On February 23, 2012, the Centers For Medicare & Medicaid Services (CMS ) issued its eagerly-awaited proposed regulation implementing the second stage of “meaningful-use” rules for adoption of certified electronic health records (EHRs), laying out requirements for better digital communication among doctors and expanded patient access to records, in order for doctors and hospitals to get incentive payments from Medicare and Medicaid. Advocates have said the use of EHRs has the potential to reduce medical errors and streamline care.
The Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act of 2009, provided $30 billion to eligible health care professionals and hospitals to qualify for Medicare and Medicaid incentive payments when they adopt certified EHR technology and use it in a meaningful way. CMS established the “meaningful use” program, which provides financial rewards in three stages if certain standards are met.
The first stage requires providers to begin setting up an electronic system and to record basic information including diagnoses and prescriptions for a portion of patients. Last year, CMS began awarding bonuses under Medicare and Medicaid to physicians who meet the initial set of meaningful-use requirements.
The rules proposed on February 23 start off by extending Stage 1 – providers who began compliance in 2011 would now have until 2014 to move on to Stage 2. Many of the objectives of the second stage will be the same — ordering prescriptions electronically, etc. — but the minimums for “meaningful usage” will go higher. For example, at least 60 percent of patients must have their medications and lab tests ordered electronically during Stage 2, instead of the 30 percent required during Stage 1.
Indeed, providers must prove their EHR system is capable of meeting a list of specific objectives outlined by CMS, such as having the capability of exchanging a patient’s notes, medication list, allergies, and diagnostic test results. Hospitals would have to show they’ve amassed the vital statistics of more than 80 percent of their patients in digital form, among other targets, to continue collecting the incentive payments.
The rules require systems to be able to transfer patient information across platforms. A “summary of care” — which includes past diagnoses, procedures and test results – must be able to follow patients across referrals and changes in health care provider. The information should also be available to some patients, who under Stage 2 requirements should be able to view their records online, as well as download and transfer information. Additionally, some patients must be able to communicate with their doctors through a secure, online system.
A few new initiatives, although not absolute requirements for providers, were also added in the Stage 2 rules. For example, it’s suggested that systems be able to transmit data to public health agencies and connect to registries, like those used for cancer research. Providers are also encouraged to record family health history and be able to transmit imaging results to help avoid the need for duplicate scans.
The Stage 2 rules also advance other government health initiatives. Records will be used to help measure the quality of care being provided and would be aligned with reporting requirements for accountable care organizations and other quality efforts coming out of the 2010 federal health law.
“We know that broader adoption of electronic health records can save our health care system money, save time for doctors and hospitals, and save lives,” said HHS Secretary Kathleen Sebelius in a statement. “We have seen great success and momentum as we’ve taken the first steps toward adoption of this critical technology. As we move into the next stage, we are encouraging even more providers to participate and support more coordinated, patient-centered care.”
The number of hospitals using EHRs has more than doubled in the last two years from 16 to 35 percent between 2009 and 2011, says CMS. Eighty-five percent of hospitals now report that by 2015 they intend to take advantage of the incentive payments.
The proposed regulation will be subject to a 60-day comment period after publication in the Federal Register on March 7, 2012. A second, technical rule that will describe what standards an electronic health record system must meet in order to be certified has not yet been released, but is expected to follow soon.