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Letter tells CMS to set more specific EHR goals


By Jennifer Lubell
Posted: March 18, 2010 - 11:00 am ET
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To successfully implement the broad use of electronic health records, the CMS needs to make its health goals and targets more explicit, according to public comments submitted by healthcare leaders from 56 organizations on the agency's meaningful-use rule.

The Markle Foundation, the Center for American Progress and the Engelberg Center for Health Care Reform at Brookings were the three organizations that coordinated these comments and submitted them to the CMS in response to several rules governing meaningful use and certification of EHRs.

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The rulemaking originated from the American Recovery and Reinvestment Act of 2009, also known as the stimulus law, which provided billions of dollars in federal subsidy payments to hospitals and office-based physicians for the purchase of EHR systems. HHS plans to administer the new subsidies beginning in 2011.

The goal of meaningful use is to improve healthcare efficiency, safety and quality, not just to adopt EHRs, yet the rulemaking fails to establish a set of clear and measurable goals for achieving the quality metrics it proposes, healthcare leaders stated. Unless these goals are understood by the provider community, compliance with meaningful use will become more of an exercise to fulfill reporting requirements instead of an opportunity to use health IT to improve care, the groups warned.

“Health information technology can be a very effective tool to help providers and patients get better, less costly care. That's why investments in health IT should prioritize key quality and outcome reporting requirements, while also streamlining the administrative overhead,” Mark McClellan, director of the Engelberg Center at Brookings and former CMS administrator, said in a written statement. “Our comments lay out a feasible path toward measuring and supporting a key goal of healthcare reform—achieving better results for patients—so that providers can focus their efforts on what's most important for reaching this goal.”

The success of this new federal incentives program for health IT will depend on several factors: a specific set of health improvement goals, a prioritized set of metrics, and the broad participation of healthcare providers and patients, the groups stated.

These health improvement goals should focus on improving medication management and reducing readmissions to hospitals, “so that everyone—including the public—can play a role in contributing to these priorities,” the groups stated.

The new health IT program should encourage providers to adopt electronic records by prioritizing the requirements necessary to receive payments, according to their comments. Providers should have to report only summary statistics to HHS, and not information that is patient-level or personally identifiable. In addition, providers should receive feedback from the program to help them examine their own practices.

Patients should also be able to obtain electronic copies of their health information, according to the comments.

Healthcare entities weren't the only ones calling for changes. In a letter, 249 House members urged the agency to revise its proposed definition and requirements for hospitals hoping to qualify for incentive payments as “meaningful users” of EHR technology.

“The EHR rule goes against the intent of Congress to reward those hospitals that already have taken important steps toward implementing EHR systems and to provide incentives to encourage further development. It proposes an ambitious all-or-nothing approach in which hospitals would be required to adopt all 23 separate EHR objectives, or requirements, that very few hospitals have yet been able to accomplish,” the letter stated.

The comment period on the rulemaking ended March 15. The CMS, drafter of the rule on meaningful use, estimates it has received more than 1,000 comments on the rules.

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