The wait is over: HHS unveils ‘meaningful use’ plan

The Centers for Medicare and Medicaid Services and the Office of the National Coordinator today released its long-awaited proposal for “meaningful use,” a detailed, 700-page master plan for improving healthcare value and quality by accelerating the use of health IT by doctors and hospitals.

Nearly a year in the making, the proposed rules offer doctors and hospitals tens of thousands of dollars in financial incentives for meeting three stages of progressively more demanding goals for using health IT in their practices.

Measures range from what percentage of physicians’ orders must be made electronically (80 percent for physicians; 10 percent for hospitals) to how many times providers must test their ability to transmit data from EHRs to public health agencies.

“Over time, we believe the EHR incentive program under Medicare and Medicaid will accelerate and facilitate health IT adoption by more individual providers and organizations throughout the healthcare system,” said Dr. David Blumenthal, the national coordinator for health IT, in outlining the plan.

The price tag for the incentives may also be a good deal lower than originally estimated. The Congressional Budget Office initially estimated outlays could be as high as $34 billion. In an new analysis, the cost ranges from as low as $14.1 billion to a high of $27.3 billion.

The fact that the program is voluntary might be one reason for the gap, officials said. A better understanding of the actual terms of the package is another. “It’s a more specific refining of the actual requirements and eligibility of various organizations,” said Tony Trenkle, director of CMS’s Office of e-Health Standards and Services.

In crafting the plan, the healthcare officials said they took pains to ensure definitions for meaningful use were consistent for providers who qualified for incentives from Medicare and those whose payments and progress in becoming meaningful health IT users would be managed by Medicaid.

“We worked closely with ONC staff to make sure that we were coordinated as needed,” said Trenkle. “There is a lot of dependency on the other in each regulation.”

The rules proposed today constitute the first of what will be three distinct stages of meaningful use criteria to be unveiled separately between now and 2013, officials said.

The initial Stage 1 set of criteria, part of what Blumenthal described as an “evolution” of meaningful use, would focus on collecting data electronically, sharing information with other providers and patients, and reporting quality measures to the government.

A second stage of criteria would be proposed by the end of 2011 and would focus on structured information exchange and continuous quality improvement. Stage 3 criteria, to focus on decision support for “national high priority conditions” and population health, would be unveiled by the end of 2013.

"CMS will establish stricter and more extensive criteria for demonstrating meaningful use over time,” said Jonathan Blum, director of the Center for Medicare Management.

But in setting up its 2011 challenge, CMS outlined a series of precise meaningful use tests, which providers and hospitals must pass to be entitled to first year payments. “We not only discuss the length of the reporting periods, but we also discuss each objective and the specific measures that have to be met,” said Trenkle.

For example:

-- To improve quality, safety and efficiency, physicians must use a computerized physician order entry (CPOE) system for 80 percent of all their medical orders. Hospitals must conduct 10 percent of all orders using CPOE.

-- To meet a 2011 goal of engaging patients and families directly in their own healthcare, providers supply a electronic copy of their health record within 48 hours to at least 80 percent of patients who request on.

-- In the area of improving care coordination, providers must make available a summary of care record for at least 80 percent of transitions of care and referrals.

-- To advance the aims of population and public health, providers must conduct a least one test of their EHR’s  capacity to submit electronic data to immunization registries.

In addition to the notice of propose rulemaking for meaningful use, the ONC also announced an interim final rule covering technical standards and features that electronic health record systems must incorporate to be certified to meet meaningful use.

The standards and certification criteria “are very specifically linked to the definition of meaningful use” outlined in CMS’s accompanying proposed rule. “This initial set of standards begins to define a common language to ensure accurate and secure health information exchange across different EHR systems,” Blumenthal said.

The ONC rule describes standard formats for clinical summaries and prescriptions; standard terms to describe clinical problems, procedures, laboratory tests, medications and the secure transportation of this data using the Internet.

“We expect that the standards and certification criteria will evolve over time, as stages of meaningful use evolve in future regulations, technology evolves, and the market expresses itself in terms of which versions of standards it feels are most compatible with usability for meaningful use,” Blumenthal said.

“We hope we have provided a pathway to more uniform standards over time, while at the same time making it possible in 2011 for well intended providers to become so and for the industry to create technology to support them,” he added.

HHS officials emphasized the CMS meaningful use plan is still a proposal only. According to the announcement, the public has 60 days to comment on the regulation after it is published in the Federal Register. Subsequent revisions will be made, with the final rule expected in spring of 2010.

The ONC rule on standards and certification will become effective 30 days after it is published in the Federal Register, but the public may comment on its possible refinement over the next 60 days, and a final rule will be issued in 2010.

The standards rule focuses only on standards that comprise a certified EHR. The actual process by which those systems will be certified will be the subject of an additional notice of proposed rulemaking ONC will announce later in 2010.