HHS dials back requirements, offers flexibility in final meaningful use rule

Meaningful UseIn releasing the final rules for Stage 1 of the "meaningful use" Medicare and Medicaid EHR incentive program on Tuesday, federal officials have pulled back from the more aggressive plan outlined in an earlier proposal.

CMS has broken up the approximately two dozen objectives into two groups, a set of required "core objectives" and a list of "additional important activities" that providers may choose from in meeting the new standards. "The DHHS received many comments that this approach was too demanding and inflexible, an all-or-nothing test that too few providers would be likely to pass," national health IT coordinator Dr. David Blumenthal and Marilyn Tavenner, principal deputy CMS administrator, explain in a New England Journal of Medicine article published Tuesday.

The core set contains 14 measures for hospitals and 15 for physicians and other "eligible professionals," including recording patient demographics, maintaining problem lists, computerized physician order entry for some medication orders and reporting on clinical quality measures to CMS or state Medicaid programs. The second category lists 10 additional elements from which providers must choose five to implement in the first two years of the program, 2011-12.

Some of the objectives themselves also have been relaxed, in response to the more than 2,000 comments HHS received on the proposal. For example, providers will only have to write 40 percent of their prescriptions electronically; the proposed rule called for a 75 percent rate. And they will need to implement just a single rule to meet the requirement for clinical decision support, down from five rules in the earlier plan. "It was purely a matter of what was reasonable to ask of an average provider," Blumenthal said of the new e-prescribing requirement at a press conference Tuesday morning. He said HHS wants the rules to be "aggressive but achievable."

In addition, CMS has reduced the number of quality measures providers must report on. "We deferred some of the administrative transactions" to Stage 2, said Tony Trenkle, director of the CMS Office of e-Health Standards and Services.

HHS Secretary Kathleen Sebelius called meaningful use a key part of overall healthcare reform. "Electronic health records are the foundation of a robust healthcare system," Sebelius said. "Electronic health records make all of these transformations possible."

She mentioned the corresponding ONC final rule on standards and certification of EHRs--also released Tuesday--and the recently published proposal to tighten HIPAA privacy protections an important elements of the overall plan.

HHS officials did not, however, say when to expect more clarity on Stage 2 (2013-14) and Stage 3 (2015-16) of the incentive program.

To learn more:
- see the final rule on meaningful use (.pdf)
- find the final rule and associated fact sheets on standards and certification of EHRs
- read Blumenthal and Tavenner's article in the New England Journal of Medicine
- take a look at this companion NEJM piece from Surgeon General Dr. Regina Benjamin
- read this HHS press release