Final meaningful use rules for electronic health records reaction

by Joyce Frieden

The Department of Health and Human Services has released its final rule on “meaningful use” of electronic health records with the goal of making it easier for physicians to comply.

“We want these objectives to be ambitious but achievable,” David Blumenthal, MD, MPP, the department’s National Coordinator for Health Information Technology, said at a press conference on Tuesday announcing the release of the final rules. “So we added some choice.”

As part of the Recovery Act, the federal government will be offering financial incentives beginning in 2011 to physicians and hospitals that make “meaningful use” of electronic health records — $44,000 to physicians who see Medicare patients and $63,000 to physicians who see Medicaid patients. The proposed rule, issued on Dec. 30, 2009, explained what criteria needed to be met to constitute “meaningful use.”

But critics objected that the proposed rule was too hard for physicians to comply with and would not give them enough incentive to buy an electronic health record (EHR) system.

In order to make things more flexible in the final rule, the Centers for Medicare and Medicaid Services (CMS) — which was in charge of writing the regulations — reduced the number of core requirements physicians and hospitals must meet during the first two years of EHR implementation, Blumenthal said.

“There are a core set of objectives — 15 for healthcare professionals and 14 for hospitals — that all professionals and all hospitals need to obtain; an additional 10 are a ‘menu’ — the a la carte part. Eligible physicians and hospitals can choose five to meet [during Stage 1]; the rest would be deferred to Stage 2,” Blumenthal explained.

Another example of relaxing the rules is the requirement for electronic prescribing. In the proposed rule, “eligible professionals had to prescribe 75% of prescriptions electronically,” said Blumenthal. “In the new rule, that number is 40%.”

Donald Berwick, MD, making his public debut as newly appointed CMS administrator, noted that he had used EHRs during most of his career as a practicing pediatrician and that he had been “spoiled” by never having to rummage through paper records to find a missing test result.

EHRs are “better for everyone,” Berwick commented. “The question is, if it’s so good, why aren’t we there yet … for all patients? The reason is, because it’s hard.

“Moving from legacy paper systems to modern information technology is a big change; it’s really a new culture, and you don’t get there in one step. Today’s final rule represents really, really good progress to get us toward the answers we need. It will be better for patients and for the people who care for them, and it’s going to be less costly,” he added.

Surgeon General Regina Benjamin, MD, who also appeared at the press conference, said that after her clinic’s paper records had been ravaged three times — twice by hurricanes and once by fire — she didn’t have to do much convincing to get her staff to agree to adopt EHRs. “My staff told me they didn’t want to have to bake charts in the sun again” to dry them out.

However, the American Medical Association (AMA) expressed caution about the new final rule.

“The AMA will carefully review the rule to see if the requirements have been reduced to allow more flexibility than the proposed rule, as AMA urged [in its written comments],” AMA board member Steven Stack, MD, said in a statement. “After thoroughly reviewing the final rule, the AMA will work to help educate physicians on the requirements for meaningful use and how they can incorporate them in their practices.”

The AMA used the occasion to push once again for Medicare physician payment reform.

“Physicians recognize the potential for health information technology and want to adopt new technologies, but costly EHR systems are out of reach for many physicians because of low Medicare payments and the prospect of steep cuts in December,” Stack said. “Congress needs to repeal the flawed Medicare physician payment formula to help eliminate one major obstacle to physician adoption of new technologies.”

The American College of Cardiology (ACC) was more laudatory.

“The American College of Cardiology applauds the CMS and the Office of the National Coordinator for moving the country forward, and we appreciate them listening to cardiologists and for ensuring that we implement meaningful use in an appropriate fashion,” commented ACC president Ralph Brindis, MD, in a statement. “The changes to the core requirements will make it easier for physicians to comply and encourages practices to begin implementation and adoption of EHRs.”

A summary of the new “meaningful use” rule was published online Tuesday in the New England Journal of Medicine.

Joyce Frieden is a MedPage Today News Editor.

Originally published in MedPage Today. Visit for more health reform news.

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  • jsmith

    Meaningful use. What a joke. Where are the definitive data showing that all this fooling around with computers decreases costs or improves quality. Those data do not exist!
    We doctors are such fools, always falling for a little bit of money on the frontside and getting stung by the scorpion’s tail later. Do you think these will be the last of the mandates? Do you think the government is looking out for you?
    Don’t take the bait. 44k is peanuts.You’ll have to pay back many times that amount in direct costs and in heartache.
    Remember, our job is prevention, diagnosis and treatment, not farting around with computers for little, if any, benefit.

  • Edward

    jsmith may be right about the proof that all this really makes a difference, but he’s absolutely wrong if he thinks by not adopting and EMR and utilizing it’s benefits he can survive longterm. Almost all of the “core requirements” and most of the options are already done by many of us using EMRs. Many of them seem to lead to better metrics, if no proven outcomes. For me, I’ll take the $ as a little thank you for having already done most of the work. Hopefully this ruling will force various EMR vendors to find a way to allow data transfer between systems.

  • jsmith

    I too already work with an EHR since the group I work at got one 3 years ago, over my strenuous and, if I might be immodest, prescient objections. It has been a boondoggle, burning precious doctor and nurse time and sucking money.
    Of course I realize EHRs will be required to survive long-term. But short -term is not long-term, and there is a slight possibility that the technology might improve, although I really doubt it will. Even if it doesn’t, shooting oneself in the foot later is clearly better than shooting oneself in the foot sooner. Docs should wait and only get EHRs if they are absolutely forced to do so.
    Better metrics are meaningless. Outcomes matter.

    • r watkins

      “Better metrics are meaningless. Outcomes matter.”

      Amen, brother!

  • CSmith MD

    EHRs will only be meaningful when we decide which data elements are truly necessary. Diagnosis codes, lab and imaging reports, medication and allergy lists, vital signs and maybe computerized order entry are probably the only relevant elements. HPI, ROS etc. can be in a dictated note but should not be data elements. They drown the relevant data and the time to enter this data could be better spent serving patients. Ironically, we need to abandon the E&M system of reimbursement to have a meaningful EHR.

    • r watkins

      “we need to abandon the E&M system of reimbursement to have a meaningful EHR.”

      Excellent, excellent point. I think this is one of the main, if not the main, reasons that many countries have widespread EMR use while the US does not.

      It is very easy to imagine an excellent EMR system if it were designed only to deal with patient care. Unfortunately, that’s not what we’re getting here.

  • Marc Gorayeb, MD

    $44,000. Money just floating down from the heavens. Let’s declare a corollary to “you get what you pay for.” The price for services or products you buy with ‘free’ money will inevitably be inflated by at least the amount of ‘free’ money you received. Good luck with budgeting for those annual maintenance and update fees.

  • DocB

    we are damned by a simple curse.

    we hav socialized incomes but free market expenses.

    44K just allows EMR companies to price their systems :just right.” and they love it!!!

    your EMR will cost you MUCH MUCH MUCH more.

    44k that will pay for about 3 yrs….. what about the other 30 yrs of my career (i hope???) of course…. thats assuming primary care even still exist in 5yrs…. then if i spend all this money on an EMR now…. wont i feel stupid.

    and meaningful use?!?!? what a joke… the board that set this up consisted of execs from allscripts and other big EMR companies…. how convenient.

  • Leor

    I agree with most of the posts here, but some of you guys are complaining about these expensive EMR’s which will suck the $44K + dry in fees, etc. Please do research and examine the other affordable options out there guys! Check out OpenEMR, for example. Open source, supported by a huge and growing physician and health IT community. Cross platform compatible (Mac, Windows, Linux). No software to buy, many companies even host it for you online. Dont get sucked into GE, Mysis, Allscripts, etc just because they are the largest ones out there! No need to spend 100K on an EMR.

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