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Winners, Losers in HHS Final Meaningful Use Rule

Gienna Shaw, for HealthLeaders Media, July 13, 2010

Resistant docs who prefer paper

There's reason for "eligible professionals" who haven't yet mastered CPOE to cheer—HHS significantly dropped the percentage of orders that must be placed electronically from 75% to 40%. And certain narcotics are exempt from e-prescribing rules, making the criteria even easier to meet.

But while some physicians will be happy that the e-prescribing bar has been lowered, others will be disappointed the number wasn't even lower—preferably zero. Some docs were buzzing that HHS's delays in announcing the final rule meant that the regulations were going to be postponed or abandoned.

The power lineup of government officials at today's press briefing—Blumenthal, Sebelius, brand-spanking new CMS administer Donald Berwick, MD, and Surgeon General Regina Benjamin, MD, should put that thought to rest once and for all.

"There should not be any doubt any more that this program is real," says Charles W. Jarvis, vice president healthcare services and government relations for NextGen Healthcare, headquartered in Horsham, PN and a subsidiary of Quality Systems in Irvine, CA.

Jarvis said he was not surprised that the criteria would remain intact but that the levels of compliance would drop significantly. Relaxing some of the target numbers, such as those for CPOE, will "allow us to help more physicians and hospitals achieve meaningful use in a practical way."

Meanwhile, 40% is not so small a number when you consider that average e-prescribing across the country is somewhere between 8% and 10%, Jarvis says. Forty percent is still a dramatic jump.

Small and rural hospitals

Thanks to more flexible requirements in the first year, one of the biggest winners will be small physician practices, rural facilities, and critical care hospitals. The relaxed rules will be much easier for these organizations to achieve.

But small and rural organizations still face a major hurdle to adoption, says Brian Ahier, health IT evangelist for information systems at Mid-Columbia Medical Center in The Dalles, OR: coming up with the money for the systems up front. (The program only pays organizations after they've been certified as meaningful users.)

In Oregon, small organizations that do not have an EHR system in place are struggling with vendor selection, never mind where to find money for hardware, software, training, support, and other associated expenses, Ahier says. "They are going to need help with the resources for implementation before they can achieve even this lower bar."

Everyone who has been waiting (and waiting) for direction

The good news is that there was news—providers and vendors have been playing guessing games on what the final rules would look like and placing bets on when, exactly, the final rule would be announced. "Hospitals should be able to march ahead and make some final decisions on their EMR decisions," Jarvis says.

But just as every healthcare provider knows that electronic health records improve quality and safety, make healthcare delivery more effective and efficient, and eventually will reduce costs, they also know full well that there are still many problems to solve, from the financing of new systems to figuring out ways to share health data among different hospitals and across state lines to worries about keeping data private and secure to questions about how to engage reluctant physicians and the public at large.

Blumenthal acknowledged these points at the briefing, though not in-depth—the point of today's announcement was to rally support and generate excitement, not to point out all the pitfalls that lie ahead on the road to meaningful use.

"We are only as good in treating patients as the information we have," he

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