Last week, the Centers for Medicare & Medicaid Services (“CMS”) and the Office of the National Coordinator for Health Information Technology (“ONC”) issued two regulations addressing “meaningful use” of certified electronic health record (“EHR”) technology and standards and specifications that will enhance the interoperability, functionality, utility and security of health information technology. The new regulations help implement the EHR incentive programs enacted under the Health Information Technology for Economic and Clinical Health Act (the “HITECH Act”) in the American Recovery and Reinvestment Act of 2009. Eligible hospitals may begin receiving incentive payments under the HITECH Act as soon as October 2010, and incentive payments to other eligible providers may begin in January 2011.
Under programs established by the HITECH Act, eligible professionals (“EPs”) and eligible hospitals participating in Medicare and Medicaid can receive incentive payments for adopting and making “meaningful use” of certified EHR technology. Accordingly, CMS proposes a phased approach to implement the requirements for demonstrating meaningful use. In stage 1, CMS proposes 25 objectives/measures for EPs and 23 objectives/measures for eligible hospitals that must be met for these providers to be deemed a meaningful EHR user. These objectives and measures include use of certified EHR technology in a manner that improves quality, safety and efficiency of health care delivery, reduces health care disparities, improves care coordination, and adequately protects privacy and security. Stage 2 would expand upon the Stage 1 criteria in areas such as disease management, clinical decision support, medication management and support for patient access to their health information. Finally, Stage 3 would focus on achieving improvements in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to self management tools, access to comprehensive patient data and improving population health outcomes. These criteria also serve as the minimum Medicaid standards. However, states may request CMS approval to implement additional, more stringent, meaningful use measures.
The interim final regulation (“IFR”) issued by ONC sets initial standards, implementation specifications and certification criteria for EHR technology. These standards include formats for clinical summaries and prescriptions; standard terms to describe clinical problems, procedures, laboratory tests, medications and allergies; and standards for the secure transportation of this information using the Internet. These standards will support meaningful use and data exchange among providers who must use certified EHR technology to qualify for the Medicare and Medicaid incentives.