Final Rule on Meaningful Use Released
The Department of Health and Human Services released the final rule on the meaningful use EHR incentive program this morning. A pre-publication copy–864 pages long–is available in advance of official publication.
Publication in the Federal Register will occur July 28, and the rule becomes effective 60 days later.
HHS also released a prepublication copy of the final rule on standards and certification criteria, which supports the meaningful use program. It will also publish July 28 and take effect 30 days later.
The releases were announced at an event in Washington, DC, featuring HHS secretary Kathleen Sebelius and other HHS officials, including David Blumenthal, head of the Office of the National Coordinator for Health IT.
The event was short on details, so identifying the changes will require working through the 864-page document. However, it is clear that the final rule eases the requirements put forth in the notice of proposed rulemaking published in January.
HHS received more than 2,000 comments on the proposed rule, Blumenthal said, and heard consistently that it was too inflexible.
In response, the final rule adds “flexibility and choice,” Blumenthal said, allowing program participants to “take different pathways to meaningful use.” The objectives, he said, are intended to be both “ambitious” and “achievable,” so that “if you try, you can get there.”
The final rule reduces both the number of requirements and the related thresholds of the measures. It adds flexibility by allowing participant to in part choose some of the objectives they will pursue.
Introducing “Core” Objectives
The final rule divides objectives into a “core” set and a “menu” set. In order to qualify as a meaningful user in stage 1, participants must meet the measure for each objective in the core set, which features 15 objectives for eligible professionals (EPs) and 14 for eligible hospitals and critical access hospitals:
- Use CPOE
- Implement drug to drug and drug allergy interaction checks
- E-prescribing (EPs only)
- Record demographics
- Maintain an up-to-date problem list
- Maintain active medication list
- Maintain active medication allergy list
- Record and chart changes in vital signs
- Record smoking status
- Implement one clinical decision support rule
- Report CQM as specified by the secretary
- Electronically exchange key clinical information
- Provide patients with an electronic copy of their health information
- Provide patients with an electronic copy of their discharge instructions (eligible hospitals only)
- Provide clinical summaries for patients for each office visit (EPs only)
- Protect electronic health information created or maintained by certified EHR
Flexibility in “Menu” Items
Blumenthal described the menu set as the “a la carte part.” It includes 10 additional objectives, of which eligible professionals and hospitals will choose five. The items not chosen will be deferred to stage 2 of the program.
Participants may select any five objectives from the menu set, with one limitation. They must choose at least one population and public health measure.
The menu set objectives includes 12 total items, 10 of which apply to EPs and 10 of which apply to hospitals:
- Implement drug-formulary checks
- Record advance directives for patients 65 years old or older (eligible hospitals only)
- Incorporate clinical lab-test results into certified EHR technology as structured data
- Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach
- Send reminders to patients per patient preference for preventive/follow up care (EPs only)
- Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, medication allergies) within four business days of the information being available to the EP (EPs only)
- Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate
- The EP, eligible hospital or CAH who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation
- The EP, eligible hospital or CAH who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary of care record for each transition of care or referral
- Capability to submit electronic data to immunization registries or immunization information systems and actual submission in accordance with applicable law and practice
- Capability to submit electronic data on reportable (as required by state or local law) lab results to public health agencies and actual submission in accordance with applicable law and practice (eligible hospitals only)
- Capability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice
HHS expects to update the meaningful use criteria every two years, with the stage 2 criteria finalized by the end of 2011 and the stage 3 criteria by the end of 2013.
CMS is posting basic fact sheets and additional information on its EHR incentive programs Web site.