First draft of EHR "meaningful use" definition unveiled

But the national health IT chief asks for revised recommendations, which will help determine who gets stimulus dollars.

By — Posted June 29, 2009

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President Obama's point man on health care information technology has asked a key working group to revise its recommendations on what constitutes "meaningful use" of electronic health records, a pivotal term that will decide which physicians can obtain billions in federal EHR money.

David Blumenthal, MD, national coordinator for health information technology, declined to specify why he asked the Health IT Policy Committee's meaningful use working group to amend the recommendations it released June 16. The panel is tasked with advising the government on a policy framework for the development and adoption of a nationwide health IT infrastructure.

"We had a lively discussion, and it was decided after considerable input on the topic of meaningful use that we would take it back to discussion to work on it a little bit longer," Dr. Blumenthal said. He said the committee expects to unveil revised recommendations by July 16, the date of its next scheduled meeting.

Dr. Blumenthal fielded questions during a June 16 conference call with Tony Trenkle, director of the Office of E-Health Standards and Services at the Centers for Medicare & Medicaid Services. CMS will rely heavily on the committee's recommendations in drafting a proposed rule on meaningful use, expected later this year, Trenkle said.

The health care community is following the EHR meaningful use debate with much interest. The federal stimulus bill provides approximately $19 billion in net Medicare and Medicaid incentives for physicians, hospitals and others not only to adopt certified EHRs but also to use them in a meaningful way. The incentives start with bonuses for early adopters but turn into penalties for those who don't act fast enough.

Incentive pay rules

Physicians with approved EHRs in place before 2011 or 2012 will be eligible for the maximum Medicare incentive payments allowed by the stimulus package. Doctors who have not adopted an EHR before 2015 and who fail to obtain a hardship exemption will see a 1% cut to Medicare pay, a reduction that phases up to 3% for 2017 and remains each year after that.

In a general sense, meaningful users have been defined as physicians who demonstrate to the government that they are using electronic prescribing, that their technology is connected in a manner that provides for electronic exchange of health data to improve quality of care, and that they submit information to the government on clinical quality measures.

But for the past month, the meaningful user working group has been trying to detail exactly what objectives physicians would need to meet to earn the Medicare incentives.

For example, the initial draft proposed that to be considered a meaningful user, practices should be able to maintain electronic medication and allergy lists, record vital signs, and incorporate lab results into their EHRs by 2011. The proposed list of mandates grows in 2013 and 2015.

During the June 16 call, Dr. Blumenthal said the group would take comments over the next 10 days on the initial recommendations. He expected to hear concerns on how quickly EHRs could be adopted, on how well meaningful use criteria could be met and on how CMS eventually will certify approved records systems.

"Our goal is to try to make it possible for as many physicians and hospitals as possible to be meaningful users by 2011," he said.

Health policy experts note the importance of practices getting a jump on using an EHR system.

"The requirements are weighted over time, but they're heavily loaded in the first couple of years," said Erica Drazen, a managing partner in the health care group at Computer Sciences Corp., a technology firm in Waltham, Mass.

Drazen said it could prove particularly difficult for practices to adopt a computerized physician order entry component, one of the 2011 requirements in the first draft. Fewer than 20% of hospitals use CPOE, and the adoption rate for physicians is similarly low, she said.

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Becoming a meaningful EHR user

The Health IT Policy Committee will revise its initial suggestions for defining "meaningful use" of electronic health records as a prerequisite for federal stimulus bonuses, but the first draft gives physicians an idea of what kind of requirements and deadlines to expect.

By 2011:

  • Use computerized physician order entry for all order types, including medications.
  • Incorporate laboratory tests into EHRs and share results electronically with public health agencies.
  • Generate lists of patients by specific condition to use for quality improvement.
  • Provide clinical summaries for patients after each encounter.
  • Exchange key clinical information among health professionals (problems, medications, allergies, test results, etc.).

By 2013:

  • Generate and transmit prescriptions electronically.
  • Manage chronic conditions using patient lists and decision support tools.
  • Use bar coding for medication administration.
  • Offer secure patient-physician messaging capability.
  • Record patient preferences in EHR.

By 2015:

  • Achieve minimal levels of performance on quality, safety and efficiency measures.
  • Give patients access to self-management tools.
  • Access comprehensive patient data from all available sources.
  • Conduct automated real-time surveillance on occurrences such as adverse events, disease outbreaks and bioterrorism.
  • Incorporate clinical dashboards into EHR.

Source: Health IT Policy Committee link

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