Everyone seems to have an opinion, or at least has written something, about the final Meaningful Use (MU) Rules that were released on July 13th. Of the multitude of posts and articles out there on the net, there the top three to get you started are:
1) ONC Chief, David Blumenthal’s article in the New England Journal of Medicine that was published on the same day wherein Blumenthal provides a clear abstract of the rules (the actual rules are 864 pgs in length and not a bad read if you have the time) in a easy to read and understand format.
2) Next, head over to the Dell website for a post by their own Dr. Kevin Fickenscher who gives an excellent background on the broader HITECH Act, the origination of the MU rules as well as taking a look at companion rules for Certification of EHRs and the new Privacy & Security rules that were also recently released.
3) Last, but certainly not least is a visit to John Halamka’s site where he provides a freely available, with no need to provide attribution, deck of slides that gives the big picture view of the final MU rules.
With such great resources out on the net, we at Chilmark Research see little need to write an in-depth review of these rules. That being said, we will provide some quick points of analysis.
1) Clearly, HHS listened to the market and the 2,000 comments it received and has relaxed the final MU rules significantly. If any provider or hospital is still complaining, well they may be the type to complain no matter what. These rules, while still challenging for some, are certainly doable. Time to stop talking and get down to work.
2) Thankfully, probably to the chagrin of payers, the requirements to conduct administrative functions (eligibility checking and claims processing) from within the EHR has been removed. This has always been a fairly silly requirement as today, much of this process is already done electronically through the Patient Management (PM) system. So no need to duplicate it within the EHR, besides which it would have been tough for many an EHR company to build out this functionality in such a relatively short timeframe.
3) The consumer engagement sections of the MU rules also saw some relaxation, but it was reasonable. What may prove more interesting here is the new requirement within the certification rules for EHRs that they provide health education resources for consumers within the context of their platform. This may prove to be a real money maker for the likes of health content providers such as A.D.A.M, Healthwise, WebMD, among others.
4) While understandable that there was some pull-back on health information exchange as we saw in the draft MU rules, we were quite surprised that it was completely eliminated in the final rules for Stage 1. HHS claims that this was done due to the lack of maturity in the HIE market. Well, yes and no. There indeed may not be a lot of multi-stakeholder, publicly-led HIEs today that are actively exchanging data, whether regional or state level, but there is a robust market for private HIEs. It is unfortunate that HHS pulled back on this one for “information sharing for care coordination” was one of the primary precepts of the original HITECH legislation. Sure, will likely see something within Stage 2, but that does not get clinicians familiar with the concept today.
5) What really caught us by surprise is a reference in the MU rules (pg 39 to be exact) wherein HHS states that they will not discuss the future direction of Stage 3 at all. Nothing. Nada. Does this portend a complete pull-back from Stage 3? Hard to say, but it is clear that HHS wants to see how well Stages 1 & 2 go over in the market before it makes any further demands on providers and the EHR vendors that serve them.
6) Along with the release of MU rules, HHS also released the final rules for EHR certification. While having not delved into these deeply, yet, the whole concept of “certification” is fraught with challenges, primary among them, technology lock-in. It is here where Chilmark believes we will see the greatest challenges to indeed create an environment that fosters innovation, providing clinicians with tools they will readily wish to use while at the same time providing some level of certification. Frankly, we do not believe it can be done. Congress really wrapped an albatross around the neck of HHS when they wrote that into the legislation.
What were they thinking?
Great writeup. I’m going to add it to my list of Meaningful Use links: http://www.emrandehr.com/2010/07/15/meaningful-use-final-rule-links/
I’m also working to create a list of meaningful use webinars if you know of any others I’d love to add them: http://www.emrandhipaa.com/emr-and-hipaa/2010/07/15/list-of-webinars-on-meaningful-use/
I second John – great post! The Dell article is especially informative.
For #6 – If you want the perspective of an EHR vendor tackling the certification process head-on, I’d be glad to connect you with our CMO. We just had a key certification meeting this morning.
Based on conversaations with a EHR vendor, my understanding is that on the required 10 measures, if they do not apply to your specialty, you can report them with a denominator of zero and therefore be in compliance. Do you have any information about this or is there any way to confirm that? For specialties such as ophththalmology or dermatology, recording blood pressures, pulses, etc usually is just not relevant or part of accepted medical practice.
Not knowing your answer right off-hand, we contacted our friends at SRS Soft, an EMR company who specializes in practices such as ophthalmology. Their VP of governmental affairs, Lynn Scheps, who has read the entire 864pg MU document provided this response:
First of all, I’m sure the vendor the person spoke to meant to say 15, not 10 required measures. That said, an EP can only exclude a measure “if the objective includes an option for the EP to attest that the objective is not applicable,” per page 767 of the Final Rule, and only the following 6 of the 15 core measures include this option (details begin on page 769):
CPOE can be excluded only if EP writes fewer than 100 Rx during the reporting period
ePrescribe – same exclusion
Record and chart vital signs – if EP believes that all 3 vital signs are not relevant to scope of practice or see no patients over 2
Record smoking status – if EP sees no patients over 13
Provide patients with electronic copy of health information – if EP receives no requests for this info
Provide clinical summaries for each office visit – if EP has no office visits
For the Clinical Quality Measures requirement, you have to report on 6 in total, and according to the CMS call I just listened to today, you can report zeros for the denominators if you cannot find measures that apply. Dermatology is a prime example of a specialty with no relevant quality measures.
Trust this answers your question(s) David with regards to the new MU rules and specialty practices.