‘Mean­ing­ful use’ at last

Regs aim to boost qual­ity, safety and ef­fi­ciency

Modern Healthcare - - Late News - An­dis Robeznieks

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

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