The Centers for Medicare and Medicaid (CMS) and the Department of Health and Human Services have released for public comment proposed rules that help, among other things, to define “meaningful use” in the context of electronic health records systems. As astute readers will note, the federal government intends to start making incentive payments to qualifying providers in 2011 who can demonstrate meaningful use of a certified health record system. 2009 was spent trying to figure out just what that phrase means, and the proposed rules (available here) provide the first formal attempt at definition by CMS.
There are three stages of meaningful use, which must be demonstrated at various points during the incentive payout schedule, depending on when the provider adopts an EHR. If, for example, a provider adopted an EHR in 2011, the provider would be required to demonstrate Stage 1 compliance in 2011 and 2012, Stage 2 compliance in 2013 and 2014, and Stage 3 compliance in 2015 in order to receive the incentive payments from the Medicare program. (There is a helpful chart on page 46 of the draft regulations). If a provider were instead to adopt in 2015, they would have to demonstrate Stage 3 compliance. For those of you thinking about waiting a few years before adopting an EHR (apparently we “adopt” rather than “birth” these systems, though from the squeals of some users, I would think the pangs of birthing are a more appropriate metaphor), be forewarned: late adoption means the expectations are higher with regards to demonstrating meaningful use if you want to get an incentive payment.
Stage 1 requirements are described in the proposed § 495.6(c), and include the following items:
(c)(1) drug interaction checking
(c)(2) problem list
(c)(3) active medication list
(c)(4) active allergy list
(c)(5) basic patient demographics
(c)(6) record basic height, weight, blood pressure, BMI, and peds growth charts
(c)(7) smoking status
(c)(8) store lab results in structured data format
(c)(9) be able to produce a list of patients by disease condition
(c)(10) implement 5 clinical decision support rules based on provider specialty or priority
(c)(11) use electronic insurance eligibility
(c)(12) submit claims electronically
(c)(13) perform a medication “reconciliation”
(c)(14) provide a summary of care record for each referral, or “transition of care”
(c)(15) capacity to submit data to immunization registries
(c)(16) capacity to submit electronic surveillance data to public health agencies
(c)(17) comply with HIPAA security regs via risk assessment and mitigations
And if that wasn’t enough, section (d) gives some more rules to comply with:
(d)(1) use “computerized provider order entry”
(d)(2) send prescriptions electronically
(d)(3) report ambulatory quality measures to CMS
(d)(4) send patient reminders for preventive care
(d)(5) provide patients with electronic health record data on request
(d)(6) provide patients with timely electronic access to their health data
(d)(7) provide each patient a clinical summary at each visit
(d)(8) exchange data with HIE’s
There is a helpful chart of these requirements that starts on page 103 of the proposed regulations, and points out where the criteria vary depending on whether a hospital or individual provider is attempting to demonstrate compliance. The regulations also propose measures to demonstrate compliance with each requirement in Stage 1, which is included in the respective requirement’s section.
Now, you probably are wondering what the Stage 2 and Stage 3 criteria are. From my reading of the regulations, these have not yet been promulgated. CMS is, however, working on it. They even give you a teaser on page 109 of some potential Stage 2 requirements.
Many of these requirements are hardly a shocker (recording a patient’s name and their height, weight, and what medications they are on, for example). These core requirements are essential to any system purporting to manage health. There are, however, a number of very interesting requirements which may be much harder for systems to obtain. For example, requiring that 80% of patient insurance information be verified electronically may be quite a stretch (and in many cases, this is not handled by a health record system but instead by a practice management system).
Also, providing patients with electronic access to their health data within 96 hours of its receipt may also require a wave of web site, firewall, and secure socket layer certificate purchases by providers, many of whom do not support this kind of access today to their health record systems. And while it would be wise to perform a medication “reconciliation” at each visit, it is not clear how this would be accomplished from the regulations as written.
Stay tuned for additional postings on this very important topic! And be sure to send in comments to CMS on these rules based on your experiences with EHR technology in your practice.