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Long-awaited meaningful use rules a concern, health IT community says

The meaningful use and electronic health records requirements recently proposed by the federal government are too restrictive, say doctors, hospitals and IT professionals.

Medical providers got their first look at federal requirements governing meaningful use of electronic health record (EHR) systems and related health information technology, and they are having mixed thoughts about the proposed rules.

The Centers for Medicare & Medicaid Services (CMS) on Dec. 30 released its notice of proposed rulemaking outlining its electronic health record incentive program. Providers and hospitals will be able to receive payments if they implement EHRs and follow meaningful use criteria, which have been defined by the rule. The U.S. Department of Health and Human Services was charged through the American Recovery and Reinvestment Act of 2009 (ARRA) to develop a program through which medical professionals would implement health IT.

The long-awaited, 556-page meaningful use rule document details the functions of electronic records that are deemed “meaningful” by the CMS. These include the use of computerized physician order entry (CPOE) for prescriptions. A separate interim final rule for standards and certification, released the same day by the Office of the National Coordinator for Health Information Technology, details the technical standards, implementation specifications and certification criteria that health IT implementations will have to include so providers meet the meaningful use components in the CMS’ proposed rule.

Doctors, hospitals and IT developers responded to the CMS proposal with a mix of cautious optimism and concern.

The American Hospital Association said the requirements in the rule are restrictive and don't reflect ARRA's goal of ensuring the adoption of health IT. "The intent behind the stimulus funds was to recognize the important efforts hospitals and physicians have undertaken to improve care and to stimulate greater use of health information technology and EHRs," said Rick Pollack, executive vice president, in a written statement. "However, the rules released yesterday create a stringent definition of ‘meaningful use’ that doesn't recognize these important efforts and would unfairly penalize many hospitals."

In addition to using CPOE, hospitals and providers will be required to record patient demographics and vital signs such as blood pressure into structured data locations in EHRs. Among the other meaningful use requirements, medical providers will have to implement specific clinical decision support tools and give patients electronic copies of medical records upon request.

The Medical Group Management Association, which represents physician practices, said it has the same goal as the federal government -- using more IT in medical practice -- but said this rule for the meaningful use of EHR makes achieving that goal particularly hard on small doctor groups. “I’m hopeful this is their first cut,” said Rob Tennant, senior policy advisor for the organization.

Tennant pointed to meaningful use requirements that are restrictive for groups that might not have a lot of money to spend on costly implementations. One use requires doctors to offer patients timely access to electronic health information. To do that, providers will have to adopt Web portals, which are expensive to maintain and which bigger provider organizations have struggled with, he said. “The smallest practices have to have this patient portal, which very few health systems have.”

The MGMA will submit suggestions on changes to the proposed rule that it believes will make implementing health IT more manageable for physicians, Tennant added.

I’m hopeful this is their first cut.

Rob Tennant, senior policy advisor, Medical Group Management Association

Calling the rule a “complex document,” the American Health Information Management Association (AHIMA) said it also was reviewing the requirements and preparing an analysis to be released in March.

“AHIMA is studying the 550-plus pages to determine how and whether it supports our HIM principles for EHRs and HIE and not jump to conclusions one way or another,” the association wrote in its statement. “We also are looking to ascertain how the proposal matches the existing certification criteria and therefore the readiness of the industry to take on the objectives outlined in the NPRM [Notice of Proposed Rulemaking]. Proposals that involve both Medicare and Medicaid reimbursement across the number of years called for in ARRA make this a complex document to review.”

The meaningful use requirements begin in 2011, which will be considered the first “payment year,” according to the federal rule. All the requirements in this proposal are considered to be “stage 1 objectives,” with further rules to be released for later stages of health IT implementation in 2013 and 2015. The CMS is seeking comments on its proposed rule. Participants have until March 13 to submit remarks.

Let us know what you think about the story; email Jean DerGurahian, News Writer.

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