CIOs, Others React To Meaningful Use Final Rule - InformationWeek

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CIOs, Others React To Meaningful Use Final Rule

Most healthcare stakeholders are reacting positively, so far, to the feds' meaningful use final rule, but not everyone is pleased.

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While CIOs, vendors and other health IT stakeholders are still poring over the 864-page e-health meaningful use final rule released this week by the Dept. of Health and Human Services, reaction so far to the HITECH Act's $20 billion-plus financial incentive program's regulations has been mostly positive.

That's mainly because HHS and its various advisory committees took to heart the gist of many of the approximately 2,000 comments it received from the public -- including hospitals, nurses, doctors, medical associations and patients -- during the crafting processes of the final rule.

The outcome: Compared with HHS' proposed rule released in January, the final rule announced this week is a more flexible, less onerous set of criteria that healthcare providers will need to meet in order to qualify for financial incentives during the meaningful use program's Stage 1, in which reward payments begin in 2011.

HHS essentially dumped its original "all or nothing" approach to the incentive program as written in its proposed rule which required "eligible professionals," such as doctors and nurse practitioners, to meet 25 requirements and hospitals 23, as well as steep "thresholds" of measures in their use of health IT systems.

Under the original proposals, healthcare providers would only qualify for the financial rewards by meeting all those criteria and measures. Success at some or most of the requirements would not be rewarded at all.

However, under the modified final rules, eligible professionals need to meet only 15 core requirements and hospitals 14. In addition, some of the threshold measures in those core requirements were also lowered to make them more easily achievable.

For instance, a previous requirement related to the meaningful use of computerized physician order entry, or CPOE, said that 80% of an eligible professional's orders (for medical tests, referrals, etc.) needed to be done electronically. That was requirement was loosened. Under the new modified rule, eligible professionals must order at least one drug via CPOE for 30% of their patients.

That change makes the CPOE requirement more doable for doctors during Stage 1, while still addressing patient safety and quality of care, which is huge goal of the HITECH programs, said Dr. David Blumenthal, national coordinator for health IT.

"Ordering medication with CPOE really reduces medication error…there is really strong evidence of that," said Blumenthal in an interview this week with InformationWeek. So, rather than require all orders, such as test and referrals to be done electronically in Stage 1, "we focused on medications and said, 'let's get them started on putting in an electronic order for a third of their patients to start,'" he said.

In addition to the core requirements, eligible providers and hospitals also meet five objectives from a menu of 10 objectives. Since hospitals and doctors practices and their specialties aren't all the same, that menu lets healthcare providers focus on areas where they are stronger or can more easily achieve a goal.

According to final rule documents, among the menu of objectives from which healthcare providers can choose to tackle during Stage 1 is "generating lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach" and also "incorporating more than 40% clinical lab results in certified e-health records as structured data"

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