The Health and Human Services department has released the much-anticipated requirements for how physicians and hospitals can qualify for tens of thousands of dollars in incentive payments to adopt and use electronic health records.

The final rule on the meaningful use of electronic health records (EHRs) eases many of the requirements that officials in HHS had outlined in a January proposal. Physician organizations had objected to that proposal, saying that it asked doctors, especially those in small practices, to do too much too quickly. Physicians were also critical of the all-or-nothing framework, which required them to meet all 25 objectives for meaningful use or lose out on incentive payments.

Federal officials aimed to address those concerns in the final rule by requiring physicians to first meet a core set of 15 requirements and then meet any 5 of 10 additional requirements. The core set includes requirements such as recording patient demographics and vital signs in the EHR, maintaining an up-to-date problem list and an active list of medications and allergies, and transmitting permissible prescriptions electronically.

“We very much want well-intentioned providers to become meaningful users,” Dr. David Blumenthal, National Coordinator for Health Information Technology at HHS, said during a press briefing to announce the final rule.

HHS officials also relaxed some of the thresholds related to the requirements. For example, under the proposed rule, physicians would have had to generate and transmit 75% of their permissible prescriptions electronically to meet the e-prescribing requirement. Under the final rule, the threshold has been lowered to more than 40% of permissible prescriptions, Dr. Blumenthal said.

The final rule also creates an easier path for physicians to meet meaningful use requirements on electronic reporting of quality data. Under the final rule, physicians will need to report data on blood pressure, tobacco status, and adult weight screening, and follow-up in 2011 and 2012, in order to qualify. Alternatives are available if those measures do not apply to their practices. Physicians will also have to choose three other quality measures to report on through their EHRs.

The final rule outlines the steps physicians must take in 2011 and 2012 to quality for the maximum incentive payments through the Medicare and Medicaid programs. The incentives were mandated by the Health Information Technology for Economic and Clinical Health Act (HITECH), a part of 2009's American Recovery Act.

Starting in 2011, physicians who demonstrate meaningful use of certified EHRs can receive payments of up to &dollar;18,000 from Medicare. Those bonuses continue for 5 years, with physicians eligible to earn up to &dollar;44,000 in total incentives. Physicians can still receive bonuses if they begin their meaningful use of the technology later, but they must start before 2013 to get all the available incentives. A similar program is in place under the Medicaid program, with physicians eligible to receive up to &dollar;64,000 over 6 years for the adoption and use of certified EHRs.

Technical Requirements For EHRs Released

Further to the 'meaningul use' rule for electronic health records, HHS has published regulations last month that will allow for temporary certification of electronic health records—the first step in helping physicians and other providers get the software and hardware required to be eligible for bonus payments under federal health programs.

According to the Office of the National Coordinator for Health Information Technology (ONC), the rule “establishes processes that organizations will need to follow in order to be authorized by the National Coordinator to test and certify [electronic health record] technology.”

“We hope that all [health information technology] stakeholders view this rule as the federal government's commitment to reduce uncertainty in the health IT marketplace and advance the successful implementation of EHR incentive programs,” said Dr. Blumenthal in a statement.

Certification means that the EHR package has been tested and includes the required capabilities to meet the meaningful use standards issued by ONC. Hospitals and physicians will have the assurance that the certified EHRs can help them improve the quality of care and qualify for bonus payments under Medicare or Medicaid.

“By purchasing certified EHR technology, hospitals and eligible professionals and hospitals will be able to make EHR purchasing decisions knowing that the technology will allow them to become meaningful users of electronic health records, qualify for the payment incentives, and begin to use EHRs in a way that will improve quality and efficiency in our health care system,” Dr. Blumenthal said.

The July rule was for a temporary certification program. A final rule on permanent certification of EHRs will be issued in the fall.

—Alicia Ault

EHR Requirements Relaxed in Final Rule on Meaningful Use