Meaningful Use Rules Take Shape

The government has clarified its rules for achieving “meaningful use” of EHR adoption for the purposes of receiving federal stimulus dollars, and health IT expert Rosemarie Nelson says meeting the obligations appear easier than some may think.

Speaking Wednesday at the MGMA 2010 conference, Nelson said that most practices that have been maximizing usage of their existing EHRs are probably already achieving or exceeding most of the standards, or need to make only modest changes to do so. Those that aren’t, or who don’t yet have an EHR, will find the rules a useful roadmap for making the most of their new system.

“A lot of people get going with their EHR, and then they hit a plateau,” Nelson, an MGMA consultant, said. “They say, ‘OK, I have my routine down, I don’t want to have to keep changing.’ But [EHR transition] is very iterative. How you use your EHR in the first year is not as important as how you use it in the future years. It’s an ongoing thing, and you have to keep iterating through it.”

Practices that demonstrate their meaningful of use certified EHRs can collect up to $44,000 in additional Medicare payments beginning next year. Even greater sums are available under a separate Medicaid program. The sooner a practice begins the transition the better, as stimulus payments in the Medicare program are reduced annually through 2016. In 2011, practices need only to demonstrate that they were meaningfully using an EHR for 90 consecutive days, “so, conceivably, you could start Jan. 1, and conceivably, you could be finished by April 1,” Nelson said. There are no plans federally to require EHR adoption, but after fiscal year 2015, an annually increasing Medicare payment penalty, beginning at 1 percent, will be imposed for those still not using EHRs.

The three private organizations qualified by late October to issue certifications are the Certification Commission for Certification of Healthcare Information Technology (CCHIT); The Drummond Group; and Infoguard. Make sure that any EHR vendor claiming to be certified for meaningful use purposes can demonstrate that its certification comes from one of those organizations, Nelson said.

If its certification is from CCHIT, she added, make sure that it reflects the current certification related to meaningful use, rather than its less formal certification from years past.

Practices must also perform risk analyses of any privacy and security concerns related to the IT. For now, the practices must only demonstrate the completion of the analysis and the documentation of any remediation plan necessary.

Most of meaningful use requirements - 15 core objectives, plus at least five additional objectives from a set of 10 - are fairly straightforward, Nelson said. The challenge is tracking your progress and documenting that you’re meeting the objectives. For example, one requirement is that for more than 30 percent of patients that have at least one education in their medication, at least one medication is ordered using a computerized order entry system. Another requires that you have a problem list documented (or an indication of no problems) for at least 80 percent of patients.

See a complete list of meaningful use requirements here.

One requirement that may challenge some practices is that they provide an electronic copy of a patient’s record to at least 50 percent of patients that ask for one within three business days. In practical terms, its requirement can only be fulfilled through a secure online patient portal that many practices will have to add to their existing EHR systems. The addition of a portal is a good idea regardless of the requirement, Nelson said, because patients love them.

Nelson advised questioning your vendor about how it will help you document that you’re meeting each requirement. Her favorite idea: A dashboard-style checklist of measures seen by all providers when they log in, indicating how they’re doing meeting the meaningful use objectives.

For more MGMA 2010 conference coverage, be sure to visit our MGMA Conference Insider page.