu set, on the other hand, hospitals and eligible providers choose from five of 10 criteria. These include, but again are not limited to, performing medication reconciliation, submitting data to immunization registries, generating lists of patients based on specific conditions, and providing summary care records.

Learn more in "Criteria for meaningful use of EHR." Also:

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What does meaningful use mean for software vendors?

Two federal rules apply to EHR vendors.

  • The first, the standards and certification criteria, lists each Stage 1 meaningful use objective and indicates what an EHR system or EHR module must be able to do to successfully meet that objective, therefore ensuring that a user of that system or module has, in turn, met that meaningful use objective.
  • The second, the certification rule, lays out the process by which an EHR vendor gets its software tested and certified. Products passing the proverbial test are thus certified for meaningful use.

Prior to the HITECH Act, only one organization -- CCHIT -- certified EHR software. It is expected that several, if not dozens, of organizations will apply to become testing and certifying bodies. With more groups certifying software, it is further expected that more EHR software systems will be certified, which will increase the offerings available to health care providers. It also means that, as of this writing, no EHR vendor can reasonably claim to have its software certified for meaningful use.

Find out more in "Health IT certification guidelines for EHR vendors." Also:

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How can my organization achieve meaningful use?

Even with the relaxed rules, it won’t be easy.

For many providers, the first step will be to make an investment in an EHR system, either because they do not have one or because they do not like what they have. This can be a daunting task -- there are, by some estimates, more than 300 EHR vendors in the United States alone. The types of EHR applications vary, too, from Web-based Software as a Service systems, to those that are installed and hosted on a health care organization’s own infrastructure, to a mix of the two. One goal of the HITECH Act is to stimulate the development of RECs that will help providers select and implement EHR systems. (It should be noted that RECs will not actually install the systems.) While many RECs will name preferred EHR vendors, this by no means prohibits a provider from choosing a different vendor.

For those providers who do have an EHR system in place and plan to keep it, a prudent approach is a simple audit, in which an organization looks at each of the meaningful use criterion and determines whether or not it has achieved it. Criteria that have been met need not be addressed. Those that remain should be subject to an action plan, whether it’s tapping unused functionality within one’s existing system, investigating add-on modules from the same vendor, researching modules from different vendors or scrapping an inadequate, uncertified EHR system entirely.

In addition, the EHR adoption model from HIMSS Analytics represents a good set of guidelines. The eight stages of this EHR adoption model, though unofficial and not affiliated with federal meaningful use guidelines, can help providers gauge where they stand and what functionality they need to implement to make better use of EHR technology.

Learn more in "Early adopters share EHR meaningful-use best practices." Also:

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