Full Steam Ahead: Health IT Policy Committee Reviews Electronic Health Record Rules

In an effort to meet its ambitious deadline schedule, the Health IT Policy Committee (HITPC) recently met and reviewed the Notice of Proposed Rulemaking (NPRM) for the Electronic Health Records (EHR) Incentive Program for Medicare and Medicaid.

One key, as-yet undetermined, element of NPRM is the definition of "meaningful use" of EHR. The HITPC plans to define meaningful use through three stages of rulemaking, according to a timeline presented by Anthony (Tony) Trenkle, Director, of the Office of E-Health Standards and Services (OESS) in the Centers for Medicare and Medicaid Services (CMS), Department of Health and Human Services (HHS), and Farzad Mostashari, MD MPH, Assistant Commissioner Primary Care Information Project for New York City Department of Health and Mental Hygiene and Office of the National Coordinator. Medical providers will be eligible for reimbursement if their EHRs fully meet the federal government's meaningful use criteria.

According to the timeline - released on Dec. 30, 2009 - Stage 1 implementation of meaningful use rulemaking will begin in 2011. That stage consists of 25 objectives for eligible professionals (EPs), eight measures require votes of ‘Yes’ or ‘No,’ and 17 are quantitative. EP quality measures will include preventive care and screening, blood pressure management, and geriatric patients who have been prescribed certain medications.

Hospitals and critical-access hospitals (CAHs) only eligible for Medicaid will report directly to the states. Hospitals and CAHs receiving Medicare reimbursement are required to report summary data to CMS on 43 clinical quality measures. These include:

• Surgical Care Improvement Project (1 measure) 
• Hospital readmissions (3 measures) 
• Nursing care (4 measures)
• Patient Safety (5 measures) 
• Inpatient quality indicators (4 measures) 
• Venous thromboembolism (6 measures) 
• Stroke measures (5 measures) 
• Cardiac surgery (15 measures) 

To received Medicare incentive payments CMS will require EPs, hospitals and CAHs to provide a summary of quality measure data in 2011. The following year, EPs, hospitals and CAHs will electronically submit data to CMS. CMS rulemaking will define future plans for Stages 2 and 3 of meaningful use, according to Trenkle and Mostashari.

Proposed Stages of Meaningful Use Timeline Source:

Health IT Policy Committee presentation "Overview of the NPRM on EHR Incentive Program for Medicare and Medicaid"