Electronic Medical Records and Final Meaningful Use Regulations

A significant part of health care reform and the stimulus package from last year included funding and incentives for hospitals and doctors’ offices to digitize their medical practices and procedures.

Specifically, the stimulus package included up to $27 billion for those incentives, which will be given out by the Centers for Medicare and Medicaid (CMS) in three waves.

Consequently, the final regulations — all 864 pages of them –on what will constitute “meaningful use” of electronic medical records were issued. According to an analysis by the Wall Street Journal, the changes included make it easier for hospitals and doctors to qualify next year for the first round of incentive payments for adopting electronic medical records (EMRs).

The final requirements issued are what providers will have to meet — demonstrating what the government considers “meaningful use” of e-records — in order to qualify for the first round of incentives in 2011-12.

Accordingly, to help explain the final regulations, David Blumenthal, national coordinator for health IT at HHS, and Marilyn Tavenner, principal deputy administrator of CMS, published a summary in the New England Journal of Medicine (NEJM).

In particular, the final regulations make it so that rather than having to meet 23 or 25 different objectives (for hospitals and doctors respectively), providers will now have to meet just 14 or 15 “core” requirements dealing with EMR basics, such as being able to enter patient data and use a computer-based system to record medical orders.

In addition, hospitals and doctors then can pick an additional five objectives from a menu of ten options. Those include incorporating some lab tests results into records and providing a summary of care record for patients transferring to another facility.

The final requirements also relax some of the required levels of achievement for those objectives — for example, doctors’ offices now have to transmit 40% of prescriptions electronically to meet that requirement, not 75%.

In response to the final regulations, the Wall Street Journal reported a number of reactions from different health care organizations.

The American Hospital Association (AHA) said that “even the looser requirements may make it tough for hospitals to qualify.” As a result, they criticized the individual hospital requirement, and said that “the rule requires hospitals to immediately use Computerized Provider Order Entry (CPOE),” which it calls complicated, costly and time-consuming.

Next, although the Association of American Medical Colleges (AAMC) praised relaxation of some of the requirements, it “remained concerned” that “it may be unrealistic for some teaching hospitals and faculty physicians” to meet the requirements in two years. AAMC also said in their statement that the group “hoped that eligibility would be determined by hospital systems, not individual hospitals. (Each hospital in a multi-hospital system must qualify on its own to receive incentives.)”

On the industry side, Leigh Burchell, director of government relations for Allscripts, a health IT company, told WSJ that the shift from a mandated list of at least 23 requirements to a more flexible approach is the “most momentous” change from the draft version. She further added that the reporting requirements for things not captured in an EHR have eased, making things “much more user friendly” for providers. She also pointed out that the role of ER personnel in meeting the requirements has also been clarified, for the better.

Kern Medical Center CEO Paul Hensler, told WSJ that he was “pleasantly surprised” by the more flexible approach because it really lets each hospital customize its approach according to its needs and abilities.” He hoped that the changes will help hospitals with the capital to invest to focus on and implement a smaller set of requirements in order to qualify for incentives.

Mitch Morris, a national leader of health IT for Deloitte Consulting noted in an e-mail that he was surprised that there’s no word yet on when the third stage of requirements will be announced.

Charlie Jarvis, vice president of healthcare services and government relations for NextGen, a medical software company, told WSJ that the looser requirements will “help the provider community adapt more quickly,” but that some levels of compliance were still kept pretty high, at the 80% level. He also noted that it may be tough for some clients to be ready to go for the next set of requirements if they aren’t released until late next year.

Reid Conant, an emergency physician for the Tri-City Medical Center in Oceanside, Calif., wishes “there had been a requirement that detailed physician notes be part of a patient’s electronic medical records.” He believed this requirement to be necessary because without a physician narrative, he fears the records will “be reduced to point-and-click documents” that don’t distinguish between patients.

In the end, although the requirements may have been changed in some respects from the original draft, there are still a tremendous number of issues that have not been addressed adequately, and most likely will not be brought up until EHRs are put into use. Some of the difficult tasks that providers and physicians will face include privacy issues, compatibility, staffing, resources and time to successfully implement the “meaningful use” of EHRs. While the incentives create a good motivation for providers to begin adopting HIT, and the use of EHRs is promising for data sharing, implementation and results from the effective use of EHRs is a different outcome altogether.

For now, providers and physicians must continue an open dialogue with HHS regarding issues and concerns surrounding the meaningful use of EHRs so that patient care is not sacrificed for entering notes into a computer screen.