Health Information Management

HHS eases requirements for initial phase of EHR 'meaningful use'

HIM-HIPAA Insider, July 20, 2010

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HHS softened some of its proposed requirements for healthcare entities to become meaningful users of EHRs in a final rule released July 13.

The final rule—issued through CMS—defines “meaningful use” for the first two years (2011 and 2012) of a long-term financial incentive plan through Medicare and Medicaid under the Health Information for Economic and Clinical Health (HITECH) Act, signed into law by President Barack Obama February 17, 2009.

The later phases will be governed by different rules. HHS did not release the expected published dates of those rules.

HHS also released today a final rule—through the Office of the National Coordinator for Health Information Technology (ONC)—establishing an initial set of standards, implementation specifications, and certification for EHR technology for vendor products.

The rules went public despite “hundreds” of comments that called for a cancellation of the EHR incentive program due to privacy and security risks involved with the technology, according to the CMS final rule.

"This seems like a significant pushback because on some level this represents a concern which represents to some degree the willingness of these commenters to leave money on the table given the privacy and security risks involved," said Frank Ruelas, director of compliance and risk management at Maryvale Hospital and principal of HIPAA College in Casa Grande, AZ.

Differences between the proposed, finalized rules

During a press briefing this morning, David Blumenthal, MD, MPP, national coordinator for health information technology, said his department received more than 2,000 comments from the January 2010 proposed rule on meaningful use.

The comments resulted in fewer core objectives that clinicians and hospitals must meet in the first two years of available meaningful use incentives. HHS had proposed 23 objectives for hospitals and 25 for clinicians, Blumenthal said, and many commenters felt it was an “all or nothing approach.”

The final rule changes that, dividing the objectives into two sets: a core set of objectives and an additional set. Of the additional objectives, providers must maintain only some of them during the initial phase from 2011–2012. This allows providers to then choose which ones they will push to the phase after 2012. (See the two sets of objectives in this table from the New England Journal of Medicine).

"This gives providers latitude to pick their own path toward full EHR implementation and meaningful use," according to a statement from HHS.

Other notable changes in the final rule include:

  • A decrease in the percentage of prescriptions to be prescribed electronically, from 75% to 40%
  • An increase in the time period allowed to provide patients with a copy of their EHR, from 48 hours to three business days
  • A requirement that hospitals and clinicians conduct or review a security risk analysis of the certified EHR technology and implement security updates and correct deficiencies as part of their risk management process
  • Two added objectives for eligible providers (EP) and eligible hospitals, in accordance with recommendations from the Health Information Technology Policy Committee:
  • Identify and provide condition-specific patient education resources
  • Record advance directives for patients 65 years of age and older
  • A definition of a hospital-based EP as one who performs substantially all of his or her services in an inpatient hospital setting or emergency room only, pursuant to the Continuing Extension Act of 2010
  • Inclusion of critical access hospitals within the definition of acute care hospital for the purpose of incentive program eligibility under Medicaid

Next steps for eligible hospitals and EPs

Ruelas said that entities will likely need to revisit their policies to differentiate the timelines associated with requests for electronic copies of patients’ health information versus those for hardcopies.

HHS also clarified that only information that an eligible hospital or clinician has available electronically must be provided to the patient—not all paper records.

Blumenthal called the criteria “ambitious but achievable” in striding toward President Obama’s goal of all entities moving to EHRs by 2014.

Each clinician is eligible for up to $44,000 through Medicare and $63,750 through Medicaid as incentives for achieving meaningful use.

The American Health Information Management Association (AHIMA) said paper records fail to meet the demands of today’s healthcare decision-making, and it is “ready to ensure the proper implementation of electronic health records.”

"With this last hurdle behind us, the health information management profession can move forward with final preparations for implementation," Rita K. Bowen, president of AHIMA’s board of directors, said in a statement.

Today’s final rules are the third and fourth in a series of rules released in the past month under HITECH. ONC published a final rule June 24 establishing a temporary certification program for health information technology. The Office for Civil Rights (OCR), enforcer of the HIPAA privacy and security rules, released a proposed rule July 8 that would strengthen and expand privacy, security, and enforcement protections under HIPAA.

Editor’s note: For more information, visit the HHS website.A CMS/ONC fact sheet on the rules is available at A technical fact sheet on ONC’s standards and certification criteria final rule is available at

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