Feds Lower Bar for EHR Funds

Feedback prompts HHS to cut quality metrics in half and extend deadlines for fully implementing each phase of the new rules.

As part of its effort to encourage widespread adoption of electronic health records (EHR) systems, the federal government has eased the requirements that health care providers must meet if they want to receive reimbursements for such projects. The new criteria for demonstrating so-called meaningful use of electronic records are spelled out in the final Phase 1 EHR implementation guidelines that the U.S. Department of Health and Human Services issued earlier this month. The 864-page document was finalized after a three-month public comment period on draft rules that HHS released last December.

The proposal attracted some 2,000 comments that led HHS to reduce the number of specific quality metrics from 90 to 44, noted William Connelly, an attorney specializing in health care in the Washington office of law firm Manatt, Phelps & Phillips LLP.

Striking a Balance

In a story on the New England Journal of Medicine Web site, HHS officials said the final meaningful-use rule "strikes a balance between acknowledging the urgency of adopting EHRs to improve our health care system and recognizing the challenges that adoption will pose to health care providers."

The lack of clarity prior to the latest release -- and a firm 2015 deadline to qualify for some of the $36 billion in federal funds available for EHR projects -- had served as a prod for Kern Medical Center, a 222-bed teaching hospital in Bakersfield, Calif., to take early steps to make sure it could meet the final guidelines.

In a contract with Medsphere Systems Corp. to deploy its OpenVista EHR system later this year, the health care firm required the vendor to "deliver meaningful use, however the requirements turn out," said Bill Fawns, director of IT services at Kern. "Our approach to meaningful use has been to throw it back to our vendor."

A key change in the guidelines, according to experts, allows providers to begin EHR deployments in 2012, 2013 or 2014, and then take up to two full years to fully implement Phase 1 standards. The initial proposal would have required all entities to meet final Phase 3 guidelines by 2015.

Today, only 20% of physicians and 10% of hospitals use even the most basic EHR technology, acknowledged HHS Secretary Kathleen Sebelius during a news conference announcing the guidelines. The HHS Centers for Medicare and Medicaid Services, which created the meaningful-use rules, estimates that 66.4% to 92.6% of hospitals and between 21% and 53% of private physician practices will have implemented EHRs by 2015.

The latest rules do little to promote the electronic exchange of EHRs between hospitals. "There wasn't much to promote health information exchange in the proposed rule, but they scaled it back even further in the final rule," Connelly said.

He expects health information exchanges to be addressed further in Phases 2 and 3.

This story was originally published in Computerworld's print edition. It was adapted from an earlier version that first appeared on Computerworld.com.

Copyright © 2010 IDG Communications, Inc.

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