Proposed Rule for Defining Meaningful Use of EHR Technology
January 3, 2010
The Office of the National Coordinator for Health Information Technology (ONC) and the U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) have proposed two regulations that would help guide the government in awarding incentives for the meaningful use of certified EHRs under the American Recovery and Reinvestment Act of 2009. Open for public response, the regulations will be issued as a final rule in 2010 following refinement, after a comment period of 60 days.
Following the enactment of the Act in February 2009, various bodies and work groups have been established to support the incentive program that is set to begin as early as October 2010 (for some eligible hospitals), and for some others in 2011. Initially created in 2004, ONC’s role was further expanded, following the Recovery Act, with the responsibility of allowing the adoption and meaningful use of health IT among care providers in agreement with CMS; encouraging the creation of regional extension centers for state-level technical support; and reinforcement of health IT workforce, through grant allotment, and others. CMS, on the other hand, was tasked with the implementation of the incentive programs and defining the meaningful use of EHRs; implementing specifications, establishing standards, and certifying EHR technology criteria; and ensuring privacy and security issues.
Building on the HIT Policy Committee’s work on the matrices for defining ‘meaningful use’, and the input from various other stakeholders, CMS and ONC worked together in releasing the proposed rule so as to provide greater depth to the incentive program, and specifying the decisive factor for the allotment of the incentives.
CMS’ proposed rule: This outlines the projected provisions central to the Medicare and Medicaid incentive program, including payment procedures, as well as criteria required for meaningfully using EHR technology. Acting as a minimum standard for participation, the rule includes specific definitions for eligible hospitals and critical access facilities; and healthcare professionals participating in the Medicare Advantage and Medicare fee-for-service incentive plans.
Taking into account many of the public and stakeholder inputs, following the release of the matrices, the incentive plan will be carried out through a 3-stage phased approach for meaningful use implementation. This would begin with criteria covering the present practice experience of providers and existing technological competence, which would expand into more stringent and extensive requirements. With Stage 1 beginning from 2011, Stage 2 and 3 are expected to be proposed by the end of 2011 and 2013, respectively.
ONC interim final regulation (IFR): This sets various standards for EHR certification and implementation, apart from preliminary standards for health information exchange, which are anticipated to improve the functionality, utility interoperability, and security of the technology. The IFR specifications are based on established standards, such as Integrating the Healthcare Enterprise (IHE), National Institute of Standards and Technology (NIST), and HL7; as well as nomenclature and classifications: ICD-9 and 10, RxNorm, X12, NCPDP, SNOMED CT, and LOINC. As a beacon to standardizing the exchange of health information through certified technology, the IFR includes standard terms to specify laboratory tests, clinical procedures, medications, allergies, and problems; and standard formats for prescriptions and clinical summaries. A separate Notice of Proposed Rulemaking (NPRM) will be rolled out for testing, and certifying modules and complete EHRs in 2010.
The provisions of the Recovery Act are not only centered around information technology and its supporting systems, but also aims on enabling secure health information exchange to attain enhanced quality in care delivery by using the power of various resources and stakeholders inputs.
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