Proposed rules set stage for e-health records incentives

Physicians will have to submit 80 percent of their clinical orders electronically, while hospitals will have to do so for 10 percent of their orders, under expansive new proposed regulations released by the Health and Human Services Department for meaningful use of electronic health records (EHRs).

The Centers for Medicare and Medicare Services (CMS) released a 556-page proposed rule on Dec. 30 about the definition of “meaningful use” and how eligible professionals and hospitals may qualify for incentive payments as meaningful users under the American Reinvestment and Recovery Act (ARRA) of 2009. The Recovery Act allocates at least $17 billion for such payments by doctors and hospitals that buy and meaningfully use certified EHR systems.

In addition, the Office of the National Coordinator for Health Information Technology (ONCHIT) made available a 136-page interim final rule for certification requirements for EHR systems. The regulation is referred to as the "Initial Set of Standards, Implementation Specifications and Certification Criteria for Electronic Health Record Technology."

The rule calls for the industry to standardize the way in which medical data is to be exchanged electronically between organizations—including formats for clinical summaries, prescriptions, lab tests, medications and allergies—and sets forth criteria for certification of vendors’ digital health record systems.

Both regulations are to be published in the Jan. 13 Federal Register, with the public comment period expiring 60 days later.

Charlene Frizzera, CMS' acting administrator, said the two regulations are closely linked. "CMS’s proposed regulation would define and specify how to demonstrate ‘meaningful use’ of EHR technology,” Frizzera said in a news release. ONCHIT's regulation “sets forth the standards and specifications that will enhance the interoperability, functionality, utility and security of health information technology.”

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

Under the CMS rule, doctors and hospitals must demonstrate their meaningful use of digital health record systems by meeting certain benchmarks.

For example, physicians must use a computerized physician order entry system for 80 percent of their orders, while hospitals must do so for 10 percent.

Hospitals must collect data electronically for 80 percent of their patients, including up-to-date information on patients’ problem lists, active medications, allergies, demographics, blood pressure and smoking status.

Hospitals also must submit at least 50 percent of their lab results electronically, and physicians must submit at least 75 percent of the prescriptions electronically, to qualify for the incentive payments.

The Health IT Policy Committee, composed of health care and health information technology experts, prepared recommendations earlier this year on how to structure the meaningful use criteria in three stages, with increasing levels of stringency in 2011, 2013 and 2015.