Statement by Justin Barnes, chairman emeritus of the Electronic Health Record Association and vice president of marketing, corporate development and government affairs at Greenway Medical Technologies, on the issuance of the CMS/ONC Meaningful Use Final Rules.
The final Stage One Meaningful Use rulings on electronic health record (EHR) functionality by the Office of the National Coordinator for Health Information Technology (ONC) and on eligible practice and hospital professionals reporting criteria by the Centers for Medicare and Medicaid Services (CMS) speak to the understanding of establishing the balance between optimal yet reachable Stage One clinical goals and current EHR functionality available to achieve them, and promotes a healthy mix of reporting and data exchange flexibility within increasingly recognized industry standards.
While it’s clear that currently certified EHRs can provide and indeed exceed the requirements put forth in the rules, the criteria maintains the spirit of meaningful use through the fundamentals of interoperability and public health agency reporting, electronic prescribing, clinical alerts, patient empowerment and secure data exchange that are the long-term building blocks of an electronic patient record needed to improve patient outcomes and decrease medical errors and rising healthcare costs.
The timeliness of the rules that took into consideration more than 2000 public comments, and the degree of response to Greenway’s specific comments and the multitude of voices in the HIT industry was gratifying, but challenges remain. While the rules held intact that spirit of meaningful use and rightly shifts to threshold reductions, core and optional reporting objectives over time and an overall leveling of objectives into the Stage Two criteria, there is no denying the remaining complexity of managing some 1100 pages of regulations and the burgeoning certification program still in need of certifying bodies and final test scripts. Also to be determined is the timeframes between future Stage Two and beyond meaningful use additions, and the effects that will have on functionality upgrades as ICD coding, PQRI programs, for example, and the effects of health reform are taken into consideration.
These tradeoffs are many as the public and private sectors work to provide healthcare practitioners with the means to improve patient outcomes. For example, while the final rules reinforced existing industry standards and guidelines for EHR functionality implementation, the final rules also maintained instances of an 80 percent patient threshold for medication lists.
But overall there is much to reflect upon of where the industry is today compared to just a little more than six months ago. Since the initial meaningful use proposals were issued in late December of 2009, following the close of the public comment phase, Congressional action in April responded by widening the definition of eligible professionals to include those who are hospital-based. On June 24, the momentum continued with the final ruling on the establishment of an EHR certification process establishing the guidance for future Authorized Certification and Testing Bodies (ACTBs) that industry institutions such as the Certification Commission for Healthcare Information Technology (CCHIT) are expected to become. Then on July 8, HHS and the Office of Civil Rights furthered the standards of patient health record privacy and security by further recognizing the need for patients to have confidence in digital medicine and advanced, automated healthcare.
Specifically, the rulings speak to the necessary combination of flexibility and standardized data exchange and operations.
The rulings also maintain and expand the ability to report for continuous 90-day periods to qualify for maximum stimulus payments within the first meaningful use calendar year, which could lessen the time crunch causing some concern within healthcare organizations.
In detail, the rulings maintained the 90-day allowance for eligible professionals seeking EHR incentives through the Medicare pathway. The rulings expanded that allowance to the Medicaid incentives pathway as well. In addition, the Medicaid pathway allows for maximum first-year incentives for the adoption and implementation of an EHR, then followed by the 90-day reporting allowance within the first full calendar year of reporting.
This provision alone will greatly benefit the process, and in the rulings yesterday the establishment of an EHR implementation surveillance program is promised which will merge certification best practices, and, I predict, show that quality and certifiable EHRs are currently equipped to provide Stage One and beyond meaningful use capture.
From there come many examples of the flexibility and foresight the rulings balance:
Electronic prescribing allows the use of HL7 or NCPDP SCRIPT for the submission of Part D drug prescribing. And for electronic prescribing overall, the rulings only require ambulatory eligible professionals to e-prescribe more than 40 percent of prescriptions, meaning hospital-based professionals are not bound by a threshold percentage.
Problem lists allow ICD-9 or SNOMED-CT diagnoses.
CPOE speaks to entry by “healthcare professionals, office staff or those who interact directly” with healthcare operations, and specifically at least 30 percent of patients with at least one medication order must have it ordered through CPOE.
Patient summaries allows data standards through HL7, CCD and CCR exchange.
Overall, reporting thresholds have been reduced or in some cases eliminated, providing emphasis on the certified ability of EHRs and providers to enable – and report – important clinical criteria to create a digital health record such as problem lists, patient vitals and demographics and active diagnoses.
The final ruling also allows EHR providers and healthcare organizations to adopt custom or flexible means for drug alerts, meaning there is no blanket requirement for the flagging of alerts, just the requirement to so do. This allows existing EHR processes to seamlessly adapt to this aspect of meaningful use certification.
In other areas, the final rulings for example maintain thresholds of above 50 percent for the maintaining of medication allergy databases and the above-mentioned basic patient demographics and vitals, goals that are important for quality patient healthcare and reachable with current technologies.
In its fundamental form, the rules detail 15 core reporting objectives to achieve meaningful use, and provide an additional menu of 10 objectives, of which professionals can select five to implement as their individual pathway to meaningful use if done so within 2011 and 2012.
In the past six months I have had the privilege of addressing literally thousands of physicians and stakeholders through more than 100 meaningful use webinars, keynotes and appearances nationally, and I can personally attest to the interest and anticipation by healthcare practitioners.
Since its founding in 2004, the Electronic Health Record Association was worked to find collaboration and consensus on national EHR standards of functionality, data exchange and interoperability that have helped policymakers find the common ground to bridge the clinical needs of group practice and hospital practitioners with the innovations offered by their health information technology partners.
The meaningful use incentive program, like its companion Regional Extension Center, Health Information Exchange and national HIT workforce education initiatives, are combining to bridge the national goals of meaningful use and include key stakeholders throughout the healthcare industry and speaks to the broad, serious and long-term commitment to improved patient outcomes nationwide.
Now it is time for the private sector – both physicians and HIT providers, hospital systems and CIOs and even patients – to show an equal commitment to population health by taking advantage of the opportunity by sharing best practices and interoperability collaborations that policymakers and patients expect and deserve.
With these foundations in place and published yesterday in a timely manner, I and my colleagues will move forward to an open discussion of the legislative and regulatory corrections of the Stage One rulings still to be finalized in the coming days, well in time for the establishment of certification and the onset of stimulus payments.