Here’s my analysis of the key changes in the Final Rule:

1. HHS has adopted the HIT Policy Committee recommendation to frame Meaningful Use as core requirements and discretionary requirements. In so doing, they have reduced the total number of requirements and introduced choice.

In the NPRM there were 25 requirements for Eligible Professionals and 23 for hospitals.

In the Final Rule there are 15 core requirements for Eligible Professionals and 14 for hospitals.

There are 10 discretionary requirements from which 5 must be chosen.

2. Thresholds have been reduced in many cases. For example, CPOE had a threshold of 80% of orders for Eligible Professionals and 10% of orders for hospitals. The language in the final rule focuses on order entry of medications and requires that 30% of patients with medication orders to have at least 1 medication order entered electronically. This requirement applies to both Eligible Professionals and Hospitals.

3. Administrative Simplification has been postponed to Stage 2.

4. Decision Support rules changed from 5 to 1

5. Required Clinical quality measures have been reduced to 6 for professionals and 15 for hospitals. For professionals, there are 3 core measures required, 3 alternative core measures, and a choice of 3 from a pool of discretionary measures. Reporting by attestation is required in 2011, electronic reporting is required in 2012. Clinical quality measurements for specialists have been eliminated for stage 1. There has been great effort to align meaningful use with PQRI measures.

6. The NPRM did not include the recording of advanced directives or a provision for providing patients with educational materials. The final rule includes these as discretionary meaningful use requirements.

Overall this final rule maintains a balance between the policy objectives sought and the technology changes possible that are achievable now. There will still be 3 stages of meaningful use and later stages will be more demanding. All the original stage 1 requirements will still be part of meaningful use by stage 2.

In January of 2011, the clinicians may begin the 90 day process of using a certified record per meaningful use requirements. Attestation of this use begins in April 2011. CMS payments will begin May 2011.

ONC also released the final rule on Standards and Certification today. They have done a remarkable job adding detailed implementation guidance specificity for patient care summaries, public health laboratory reporting, syndromic surveillance, and immunizations. It’s a tricky balance to ensure there is enough specificity to test and certify EHRs and modules for interoperability while at the same time encouraging innovation. The final rule issued today achieves that balance perfectly, ensuring that only mature implementation guides are specified, leaving room for innovation in such as areas as how to transport data from point to point via NHIN Direct and other demonstration projects.

Overall, a very good day for ONC, HHS and stakeholders. The final rule means Meaningful Use will be achievable by many. The Standards and the process to certify their use are sufficiently specific. I’m impressed.

Source :- http://www.healthcareitnews.com/blog/meaningful-use-and-standards-are-finalized

The 864-page final rule, several weeks late from its anticipated delivery before June 21, outlines the specific qualifications providers must meet to achieve the meaningful use of electronic health records.

At a news conference Tuesday morning, federal healthcare officials praised the advance of electronic health records, while acknowledging the difficulties providers face at the onset of adoption.

According to David Blumenthal, MD, national coordinator for health information technology, the final rule differs from the proposed rule issued last January: It allows providers more flexibility in choosing which measures to use for qualifications.

According to Blumenthal, the proposed rule required doctors to comply with 23 measures, and hospitals 25 measures. The government received more than 2,000 comments on the rule, many of them asking for more flexibility in allowing clinicians to qualify.

Blumenthal said the final rule took those comments into account. The final rule requires doctors to comply with a set of 15 core objectives during the first year - or Stage 1- of adoption. Hospitals are required to comply with 14 core objectives. In addition to the core objectives, both hospitals and doctors will have to choose five more objectives from a “menu” of 10, he said. The remaining objectives will be deferred to Stage 2 of adoption.

The final rule also reduced the number of electronic prescriptions a doctor is required to make from 75 percent to 40 percent, Blumenthal said.

Kathleen Sebelius, Department of Health and Human Services Secretary, said the Federation of American Hospitals is an “enthusiastic supporter” of the new rule. The federal government hopes other groups will join them, she said.

Blumenthal, a physician, said he is confident the use of electronic health records will become a core professional competency among physicians, who will eventually lead the way in adoption. Until then, the government will encourage healthcare IT adoption through financial incentives, such as these set up under the meaningful use rule. The government will also supply “shoulder-to-shoulder” support for providers through the regional extension centers.

Key changes in the final CMS rule include:

• Greater flexibility with respect to eligible professionals and hospitals in meeting and reporting certain objectives for demonstrating meaningful use. The final rule divides the objectives into a “core” group of required objectives and a “menu set” of procedures from which providers may choose any five to defer in 2011-2012.  This gives providers latitude to pick their own path toward full EHR implementation and meaningful use.
• An objective of providing condition-specific patient education resources for both EPs (eligible providers) and eligible hospitals and the objective of recording advance directives for eligible hospitals, in line with recommendations from the Health Information Technology Policy Committee.
• A definition of a hospital-based EP as one who performs substantially all of his or her services in an inpatient hospital setting or emergency room only, which  conforms to the Continuing Extension Act of 2010
• CAHs (critical access hospitals) within the definition of acute care hospital for the purpose of incentive program eligibility under Medicaid.

A CMS/ONC fact sheet on the rules is available on the CMS Web site.

Source :  http://www.healthcareitnews.com/news/flexibility-built-final-rule-meaningful-use

Source of Funding

HHS in April announced $144 million in grants to target health IT research and work force development.

Funding was disbursed through the 2009 federal economic stimulus package (iHealthBeat, 4/5).

Breakdown of Plans

For the training, HHS has designed a curriculum to educate individuals with a health care or IT background for 12 specific roles.

The programs fall into two groups:

• A six-month program; and
• A one- to three-year training program for more advanced administrative and technical roles, such as senior clinician leaders and privacy and security specialists.

Graduates will receive a certificate in their specialties, and each school will receive approximately $1 million to implement the curriculum.

Regional Extension Centers

A large focus of the effort will be dedicated to training staff to work at 60 regional extension centers, which will help rural institutions and small physician practices install EHR systems.

The centers are expected to employ up to 30 trained workers, who will:

• Assist health care providers with reimbursement procedures;
• Assess a facility’s health IT infrastructure;
• Suggest compatible EHR systems;
• Oversee system installation;
• Analyze workflow; and
• Determine if EHR deployment meets federal “meaningful use” standards (ComputerWorld, 7/16).

Source: http://www.ihealthbeat.org/articles/2010/7/16/groups-preparing-ways-to-use-hhs-grants-for-it-training-programs.aspx

Officials also released the final rule describing the required standards and certification criteria for EHR technology. The new regulation updates the interim final rule on EHR certification that ONC released in January (Mosquera, Government Health IT, 7/13).

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHRs will qualify for incentive payments through Medicaid and Medicare.

HHS Secretary Kathleen Sebelius, new CMS Administrator Donald Berwick, National Coordinator for Health IT David Blumenthal and Surgeon General Regina Benjamin announced the rules during a news conference (Health Imaging & IT, 7/13).

Core Meaningful Use Objectives

Blumenthal said the final meaningful use rule offers health care providers more flexibility than the proposed regulations released in January.

The final rule requires physicians to meet a set of 15 core objectives during the first stage of the incentive program. Hospitals are required to meet 14 core objectives for Stage 1. In addition, all health care providers will need to comply with five objectives out of a “menu” of 10 options (Manos, Healthcare IT News, 7/13).

The earlier proposed rule included 25 objectives for physicians and 23 objectives for hospitals.

One of the core objectives requires health care providers to transmit 40% of prescriptions electronically. The requirement was relaxed from the earlier proposed regulations, which called for a 75% electronic prescribing rate.

Health care providers also will need to enact a single measure to meet the clinical decision support requirement, down from five measures in the previous proposal.

In addition, CMS reduced the number of quality measures that health care providers must report on, deferring some measures to Stage 2 meaningful use requirements (Versel, FierceEMR, 7/13).

Another core objective requires hospitals and physicians to use computerized physician order entry systems to capture at least 30% of medication orders. Under the earlier regulations, hospitals would need to use CPOE systems for 10% of medication, laboratory and diagnostic orders, while doctors would need to use the systems for 80% of such orders (Robeznieks, Modern Healthcare, 7/13).

‘Menu’ of Additional Options

In addition to the core objectives, the final rule requires doctors and hospitals to comply with five objectives out of the menu of 10 options. Health care providers will need to comply with the remaining objectives as part of Stage 2 meaningful use requirements (Healthcare IT News, 7/13).

One of the new objectives in the menu calls for health care providers to offer patients condition-specific educational resources.

Clarifications on Eligibility

The final meaningful use rule defines a hospital-based eligible professional as someone who performs nearly all services in an inpatient hospital setting or emergency department.

The rule also expands the definition of acute-care hospital to include designated Critical Access Hospitals for the Medicaid incentive program (Health Imaging & IT, 7/13).

Additional Information in NEJM Piece

Blumenthal and Marilyn Tavenner, principal deputy administrator of CMS, offered additional explanations of the final meaningful use rule in a New England Journal of Medicine perspective piece.

In the perspective piece, Blumenthal and Tavenner explain that HHS weighed 2,000 outside comments before deciding on “significant changes” to the earlier meaningful use regulations.

The piece also includes a full list of the core objectives and the menu of options for the new final rule (Hobson, “Health Blog,” Wall Street Journal, 7/13).

In addition, Benjamin authored a companion piece that also appeared in the journal (FierceEMR, 7/13).

Next Steps

In January 2011, eligible health care providers and hospitals can begin registering for the EHR incentive program. CMS will manage the registration for both the Medicaid and Medicare incentive programs from one virtual location.

Federal officials expect to release additional information on the Stage 2 and Stage 3 meaningful use requirements over the next few years (Mearian, ComputerWorld, 7/13).

Source:http://www.ihealthbeat.org/articles/2010/7/13/final-rules-on-meaningful-use-ehr-standards-released-today.aspx

HHS has sent its final meaningful-use rules and certification criteria for electronic health-record system testing to the Office of Management and Budget—typically one of the last bureaucratic hurdles before rules are released. The criteria are called for under the EHR subsidy program established by the American Recovery and Reinvestment Act of 2009.

OMB received a copy of the final rule of the “meaningful use” criteria from the CMS Monday, according to the posting on the website of its Office of Information and Regulatory Affairs.

The White House budget authority also received a copy of the final rule on an initial set of standards, implementation specifications and certification criteria from HHS on July 2.

Under the Medicare provisions of the stimulus law, to receive an estimated $14 billion to $27 billion in federal subsidies for EHR purchases, hospitals and qualifying office-based physicians must use certified EHRs in a “meaningful manner.”

Robert Tennant, the Washington, D.C.-based senior policy adviser to the Medical Group Management Association, Englewood, Colo., said he expects a quick turnaround on both rules.

“By law, they have 90 days in which to review, but I think in all practicality, OMB has been involved in the drafting of the final rules, so it’s no surprise when they get them,” Tennant said.

OMB has had HHS’ controversial final rule on the federal requirement on public and patient notification in the event of a breach of personally identifiable health information since May 15. Tennant said he expects both recently submitted rules to be released in a week or so, possibly even later this week.

Tennant also said a proposed healthcare IT privacy rule just left the OMB review list, so “it should be published in the next couple of days.”

Source:http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20100706/NEWS/307079976/1153#

Under the 2009 federal economic stimulus package, health care providers who demonstrate “meaningful use” of certified EHR systems will qualify for federal incentive payments.

ONC issued the final rule on the temporary testing and certification program on June 18, and the rule appeared in the Federal Register on June 24.

The stimulus package gave ONC the option of retaining the Certification Commission for Health IT as the sole EHR certification group or recognizing a new organization, according to Modern Healthcare. ONC opted to expand its search for a new group, and CCHIT has joined a pool of applicants for the distinction.

Carol Bean, a standards harmonization analyst for ONC, said HHS to date has received about 40 application inquiries and 14 requests for applications. She said ONC has 30 days after receiving an application to decide whether the organization qualifies as an “authorized testing and certification body” under the temporary certification program.

The final rules for the permanent authorization program have not yet been released, although a proposed rule was issued in March (Conn, Modern Healthcare, 7/1).

Source:http://www.ihealthbeat.org/articles/2010/7/2/onc-starts-accepting-applications-for-ehr-certification-groups.aspx

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of EHRs will qualify for Medicare and Medicaid incentive payments (Mosquera, Government Health IT, 6/21).

Website visitors can download fact sheets detailing the proposed program requirements and the proposed definition of meaningful use.

The site also clarifies various terms, such as “eligible professional” and “certification,” that are included in the HITECH Act (McKinney, Modern Healthcare, 6/21).

In addition, the site includes:

• An overview of the incentive program;
• Information about what health care providers are eligible for incentive payments;
• Information on how to register for the program; and
• Guidance on what health care providers can do to prepare for meaningful use.

CMS also said that it would use the website to publicize EHR training and events related to the incentive program (Government Health IT, 6/21).

According to Modern Healthcare, the website will offer more specific information about the incentive eligibility requirements after CMS issues the final rule on the EHR incentive programs later this summer (Modern Healthcare, 6/21).

Source: http://www.ihealthbeat.org/articles/2010/6/22/cms-unveils-new-website-on-meaningful-use-incentives.aspx

West Virginia has received $6 million in federal stimulus funds to establish a regional health information technology extension center.

The center has been designated as the statewide organization to provide education, training and support services to help the state’s primary-care providers implement and meaningfully use health information technology for the purpose of improving patient outcomes.

“It should be active this summer,” said an aide to West Virginia Gov. Joe Manchin, who along with other local and state officials announced on June 8 the effort to help primary-care doctors adopt electronic health.

The American Recovery and Reinvestment Act of 2009, also known as the stimulus law, mandates that providers meaningfully use an electronic health-record system to qualify for up to an estimated $27.3 billion in federal reimbursements.

To help physicians become eligible for these incentive payments, the center will, among other initiatives, provide assistance in the selection and purchasing of electronic health-record systems, project management and implementation services, and guidance on privacy and security matters.

“West Virginia remains a national leader in the adoption of health information technology, and this statewide health information-technology extension center will be another key component of our ongoing efforts to use technology to improve the health of our citizens,” Manchin said in a written statement. “This project is the latest example of how West Virginia is working to modernize its healthcare delivery system in order to improve overall healthcare, enhance efficiencies and facilitate greater information-sharing between physicians and patients,” he said.

Source:http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20100609/NEWS/100609949

CHICAGO – Officials of HIMSS Analytics, the not-for-profit subsidiary of the Healthcare Information and management System Society (HIMSS), announced Wednesday they would be adding new questions to their annual study on meaningful use to gauge hospitals’ readiness.

With hospitals expected to complete the first phase of deadlines for meaningful use by 2011 to qualify for bonuses under the American Recovery and Reinvestment Act of 2009, HIMSS Analytics will ask hospitals about their inclusion of structured document standards to convert narrative data to a structured format importable to an electronic medical record (EMR).

HIMSS Analytics tracks the EMR implementation status of more than 5,000 U.S., non-governmental hospitals through its annual study with hospital CIOs. The data gathered provides a detailed look at the clinical and financial application environments in U. S. hospitals.

HIMSS Analytics also developed the Electronic Medical Record Adoption ModelSM - or EMRAM - to score hospitals in the HIMSS Analytics Database on their .progress in completing the eight stages to creating a paperless patient record environment.

“In our evaluation of EMR Adoption Model scores over 2008-2009, we found that hospitals are continuing to advance the care delivery capabilities of their EMR environment,” said John Hoyt, vice president of HIMSS Healthcare Organizational Services.

“ARRA funding incentives are driving EMR implementation,” Hoyt said. “With this expanded arsenal of data, HIMSS Analytics can help healthcare providers better understand and follow the Meaningful Use requirements while moving higher on the EMRAM scale.”

According to Liora Alschuler executive committee representative of the Health Story Project, which helped write the new questions for HIMSS Analytics, much of the information in a patient’s medical record may be entered by the physician or nurse in chart form, such as notes taken during a clinic visit, lab reports or other information that contributes to the completeness of individual health history.

Health Story produces data standards for the flow of information between common types of healthcare documents and electronic medical records, Alschuler said.

Alschuler, principal, at Alschuler Associates, LLC, said the Health Story standards are based on HL7 Clinical Document Architecture reusing templates from the Continuity of Care Document. The Health Story Project, founded a little over two years ago, is a nonprofit collaborative of healthcare vendors, providers and associations.

“The members of Health Story believe that all of the clinical information required for good patient care, administration, reporting and research should be readily available electronically, including information from narrative documents,” Alschuler said. “With the data gathered from the HIMSS Analytics Study, we will know how hospitals are using document standards to enrich the flow of information to their EMRs.”

Officials at HIMSS Analytics said they expect to begin reporting on hospital readiness for meaningful use in September 2010.

Source: http://www.healthcareitnews.com/news/himss-analytics-gauge-hospital-readiness-meaningful-use

EHNAC, a not-for-profit standards group, issued the recommendations in response to the Office of the National Coordinator for Health IT’s Notice of Proposed Rulemaking on EHR certification.

ONC’s proposed rule calls for the establishment of a temporary EHR certification program, which eventually would be replaced by a permanent certification program. The temporary program would allow ONC-authorized certification bodies to test and certify EHRs and EHR modules.

Recommendations

EHNAC officials said the group is concerned that the current definition of ONC-authorized certification bodies would exclude EHNAC and other organizations from consideration as certifiers of health information exchanges.

The group said its recommendations would enable EHNAC to be named a health data exchange certifier without needing official designation as an EHR certifier.

In its recommendations, EHNAC called for ONC to:

• Allow certifiers to establish a “virtual” office for conducting certification tasks;
• Extend the deadline for organizations to develop certification programs to encourage more groups to apply for designation as temporary certifiers;
• Eliminate unscheduled site visits and provide organizations with sufficient time to prepare for planned visits; and
• Refrain from considering a certified testing program a necessary requirement for the certification of health IT products (Monegain, Healthcare IT News, 5/25).

Above article publish on http://www.ihealthbeat.org/articles/2010/5/25/standards-organization-calls-for-onc-to-revisit-ehr-certification-rule.aspx