HHS Meaningful Use Final Rule Draws Guarded Initial Praise

The release Tuesday morning of HHS' long-awaited meaningful use requirements for healthcare information technology drew generally favorable, but guarded reviews from patient, physician, and hospital advocacy groups—all of whom are still sifting through the dense, 863-page document.

David Blumenthal, MD, National Coordinator for Health Information Technology co-wrote in an opinion column Tuesday in The New England Journal of Medicine that the "most important part" of this regulation is what it says hospitals and clinicians must do with EHRs to be considered meaningful users in 2011 and 2012:

In the original proposal, we identified a broad set of objectives, all of which would need to be met. This included 23 objectives for hospitals and 25 for clinicians. The DHHS received many comments that this approach was too demanding and inflexible, an all-or-nothing test that too few providers would be likely to pass," wrote Blumenthal and coauthor Marilyn Tavenner, RN, principal deputy administrator of CMS.

"In the final regulation, we have divided these elements into two groups: a set of core objectives that constitute an essential starting point for meaningful use of EHRs and a separate menu of additional important activities from which providers will choose several to implement in the first 2 years."

Despite those assurances, Steven J. Stack, MD, a board member of the American Medical Association, reaffirmed that the nation's largest physicians' association is trying to determine if the new rules provide caregivers with they flexibility they'd called for during the comment period.

"The AMA and 95 state and specialty medical societies submitted formal comments to CMS on an earlier draft of this rule and cautioned that the proposed criteria for meaningful use was too aggressive and would prevent many physicians from participating," Stack said. "The AMA is committed to EHR adoption that streamlines the clinical and business functions of a physician office and helps physicians provide high-quality care to patients. It is critical that barriers to implementation are removed so physicians can successfully adopt new technology."

Stack said that after reviewing the final rule, AMA plans free webinars in the coming weeks to educate physicians on the requirements for meaningful use and how they can incorporate them in their practices.

William F. Jessee, MD, president/CEO of the Medical Group Management Association, said he was pleased that the federal government acknowledged physicians' concerns in the comment period. "While challenges remain, the final rule provides a better approach to the 'real-world' issues faced by practices as they move toward 'meaningful use' of EHRs," Jessee said. >

"Improvements sought by MGMA" contained in the final rule included a reduction in the originally unrealistic thresholds related to e-prescribing, administrative transactions and computerized physician order entry, among others," he said.

Jessee said MGMA will continue to work closely with the federal government "to incorporate additional changes related to implementation of the incentive program to allow the greatest number of practices to achieve widespread meaningful use of EHRs."

Blumenthal and Tavenner said the meaningful use rule must be achievable and ambitious and "strike a balance between acknowledging the urgency of adopting EHRs to improve our healthcare system and recognizing the challenges that adoption will pose to healthcare providers"

"The regulation must be both ambitious and achievable. Like an escalator, HITECH attempts to move the health system upward toward improved quality and effectiveness in health care. But the speed of ascent must be calibrated to reflect both the capacities of providers who face a multitude of real-world challenges and the maturity of the technology itself," Blumenthal and Tavenner wrote.

The Federation of American Hospitals, the lobbying and trade association for for-profit hospitals, offered guarded praise for the new rules, saying they should help provide the impetus for hospitals to advance HIT for improved patient care. However FAH President/CEO Chip Kahn said "there is further work to do."

"Under today's final rule, multiple hospitals under a single Medicare provider number will not receive their full allotments," Kahn said. "Patients of a hospital should be confident that their hospital is receiving the full HITECH incentive, regardless of whether that hospital has an individual provider number or shares a provider number with other hospitals."

Kahn said it is "essential" that Congress clarifies the definition of an eligible hospital to put all hospitals on a level playing field for the distribution of incentive payments.

In addition, FAH wants HITECH incentive payments to recognize the continuum of patient care. "Congress should expand the legislation's reach to include post-acute hospitals and care," Kahn said. "Doing so is a step we must take to reap the full rewards that information technology can offer patients through improved care integration and coordination."

Christine Bechtel, vice president of the National Partnership for Women & Families, a patients rights advocacy group, applauded the Obama Administration for "making some reasonable concessions but standing firm against industry pressure to gut the regulations."

"Providers who take federal aid will now, appropriately, be required to use IT in ways that improve outcomes for patients and support the caregivers who now struggle to coordinate care in our fragmented system," Bechtel said. "An end is finally in sight for the days when doctors have to sift through incomplete and incomprehensible hand-written medical records—when patients must tote test results from doctor to doctor—and when family caregivers spend endless time trying to coordinate medications and treatments for those who can't do so for themselves."

As HIT gathers momentum, Bechtel said regulations should be strengthened "so providers who violate privacy laws are ineligible for federal IT dollars, and so providers are required to give all patients timely access to their health information as well as to the kind of education resources that help improve their outcomes."