Feds give break on electronic health records

Healthcare providers get a special 3 month reporting period in 2014

The Office of the National Coordinator for Healthcare IT has published the final electronic health records (EHR) certification criteria for Stage 2 of Meaningful Use, and there was one significant change: additional time for meeting the deadline.

Not unexpectedly, the final rules for Stage 2 of the "Meaningful Use" of EHRs will require patients get involved in using the technology in order for providers to get reimbursement funds.

The U.S. government's Centers for Medicare & Medicaid Services (CMS) established an original timeline that would have required Medicare providers who first demonstrated Stage 1 of meaningful use in 2011 to meet the Stage 2 criteria in 2013.

The Stage 2 final rules, published today, however, give providers more time to meet the criteria.

Under the change, a provider that attested (demonstrated) to Stage 1 of meaningful use in 2011 would attest to Stage 2 in 2014, rather than in 2013.

CMS also created a special 3 month reporting period rather than the standard 12 months to allow providers attesting to Stage 1 or Stage 2 in 2014 time to implement or to upgrade newly-certified EHR technology. The reduced reporting period will give providers time to meet Stage 2 requirements without delaying Stage 3 participation, according to Dianne Bourque, a health law attorney at Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C. in Boston.

"CMS is recognizing that vendors will need time to develop certified electronic health record technology," Bourque said in an email response to Computerworld

"CMS has tried to reduce hurdles for certain providers and allow more to achieve meaningful use by expanding exceptions to payment adjustments. For example, there are now exceptions for providers who lack broad band internet access, or who have been victims of natural disasters," Bourque added. "There are also exceptions for providers who lack face-to-face contact with patients, such as pathologists."

While some timeline modifications were lauded, others were a disappointment for members of the American Hospital Association (AHA). Linda Fishman, senior vice president of public policy analysis & development at the AHA, said she her organization appreciates "that CMS has allowed for a shorter meaningful use reporting period for 2014."

But "we are disappointed that this rule sets an unrealistic date by which hospitals must achieve the initial meaningful use requirements to avoid penalties," she wrote in a statement issued last night. "In addition, CMS complicated the reporting of clinical quality measures and added to the meaningful use objectives, creating significant new burdens."

The final rules, which are the guidelines to receive reimbursement money and avoid Medicare penalties, require hospitals, clinics and private physician offices to be able to share patient information electronically with other unaffiliated facilities.

By 2016, there will be three sets of rules that the healthcare community must follow in rolling out EHRs in order to receive reimbursements and avoid penalties.

"Stage two of the Meaningful Use rules program will begin as early as 2014. No providers will be required to follow the Stage 2 requirements outlined in the final rules before 2014," a a separate news announcement released on Thursday stated.

For 2014 only, providers that are beyond the first year of demonstrating meaningful use will have a three-month quarter reporting period to allow an additional up to nine months to upgrade certified EHR technology to the 2014 "Stage 2" edition.

Bourque said CMS did respond to provider concerns about requirements for online access to health information by patients and secure messaging between providers and patients, "both of which create their own practical concerns."

"CMS has reduced the requirement from 10% to 5% of the patient population in recognition of these concerns. CMS believes that 5% is reasonable and that online access to health information and real time communication with providers will promote patient engagement," Bourque said.

Just as with Stage 1 rules, which were published in July of 2010, under Stage 2 criteria, clinicians must meet (or qualify for an exclusion) to more than a dozen core objectives and choose from another menu of objectives. Among the changes: Offering lab results in EHRs is no longer an option; It is now a core requirement.

The final Stage 2 rule adds "outpatient lab reporting" to the menu for hospitals and "recording clinical notes" as a menu objective for both physicians and hospitals. There will be 20 measures for "eligible providers" (17 core and three of six menu items) and 19 measures for eligible hospitals and critical access hospitals (16 core and three of six menu).

Among other Stage 2 rules, healthcare providers must offer outpatients access to updated information on EHRs no longer than four business days after the data is available to the healthcare provider. Additionally, more than 50% of all patients who are discharged from the inpatient or emergency department must have their information available online within 36 hours of discharge.

To spur provider commitment to electronic exchange, CMS had initially proposed two measures in Stage 2. The first measure required that a provider send a summary of care record for more than 65% of transitions of care and referrals. In the final rule CMS is reducing the first measure to a lower threshold of 50%.

Hospitals, clinics and private practices must also prove at least 10% of their patients are actually accessing healthcare information on EHRs. That includes radiological imaging results, which can be accessed directly in an EHR or through a link in the records to the images.

Additionally, any EHR system must have the capacity to provide clinical decision support, include patient demographic and clinical health information such as medical history and problem lists, and have the capacity to support physician order entry.

And all EHR systems must have the capacity to protect the patient confidentiality, integrity, and availability of health information stored and exchanged.

Lucas Mearian covers storage, disaster recovery and business continuity, financial services infrastructure and healthcare IT for Computerworld. Follow Lucas on Twitter at @lucasmearian or subscribe to Lucas's RSS feed. His e-mail address is lmearian@computerworld.com.

See more by Lucas Mearian on Computerworld.com.

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