On February 23, 2012, CMS released a proposed rule to specify the Stage 2 criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals must meet in order to qualify for Medicare and/or Medicaid electronic health record (EHR) incentive payments under the Health Information Technology for Economic and Clinical Health (HITECH) Act.  By way of background, a July 28, 2010 final CMS rule establishing meaningful use requirements for the Medicare and Medicaid EHR Incentive Programs set forth three implementation stages, with each stage requiring increasing use of EHRs and electronic information exchange. Under Stage 1, which began in 2011 and is the starting point for all providers, "meaningful use" consists of transferring data to EHRs and being able to share information such as electronic copies and visit summaries for patients (note that certain Stage 1 criteria would be modified under the proposed rule). Stage 2 meaningful use criteria, which are the focus of the proposed rule, seek to increase the electronic capturing of health information in a structured format, as well as increasing the exchange of clinically relevant information between providers of care at care transitions. The proposed rule also includes new Stage 2 objectives with greater applicability to specialty providers, such as the ability to make imaging results and information accessible through certified EHR technology and the capacity to report information to patient registries. As the Obama Administration announced in November 2011, under the proposed rule, any provider who first attested to Stage 1 criteria in 2011 will have until 2014 to begin using Stage 2 criteria (instead of 2013 as provided under the 2010 rule). Under Stage 3, which CMS expects to implement in 2016, "meaningful use" includes demonstrating improvement in quality of health care. The proposed rule also specifies Medicare payment adjustments that would apply beginning in 2015 if covered providers fail to demonstrate meaningful use of certified EHR technology and other program participation requirements according to CMS timelines. CMS is proposing exceptions to the payment adjustments related to: availability of internet access or barriers to obtaining information technology infrastructure; newly practicing EPs who would not otherwise be able to avoid payment adjustments; and unforeseen circumstances such as natural disasters. The proposed rule is scheduled to be published March 7, 2012, and comments will be accepted for 60 days after publication.

In a related development, the HHS Office of the National Coordinator for Health Information Technology (ONC) has issued a proposed rule that details the capabilities and related standards and implementation specifications that certified EHR technology will need to include to, at a minimum, support “meaningful use” by eligible health care providers beginning with the 2014 EHR reporting periods. The rule also proposes revisions to the permanent certification program for health information technology, which includes changing the name of the program to the "ONC HIT Certification Program.” The official version will be published on March 7, 2012. Comments will be accepted for 60 days after publication.