Sebelius Announces Final EHR Rules
Now O-HITEC can begin working with primary care providers to help develop their EHR systems
O-HITEC is one of 60 Regional Extension Centers around the country designated to offer healthcare providers a local resource for technical assistance, guidance, and information on best practices to support and accelerate provider efforts to adopt EHRs.
“For years, health policy leaders on both sides of the aisle have urged adoption of electronic health records throughout our health care system to improve quality of care and ultimately lower costs,” Secretary Sebelius said. “Today, with the leadership of the President and the Congress, we are making that goal a reality.”
Established under the HITECH Act under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, eligible health care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt certified EHR technology and use it to achieve specified objectives. One of the two regulations announced defines the “meaningful use” objectives that providers must meet to qualify for the bonus payments, and the other regulation identifies the technical capabilities required EHR products to be deemed certified.
With “meaningful use” definitions in place, O-HITEC will be working with primary care providers and their practices to ensure that the EHR system they acquire will support achievement of “meaningful use” objectives. With the announcement, a concentrated five-year national initiative to adopt and use electronic records in health care can begin.
“Our Regional Extension Center provides the needed hands-on, field support for all healthcare providers to rapidly adopt and meaningfully use health IT,” said Clayton Gillett, O-HITEC’s director. “We fill the role of trusted advisor for providers in Oregon, offering a functional combination of national insight and local expertise.”
Two companion final rules have also been announced. One regulation, issued by the Centers for Medicare & Medicaid Services (CMS), defines the minimum requirements that providers must meet through their use of certified EHR technology to qualify for the payments. The other rule, issued by the Office of the National Coordinator for Health Information Technology (ONC), identifies the standards and certification criteria for the certification of EHR technology, so eligible professionals and hospitals may be assured that the systems they adopt are capable of performing the required functions.
“As an Oregon health care provider and user of an EHR in my clinic, the ONC’s message is a win for patients and providers,” said Dr. Chip Taylor, a family physician at Gabriel Park Clinic in Portland and O-HITEC’s medical director. “EHRs make providing care easier for clinicians and better for patients.”
The CMS rule announced makes final a proposed rule issued on Jan, 13, 2010. The final rule includes modifications that address stakeholder concerns while retaining the intent and structure of the incentive programs. In particular, while the proposed rule called on eligible professionals to meet 25 requirements (23 for hospitals) in their use of EHRs, the final rules divides the requirements into a “core” group of requirements that must be met, plus an additional “menu” of procedures from which providers may choose. This “two track” approach ensures that the most basic elements of meaningful EHR use will be met by all providers qualifying for incentive payments, while at the same time allowing latitude in other areas to reflect providers’ needs and their individual path to full EHR use.
“Health care is finally making the technology advances that other sectors of our economy began to undertake years ago,” Dr. Blumenthal said. “These changes will be challenging for clinicians and hospitals, but the time has come to act. Adoption and meaningful use of EHRs will help providers deliver better and more effective care, and the benefits for patients and providers alike will grow rapidly over time.”
To Learn More
For more information on OCHIN, click here.
For more information about O-HITEC, click here.
For additional information about the Health Information Technology Regional Extension Centers, click here.
A CMS/ONC fact sheet on the rules is available here.
Technical fact sheets on CMS’s final rule are available here.
A technical fact sheet on ONC’s standards and certification criteria final rule is available here.
The final rules are available here.
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Comments
It is important to note that adopting an EHR that meets the meaningful use standard is not a mandate providers are required to adhere to. It is a mandate if qualified health care professionals who accept Medicare Part B or Medicare Advantage or qualify for the Medicaid incentives are interested in tapping into the EHR incentive dollars outlined in the American Recovery and Reinvestment Act (ARRA), Division B, Title IV.
While the incentive section of ARRA includes additional dollars for qualified health care professionals working in underserved areas, small and rural providers are still at a disadvantage. To take advantage of the incentive dollars, the provider is required to implement an EHR that meets the meaningful use requirements before they can take advantage of the incentive dollars. That means the small practice needs to pay for the application, pay for staff training, pay for data conversion (often from paper), etc. before any dollars are received as part of this federal stimulus program. This has been identified by small and rural providers as a significant barrier to moving to an EHR that can demonstrate meaningful use.
It is important to note that this is somewhat of a domino process - now that the rules are out there, vendors need to reprogram or upgrade EHRs and EMRs, those applications need to be certified by the federal government (and the CCHIT certification many already have does not count) and then providers can implement or upgrade to an EHR or EMR where the provider can demonstrate meaningful use. It is not necessarily likely that hospitals can take advantage of the incentives by October 1, 2010 and other qualified health care professionals by January 1, 2011. Implementation or an upgrade is usually not a quick and simple process.
Another barrier that is not necessarily being fully considered is all covered entity health care providers need to move to the ICD 10 diagnostic code set by 2013. A number of provider organizations will be balancing implementation and upgrade of EHRs now to an application that does not accommodate ICD 10 (that’s not a vendor requirement now) to take advantage of the incentives and upgrading again in 2012 to meet the ICD 10 conversion federal rule requirements.
Large providers will likely take advantage now by upgrading EHRs but small to medium sized providers may wait until 2013 to avoid the cost of a second upgrade, more training, data conversion, etc. The conversion to ICD 10 is significant and will be very costly to the healthcare industry.
Another barrier to moving to “meaningful use” sooner rather than later is the low Medicare reimbursement in Oregon. As one Eugene specialist told me, he does not take Medicare patients so the “stick” built into the incentive language (a reduction of Medicare reimbursement 1% per year) has not impact. As he said, “A reduction of 1% of zero is still zero. Why should I spend the money?”
Chris Apgar, CISSP
Chair, Oregon & SW Washington Healthcare, Privacy & Security Forum
President, Apgar & Associates, LLC
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