By 2014, hospitals and physicians whom Medicare reimburses for services and items will need to have adopted an electronic health record (EHR) according to rules promulgated under the Health Information Technology for Economic and Clinical Health Act (HITECH) or risk reductions in their Medicare reimbursement. On December 30, 2009, the Office of National Coordinator for Health Information Technology (ONC) and the Centers for Medicare and Medicaid (CMS), under the auspices of the U.S. Department of Health & Human Services (HHS), released their respective proposed rules for qualifying for EHR stimulus funds under HITECH: The “meaningful use” and “certified” EHR standards. 

Under HITECH, hospitals and physicians must make a “meaningful use” of a “certified” EHR in order to qualify for the EHR stimulus funds. Such meaningful use must be demonstrated in each year for which stimulus funds are available.  HITECH directs HHS to re-evaluate the “meaningful use” and EHR certification standards each year and to increase or refine the standards as necessary to meet the objective of having an interoperable EHR before 2015.  The ONC standard addresses the implementation and certification standards that an EHR must meet to qualify. The CMS standard defines and specifies how to demonstrate meaningful use of the certified EHR.

The first year for which providers can qualify for stimulus funds is 2011.*(See post-script below.)  Here is how CMS summarizes the first year’s “meaningful use” standard:

The proposed Stage 1 criteria for meaningful use focus on electronically capturing health information in a coded format, using that information to track key clinical conditions, communicating that information for care coordination purposes, and initiating the reporting of clinical quality measures and public health information.

The proposed criteria for meaningful use are based on a series of specific objectives, each of which is tied to a proposed measure that all EPs [eligible professionals] and hospitals must meet in order to demonstrate that they are meaningful users of certified EHR technology.

For Stage 1, which begins in 2011, CMS proposes 25 objectives/measures for EPs and 23 objectives/measures for eligible hospitals that must be met to be deemed a meaningful EHR user. 

In 2011, all of the results for all objectives/measures, including clinical quality measures would be reported by EPs and hospitals to CMS, or for Medicaid EPs and hospitals to the states, through attestation.

In 2012, CMS proposes requiring the direct submission of clinical quality measures to CMS (or to the states for Medicaid EPs and hospitals) through certified EHR technology.  CMS recognizes that for clinical quality reporting to become routine, the administrative burden of reporting must be reduced. By using certified EHR technology to report information on clinical quality measures electronically to a health information network, a state, CMS, or a registry, the burden on providers that are gathering the data and transmitting them will be greatly reduced.  The burden of generating the necessary information for the provider to then use the information to improve health care quality, efficiency, and patient safety will also be reduced.

The proposed CMS rule and fact sheets can be found here.  The proposed ONC rule and additional information about the certification standards can be found on the ONC HIT webpage here.

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 *When Can Hospitals and Physicians Start Qualifying for the Stimulus Payments?  CMS’ proposed rule for “meaningful use” goes into some detail regarding the qualification period and when hospitals and EPs can first qualify for EHR stimulus payments.  First, CMS proposes using the calendar year as the stimulus “payment year” under both Medicare and Medicaid EHR stimulus programs for all eligible professionals (EPs). CMS proposes using the fiscal year as the stimulus “payment year” under both Medicare and Medicaid EHR stimulus programs for all eligible hospitals. Accordingly, for hospitals, the “2011 payment year” for Medicare program stimulus payments begins on October 1, 2010, and for EPs, the “payment year” begins on January 1, 2011. 

However, CMS has added a twist.  For the “2011 payment year,” hospitals and EPs need only demonstrate meaningful use of their EHR for a 90-day period.  For hospitals, the 90-day period for the first payment year can be any 90 days from October 1, 2010 through September 30, 2011.  For EPs, the 90-day period can be any 90 days from October 1, 2010 through December 31, 2011.  Under the Medicare stimulus program, due to the limited time available for CMS to finalize the rules and get the program up and running, the first 90-day period of “meaningful use” that CMS will consider for either hospitals or EPs cannot begin before October 1, 2010.  Accordingly, both hospitals and EPs who are ready to demonstrate “meaningful use” from October 2, 2010 through December 31, 2010, can qualify for the 2011 payment year stimulus on January 1, 2011.  The last 90-day period that hospitals can demonstrate meaningful use for the 2011 payment year will be from July 3, 2011 through September 30, 2011, the last day of the Federal fiscal period. EPs will have until October 2, 2011 through December 31, 2011, the last day of the 2011 calendar year, to demonstrate meaningful use for the 2011 payment year.

For the succeeding payment years (2012, 2013, 2014, etc.), “meaningful use” must be demonstrated for the entire “payment year” (fiscal for hospitals and calendar for EPs).  Accordingly, for hospitals, for which the fiscal year begins on October 1, meaningful use for the 2012 payment year must be demonstrated from October 1, 2011 through September 30, 2012. For EPs, who are subject to a calendar year, meaningful use for the 2012 payment year must be demonstrated from January 1, 2012 through December 31, 2012. (Note that eligible hospitals and EPs do not have to qualify during the first possible “payment year” in order to receive EHR stimulus; however, if they do start in a later payment year, their total stimulus payments will be less that those who qualified in an earlier payment year.)

The “payment year” for Medicaid stimulus payments can begin in 2010 if CMS approves the State’s plan for early adoption and payment.  It seems rather doubtful that states still struggling with budget crises (such as in Kentucky and California) are going to be throwing resources into getting their State Medicaid EHR stimulus program up and going in 2010!  If you are in a financially healthy state that has been ahead of the game on EHR implementation (one of the 10 states for which CMS has approved a EHR stimulus grants), and you are a provider who is considering opting into the Medicaid EHR incentive program, then the detailed discussion of this program on pp. 275-347 of CMS’ proposed “meaningful use” rule is essential reading.