With the clock ticking on 2009, healthcare providers and clinical software systems developers were still waiting for the CMS to release a federal rule explaining the meaning of “meaningful use.”
Still no 'meaning'
Health IT industry still waiting on CMS' use rules
The rule, expected before year-end as part of the stimulus law, is widely anticipated as it holds the key to $34 billion in payments for hospitals and physicians to subsidize the cost of purchasing electronic health-record systems.
At one time it was said the federal definition and criteria for the “meaningful use” of EHR systems would be released by mid-December, but that target passed last week as key federal policymakers on the issue met and were still accepting suggestions on possible meaningful-use criteria.
“Meaningful use is critical to the whole success of the project, because they don’t just want people buying electronic health records and putting them on a shelf and not using them,” said Dave Roberts, vice president of government relations for the Chicago-based Healthcare Information and Management Systems Society. “The whole idea is that providers and hospitals have to really utilize the technology to improve the quality of care, reduce utilization and, hopefully, reduce cost,” Roberts said.
The stimulus law, formally the American Recovery and Reinvestment Act of 2009, requires HHS to publish by Dec. 31 standards for the certification of EHRs to criteria outlined in the law, but to be fleshed out by HHS, most likely in the form of an interim final rule.
To qualify for stimulus subsidy payments, providers must use certified EHRs in a meaningful way. That term—also defined broadly in the law—calls for a provider to use an EHR for electronic prescribing, reporting quality measures and exchanging information to improve the quality of care.
The CMS, which will administer the provider EHR subsidy program, also will write the rules on meaningful use.
The federally chartered Health Information Technology Policy Committee on Dec. 15 parsed some recommendations from one of its work groups on what to do about standards for electronic laboratory orders at the meeting where some industry insiders believed the rule could be released. But in a sign it’s still being written, the policy committee then hustled up a vote to accept the work group’s eleventh-hour recommendations so that they still could be considered by CMS rule writers before the first round of meaningful-use criteria are published.
The stimulus law called for creation of the HIT Policy Committee to advise HHS’ Office of the National Coordinator for Health Information Technology on a host of subjects. Committee members have spent a significant portion of their time since the group was launched in May dealing with meaningful-use recommendations.
Earlier this year, the HIT Policy Committee produced a host of suggestions to the ONC on meaningful use. It recommended three tiers of increasingly more stringent criteria lasting for periods of two years each.
The years 2011, 2013 and 2015 were chosen as the starting and ratcheting-up dates to coincide with break points in the subsidy payment regime. Physicians who qualify for EHR subsidies will receive their maximum initial payments of $18,000 under Medicare if they start meaningfully using their EHRs in 2011 or 2012.
The recommendations the HIT Policy Committee voted on last week came from its information exchange work group and specified standards for providers to use when electronically ordering laboratory tests for a patient.
Work group co-Chairman Micky Tripathi, who is president and CEO of the Massachusetts eHealth Collaborative, said 70% to 80% of laboratory transactions are not performed using EHR systems. The failure of the healthcare industry to come together on a common set of messaging standards and their implementation guides for laboratories is “in many ways, the Achilles’ heel of meaningful use,” he said. “There are a lot of standards out there that are not used, and many standards that are used in various ways,” Tripathi said. In addition to 5,200 commercial laboratories, there are 8,500 hospital laboratories, 400 public health laboratories and 115,000 small laboratories in physician offices and clinics, Tripathi said.
David Blumenthal, the physician who heads the ONC, said his office needed “a little more time to digest” other work-group recommendations, including a possible federal pre-emption of state laboratory laws, which might have legal implications.
The HIT Policy Committee also heard from Paul Egerman, co-chairman of the certification and adoption work group of the HIT Policy Committee, who said that the Certification Commission for Health Information Technology could have a competitor.
Under the stimulus law, the ONC “shall keep or recognize a program or programs for the voluntary certification of health information technology.”
The Drummond Group, an Austin, Texas-based software-testing service provider, “threw their hat in the ring and want to become a certification organization,” Egerman said. “They are putting together a second certification organization emphasizing vendors that provide software to physician groups, particularly small physician groups.”
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