HHS relaxes EHR meaningful use rule to encourage adoption

The Department of Health and Human Services (HHS) set the bar lower and relaxed its meaningful use rule to encourage providers to adopt electronic health record systems, HHS officials announced Tuesday.

The final regulation divides goals into two sets. Providers, who include eligible professionals, hospitals, and critical access hospitals, must meet a core set of 15 objectives. They must also choose five items à la carte from a menu of 10 objectives.

The final rule represents a step back from a more demanding rule proposed in January which called for clinicians to meet 25 objectives and hospitals to meet 23 with no flexibility built in.

"We want providers to become meaningful users," said David Blumenthal, national coordinator for health information technology at HHS. He called the goals ambitious, but achievable. "We want providers to be able to get on this escalator and stay on it."

The changes allow providers to pick their own path toward full EHR implementation and meaningful use, Blumenthal said.

The final rule also lowered the bar on the use of e-prescribing. The proposed rule called for 75 percent of prescriptions to be done via e-prescribing; the new rule calls for around 40 percent.

HHS relaxed the goals in response to the 2,000 comments submitted on the rule proposed in January. Some complained that the proposed rule was too "all-or-nothing" and that it was too inflexible or too demanding. There were concerns about the pace and scope of the rule.

To be considered meaningful users, providers will have to meet certain targets related to EHR use. Some examples of required core measures include:

• Implement one clinical decision support rule
• More than 30 percent of patients with at least one medication in their medication list have at least one medication ordered through CPOE
• More than 50 percent of patients who request an electronic copy of their health information receive a copy within 3 business days

The menu of other measures includes these targets:

• Generate at least one listing of patients with a specific condition
• More than 10 percent of patients are given patient-specific education resources
• Medication reconciliation is performed for more than 50 percent of transitions of care

The goal of the announced rule is "to push the entire healthcare system forward while giving doctors and healthcare systems the flexibility to find their way, HHS Secretary Kathleen Sebelius said during a press conference. The regulation spells out how hospitals and clinicians must use EHRs to be considered meaningful users in 2011 and 2012, thereby qualifying for incentive payments.

The final rule will apply for the first two years, 2011-12. The rule likely will be modified for later phases, Blumenthal noted. For example, ideally, a health information exchange would make it possible for health information to follow patients as they move across systems and states. Right now, the capacity for such an exchange doesn't exist yet. Later versions of meaningful use will demand more related to information exchange capabilities than the first version, Blumenthal said.

Some $27 billion in incentive payments will become available over 10 years, starting in 2011. Clinicians will be eligible for up to $44,000 through Medicare and $63,750 (through Medicaid).

To learn more:
- find the final rule and associated fact sheets here
- read about the just new meaningful use regulation for EHRs in this NEJM article
- read a related FierceHealthcare article
- read related FierceEMR article

Related Stories:
AHA pushes for more flexibility in meaningful use
SPOTLIGHT: Does meaningful use fit with organizational strategy?
HHS hints at possible 'meaningful use' changes

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