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For doctors, meaningful use final rule mostly positive

Doctors stand a better chance of achieving meaningful use under the final rule spelled out by CMS and ONC, but some tweaking of EHR systems will still be necessary to comply.

Some of the words being used to describe the meaningful use final rule -- thoughtful, logical and considerate -- are not those typically ascribed to federal documents. But providers are welcoming the approach officials have taken to the meaningful use criteria, even while they continue to express their concerns about the structure of the incentive payments.

The Centers for Medicare & Medicaid Services (CMS), along with the Office of the National Coordinator for Health Information Technology (ONC), worked carefully to create regulations that health care professionals can understand, according to Mike Lee, a physician who is director of clinical informatics for Atrius Health. “I expected to read 800 pages of just miserable, horrible government regulation,” he said. Instead, the rule is “thoughtful, measured, clear.”

However, the way hospitals will receive incentive payments is unfair, others say. Hospitals testifying to the House Ways and Means Subcommittee on Health say the structure that allows multiple facilities operating under one Medicare number to receive only one incentive payment will interfere with the launch of health IT in their clinics and physician practices.

The meaningful use final rule, dubbed the Electronic Health Record Incentive Program, defines what it means to be a meaningful user of health IT and spells out in detail how providers who want to qualify for incentive funds can become meaningful users. Some $27 billion  is up for grabs during the next decade among doctors and hospitals that adopt electronic health record (EHR) systems and other health technologies that pass federal muster.

The rule clocks in at a total of 864 pages, as CMS officials sought to incorporate the more than 2,000 comments they received on proposed meaningful use requirements. Overwhelmingly, industry professionals urged the government agency to scale back the number of measures they would be required to implement through electronic records.

And, ultimately, CMS did so. Instead of requiring providers to implement technology that covers 24 meaningful use criteria, doctors and hospitals instead will be allowed to implement a core set of 15 objectives and choose another five out of a menu of 10.

The federal agency stepped away from its “all or nothing approach” and introduced flexibility that doctors can work with, according to Jason Mitchell, a physician who is assistant director of the Center for Health IT at the American Academy of Family Physicians (AAFP). “Overall, we’ve been pleased.”

One of the most significant changes to the meaningful use final rule is how doctors will have to measure the core objectives, Mitchell said. They will be able to calculate the numerators and denominators for patient populations using the EHR systems; under the proposed rules, those calculations would have been done manually.

I expected to read 800 pages of just miserable, horrible government regulation.

Mike Lee, MD, director of clinical informatics, Atrius Health

In addition, the final rule scales back the use of computer physician order entry (CPOE) for Stage 1. Instead of requiring a full CPOE, doctors can begin with just entering medication orders. That’s a relief for AAFP members and small practitioners who do not have the connectivity yet for a full system, Mitchell said.

Still, doctors will be pushing hard to meet all the meaningful use criteria, either by tweaking current systems or shopping for EHR systems that have the necessary components, he added. “There are certainly a number of components that aren’t there at all,” he said, pointing to structured data elements within EHR systems as an example.

In one area, however, doctors with systems already installed might be ahead of the curve, according to Cliff Shannon, chief communications officer for the Pittsburgh Regional Health Initiative (PRHI). One of the objectives in Stage 1 is to begin using decision-support tools that facilitate better clinical choices, such as ensuring a medication is in the correct dosage. “That’s the place where existing systems are helping,” he said.

PRHI, the nonprofit operating arm of the Jewish Healthcare Foundation, also operates as the designated Regional Extension Center for Pennsylvania and, as such, it is currently researching EHR vendors for prospective physician clients. “Doctors will be motivated to get on board with the meaningful use program quickly to take advantage of incentive dollars, Shannon said. “The opportunity is there for small and medium-sized [organizations].”

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

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