‘Meaningful use’ at last
Regs aim to boost quality, safety and efficiency
As 2009 came to a close, healthcare providers found more meaning in the federal government’s healthcare information technology agenda when HHS issued two sets of regulations that explain how they can get federal financial subsidies for their IT projects in the years ahead.
David Blumenthal, the national coordinator for health information technology, said the proposed definitions and new regulations were meant to establish “a pathway toward more uniform standards over time,” while providing flexibility in recognition of evolving technology and market conditions. He also noted that the definition of “meaningful use” combines electronic health-record applications that are the most useful to have and the one that most healthcare professionals are most capable of obtaining.
The first set of regulations lists the meaningful use criteria that healthcare providers must meet to qualify for federal IT subsidies based on how they use their electronic health records. The second set of regulations lays out the standards and certification criteria that those EHRs must meet for their users to collect the money.
Between $14.1 billion and $27.3 billion is at stake, made available under the Health Information Technology for Economic and Clinical Health Act provisions of the American Recovery and Reinvestment Act of 2009.
Previous estimates had put the cost of the subsidies at around $34 billion, but Tony Trenkle, director of the Office of E-Health Standards and Services at the CMS, said the estimate had been lowered to between $14.1 billion and $27.3 billion after “specific refining of requirements and eligibility of organizations.”
The 554-page set of meaningful use regulations are subject to a 60-day public comment period after which HHS would issue final regulations. The 136 pages of EHR certification regulations are interim final regulations that take effect in 30 days with a 60-day public comment period. HHS said final regulations will be published in 2010.
Under the proposed meaningful use regulations, eligible healthcare providers must use their EHRs to: improve the quality, safety and efficiency of healthcare services; reduce healthcare disparities; engage patients and their families; improve the coordination of care; improve population and public health; and ensure the privacy and security of personal medical information.
Under the interim final EHR regulations, EHRs must be able to securely exchange information among providers and between providers and patients using standardized data elements and technologies. The regulations outline standardized formats for such things as clinical summaries; medical descriptions of clinical conditions and test results; and how that information is exchanged over the Internet.
Jonathan Blum, director of the Center for Medicare Management at the CMS, noted that the definitions “seek to harmonize” differences in regulations that exist between Medicare, Medicare Advantage and Medicaid programs.
By aligning these programs “to the fullest extent possible,” Cindy Mann, director of the Center for Medicaid and State Operations at the CMS, said it was sending a message about the government’s commitment to care coordination.
According to the healthcare information technology section of the HHS Web site, the focus on meaningful use “is a recognition that better healthcare does not come solely from the adoption of technology itself but through the exchange and use of health information to best inform clinical decisions at the point of care.”
The subsidies—or, as HHS calls them, “incentive payments”—are scheduled to begin in 2011 and gradually decrease before financial penalties start to kick in later. While the subsidies were applauded by many physician organizations, the proposed penalties became something of a rallying point for critics of the administration.
“Eligible professionals” can receive between $15,000 and $18,000 in their first year of participation in the federal program, $12,000 in the second, and $8,000 in the third.
Under the high-end $27.3 billion estimate for the program, a total of $11.2 billion would be distributed to Medicare-eligible hospitals, $5.4 billion to Medicare-eligible professionals, $4.1 billion to Medicaid-eligible hospitals, and $6.6 billion to Medicaid-eligible professionals.
The significant volume of regulations released before a long holiday weekend sent providers and provider organizations searching for something meaningful to say about them pending a more detailed analysis in the weeks ahead.
In a statement attributed to board member Steven Stack, the American Medical Association said it is committed to EHR adoption and that it will comment on the proposals after careful study. “We have provided ongoing input this year on standards for the use of EHRs, and have stressed the importance of realistic timeframes for adoption, the removal of extraneous requirements that would delay successful adoption and reasonable reporting requirements,” the statement said. “We want physicians in all practice sizes and specialties to be able to take advantage of the stimulus incentives and adopt new technologies that can improve patient care and physician workflow.”
Interestingly, a study released a day before the regulations came out said commercial EHRs are falling short on some aspects of improving care coordination between patients and clinicians. The Center for Studying Health System Change conducted the study, which was published online in the Journal of General Internal Medicine.
The study, “Are electronic medical records helpful for care coordination? Experiences of physician practices,” was based on a total of 60 interviews—52 physicians and other staff at 26 small and medium-size physician practices with commercial ambulatory EHRs in place for at least two years; chief medical officers at four EHR vendors; and four national thought leaders active in health information technology implementation.
The research, supported by the Commonwealth Fund, found that commercial ambulatory-care EHRs do facilitate care coordination within a practice by making information available at the point of care. However, they are less helpful for exchanging information across physician practices and care settings.
— with Jennifer Lubell