By Claire Cowart Haltom
July 26, 2010 | For months, health and IT industries have been chomping at the bit to get their portion of $27 billion in federal incentive payments for the implementation of electronic health records (EHRs). However, until last week, these industries have been stuck in a holding pattern awaiting the regulations that would define exactly which uses for EHRs would qualify for federal stimulus money (see, “Harnessing (and Securing) Meaningful Data”, May 2010). On July 13, the U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced final rules for the "meaningful use" of EHRs.
Back in February of 2009, Congress passed the Health Information Technology for Economic and Clinical Health (HITECH) Act with the goal of expediting the implementation and “meaningful use” of EHRs. Under HITECH, eligible health care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt certified EHR technology for meaningful use. However, until last week "meaningful use" had gone undefined and EHR implementation was at a standstill.
HHS recognized the struggle between the need for systematic and uniform implementation of EHRs across all providers and the need for health care providers to chart their own courses in implementation of EHRs. Seeking to address this, HHS adopted a two track approach to meaningful use. The first track mandates a list of requirements that all EHR systems must meet. The second track grants providers the flexibility to choose the way they want to implement EHRs.
According to CMS, this two track approach makes significant strides towards implementation of the most basic elements of meaningful EHR use, while allowing providers the flexibility to choose their own path towards full EHR implementation.
The two tracks consist of a core group and a menu set. The final rule mandates that providers meet a core group of 15 required objectives and then they may choose 5 additional procedures from a menu of 10 options to implement in 2011-2012.
The core objectives include:
- Entry of basic data (e.g. patient vital signs, demographics, active medications, allergies, current and active diagnoses and smoking status)
- Providing patients with a summary for each office visit or hospital discharge instructions upon request
- Providing patients with an electronic copy of their health information on file with the provider upon request
- Generating and transmitting permissible prescriptions electronically (does not apply to hospitals)
- Providing for computer provider order entry (CPOE) for medication orders
- Implementing drug-drug and drug-allergy interaction checks
- Allowing the electronic exchange of key clinical information among providers and patient-authorized entities
- Implementing one clinical decision support rule and ability to track compliance with the rule (e.g. an electronic alert prompting providers to give aspirin to patients presenting with acute coronary syndrome)
- Activating systems to protect privacy and security of patient data in the EHR
- Reporting clinical quality measures to CMS or states
Once providers have satisfied the core group of mandated procedures, they may choose five options from the menu set of procedures for implementation in 2011-2012. These options include:
- Performing drug-formulary checks
- Incorporating clinical laboratory results into EHRs
- Providing reminders to patients for needed care
- Identifying and providing patient-specific health education resources
- Employing EHRs to support the patient’s transitions between care settings or personnel
- Providing patients with timely electronic access to their health information (including lab results)
- Submitting data to immunization registries
For most of the core and menu items, the rules also specify the benchmark that must be met in order for a user to be considered a “meaningful user.” Providers are likely to find some benchmarks easy, for instance providers must only provider 10% of patients with patient-specific education resources. However, other benchmarks, such as the requirement that 80% of patients have at least one entry recorded for medication allergies (“no allergies” being an accepted entry), may prove more challenging.
Now that “meaningful use” has been defined, EHR vendors should begin tailoring their EHR systems to meet these requirement objectives. Providers are likely to be bombarded in the coming months by offers of meaningful use compliant EHR systems. HHS is establishing a nationwide network of Regional Extension Centers to assist providers in adopting and using in a meaningful way certified EHR technology.
The result of successful EHR implementation, improved quality and safety measures for patients, is essential to our health care system. However each provider's experience down the path to implementation is likely to be a little different.
Technical fact sheets on CMS's final rule are available at http://www.cms.gov/EHRIncentivePrograms/
Claire Cowart Haltom is a health care attorney at Baker Donelson. She can be reached at chaltom@bakerdonelson.com.