The Department of Health and Human Services (HHS) released the final meaningful use rules on Tuesday, July 13th, 2010, at 10:00 AM. These rules outline the features Electronic Health Record (EHR) software must provide in order to become certified. Purchasing software with the required features is not enough; physicians will have to use the features according to defined measures in order to qualify for the stimulus funds.
HHS Secretary Kathleen Sebelius said, “For years, health policy leaders on both sides of the aisle have urged adoption of electronic health records throughout our health care system to improve quality of care and ultimately lower costs. Today, with the leadership of the President and the Congress, we are making that goal a reality.”
Bill Connelly, an attorney with the Healthcare Division of the New York-based law firm of Manatt, Phelps & Phillips LLP, said the changes made by the CMS in quality measures were significant. The CMS dropped the measures from 90 to 44, and physicians only need report electronically on three. For example, if a patient has diabetes, a physician or hospital is required to report that they are in fact taking blood pressure readings on that patient, or if a patient has had a heart attack, they must report that they have prescribed an aspirin regimen. Part of the reason for the dropping so many of the requirements in the first phase of meaningful use rules is that CMS itself has no way to receive reports electronically much of the time, Connelly said.
The new rules were finalized after a three-month public comment period during which more than 2,000 recommendations were received by the U.S. Department of Health and Human Services on its preliminary “notice of proposed rule making” effort. The final document is 864 pages long.
So, if you are a physician and you’ve been holding back, the time to act is now. And if you have any doubts on why this is so important to your practice, your patients and America consider this:
While 46 percent of U.S. primary care doctors report using Electronic Medical Records – up from 28 percent in 2006 – they lag well behind:
- Netherlands (99%)
- New Zealand (97%)
- U.K. (96%)
- Australia (95%)
- Italy (94%)
- Norway (97%)
- Sweden (94%)
US Healthcare is big i.e. $2.5 Trillion. The government has a huge stake.
U.S. Health Insurance Coverage: 2009 data published in 2010
- Uninsured: 46.430 million
- Medicare 46.589 million
- Medicaid 46.867 million
- Medicare/Medicaid -3.382 million
- Other 4.841 million
- Public: 94.914 million
- Group 169.342 million
- Individual 26.777 million
- Private: 196.119 million
Mark Segal, vice president of Government and Industry Affairs for GE Healthcare IT, said CMS basically took what were a set of “all or nothing” rules and accounted for the realities of implementing EMRs in a short time frame. For one, they lowered the percentage of EMRs that had to include patient demographic and vital sign information from 80% to 50%. “It’s more attainable. It gives them more leeway,” he said.
One thing the CMS had no flexibility with in its rules was the 2015 deadline for implementing EMRs. The timetable for meeting the standards was set in stone by the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. In HITECH, healthcare entities must implement EMRs by 2015 or face monetary penalties in the form of Medicare reimbursement funds.
“I think there’s a lot of folks that are all of a sudden realizing that they’re in a real predicament. What I sense from talking to other organizations is that they didn’t take this quite as serious as they should have,” said Bill Fawns, director of IT services for County of Kern Medical Center in Bakersfield, Calif.
“Our approach to meaningful use has been to throw it back to our vendor. So contractually we obligated our vendor to deliver meaningful use however the requirements turn out,” Fawns said.
He said one of the greatest challenges with deploying an EMR has been setting up a wireless infrastructure in a hospital campus that has a mixture of new and old buildings, and pushback from the hospital staff.
“We’re a teaching hospital, so on one end of the spectrum we have residents born with a computer in their hand and so they look at this as an opportunity to move forward; on the other side of the spectrum are the physicians who are in their 60s and the very idea of signing onto a computer is a big question mark to them,” Fawns said.
While he sympathizes with organizations struggling with implementing EMRs, Fawns said he has mixed feelings about organizations that would complain about the 2015 deadline the government has set.
“We’re aggressively going after this. Part of me thinks other organizations could have done that too,” he said. “My guess is there will be enough cries that deadline will be extended. But even it it’s left as it is now, it is enough time if they want to get serious about an EMR.”
Segal said the 2015 deadline is not as dire as it appears. While HHS wanted all entities to achieve stage three meaningful use by 2015, that spurred concerns among healthcare providers who voice their concerns, and were heard.
“In some cases, if you started EMRs later, you needed to move through each stage in one year. That didn’t logically take into account the time needed to progress from one stage to another,” Segal said.
The final rules state that reimbursement payments for Medicare providers may begin no sooner than October for eligible hospitals, and no sooner than January 2011 for eligible health care professionals. The rules allow providers to begin EMR implementation in 2012, 2013 or 2014, and still have two full years to implement stage one standards. Health care providers only need to record 90 days of EMR information to report to CMS to qualify for reimbursement payment, instead of a full year as the preliminary rules required.
