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2/18/2010
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Federal Health IT Group Refines Meaningful Use Rules

Health IT Policy Committee aims to make it easier to meet some requirements for deploying e-health record systems but also adds more rules.

The federal Health IT Policy Committee isn't happy with the proposed definition of what constitutes the meaningful use of e-health records. But that doesn't mean it's getting any easier for healthcare providers to qualify for the stimulus funds that will reimburse them for EHR investments.

That's largely because the committee--which advises the Department of Health And Human Service's national coordinator for health IT, Dr. David Blumenthal--is adding as much as to the Meaningful Use rules as it's taking out. The rules will determine whether a healthcare provider qualifies for stimulus funds.

The committee latest focus is on getting more flexibility in the application of the rules. Dr. Paul Tang, chief medical information officer at Palo Alto Medical Foundation and chair of the committee's Meaningful Use Workgroup, proposed that providers be allowed to defer up to three measures until later years, while still qualifying for cash after meeting Stage 1 requirements. No requirements involving privacy or security would qualify for deferral. And none of the current requirements will be taken off the table, Tang said, meaning providers would still have to work towards achieving every metric.

Committee member Christine Bechtel, VP of the National Partnership for Women and Families, suggested that a better approach might be to require pursuit of all measures, but lower the percentage of compliance required within individual areas. That way no organization could completely leave any measure by the wayside for any period of time, Bechtel said.

Though it's unclear which approach the committee will recommend, there's no doubt modification of some sort is supported.

The Workgroup went on to recommend that several other measures be added into the proposed requirements. Some of those additions were ones that Blumenthal's office originally recommended but they weren't included in the Notice of Proposed Rulemaking on Meaningful Use issued late last year. Among those recommendations are:

  • Reinstate the requirement that doctors include progress note documentation of interactions with patients to be eligible for reimbursement during Stage 1 of Meaningful Use compliance;
  • Remove "core" quality measures that would apply to virtually all eligible providers during Stage 1;
  • Reinstate recommendation to stratify quality reports by variables, such as a patient's race, ethnicity, gender, primary language, and type of insurance;
  • Require providers to maintain up-to-date lists--not just one-time entries--of key patient summary information;
  • Reinstate recommendation to include instructions for care after a patient can no longer communicate as part of Stage 1;
  • Reinstate recommendation to include patient-specific education resources as part of Stage 1;
  • Reinstate recommendation to include clinical efficiency measures in Stage 1, such as percentage of all medications entered into the EHR as a generic formulations for drugs where a generic options exist;
  • The Centers For Medicare And Medicaid Services should clarify its intentions for Stages 2 and 3 of the Meaningful Use requirements so vendors and providers can coordinate their five-year plans with those requirements;
  • Amend criteria for prevention and follow-up reminders to give providers discretion in targeting them. This would let doctors select reminders most relevant to the health issues of the people they work with;
  • Clarify the term "transitions of care"--when a patient moves from one care setting to another--and delete the term "relevant encounters," which the committee says is imprecise;
  • Computerized physician order entry should be done by authorizing provider

    Regarding the last measure, a spirited discussion of just who is an authorized provider in an academic medical center ensued. That's because in many of those organizations, nurses, pharmacists, students, and residents enter orders. When the person making the ordering decision isn't a legally qualified provider, the order is reviewed by someone who is. The question becomes: does the individual reviewing the order need to be exposed to the clinical decision support rules that an EMR provides?

    As happens generally in such meetings, important questions like these were brought to light, debated, recognized as important, and left unresolved.

    Other important points of discussion included:

  • The fact that providers will be required to develop manual processes to report on many of the measures;
  • Most EHRs aren't able to produce the quality metrics that the proposed Meaningful Use rules would require;
  • Health and Human Services still hasn't issued proposed rules for certifying EHR systems as compliant with Meaningful Use requirements and how this is contributing to anxiety among vendors and providers about timelines for qualification. Paul Egerman, co-chair of the Workgroup on Adoption and Certification, recommended vendors look to the recently released Interim Final Rule on initial standards, implementation specifications, and certification criteria for EHR technology to direct them until certification guidance is issued. Regarding the delay--the proposed rules on certification were expected in January--he said byzantine government requirements are to blame. "This is an unbelievably complicated area. IRS, SEC and antitrust issues are nothing compared to the extraordinary complexity of this rulemaking process."


    Anthony Guerra is the founder and editor of healthsystemCIO.com, a site dedicated to serving the strategic information needs of healthcare CIOs. He can be reached at aguerra@healthsystemCIO.com.

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