Final “Meaningful Use” Rules Seen

The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator (ONC) announced the final rules for meaningful use , incentives, standards and certification today. The requirements to qualify as a meaningful user of EHR technology, and therefore receive incentive payments as defined in the HITECH portion of the American Recovery and Reinvestment Act (ARRA), had been the subject of hot debate over the past year as providers wondered whether they could actually meet the terms set forth in the proposed rules seen earlier this year. The final rules do scale back the number of objectives that must be met somewhat, and provide more flexibility for providers to continue along individualized paths to meaningful use. Hospital systems that share a CMS Certification Number (CCN) will be disappointed to learn that the payments will still be made based on the single number, not as individual hospitals. This could mean millions to some systems, which are no doubt investigating how to separate their operations under multiple CCNs. The hospital-based physician definition was clarified to exclude physicians performing all work in an inpatient hospital setting or emergency room.

ONC is still the process of identifying organizations that will be certified testing and certifying bodies, but it projects that certified software will be available for purchase by this fall. Registration for the incentives begins in January, 2011, and be managed online by CMS. Attestations from providers seeking incentives will be made starting in April, 2011, with payments starting in May, 2011. Medicaid payments will occur on schedules dependent upon individual states and the status of their plan and progress made.

The final rules on meaningful use and the incentive program will be published in the US Federal Register July 28.

-Rod Piechowski

Copyright © 2010, Rod Piechowski, Inc., Consulting

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CCHIT Statement on Final Certification Rules

The Certification Commission for Health Information Technology (CCHIT) will apply to become a certifying body under the rules recently issued. Karen Bell, the organization’s new Chair, says the group fully expects approval. The full statement is here.

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Two kinds of thinking

Certification Rules Are In

A nice range of things to consider over the weekend: first, the final rules for the temporary electronic health record (EHR) certification program were released. If you’re reading from outside the US, this is just one piece of the giant puzzle currently being assembled here to push physicians and hospitals closer to the use of EHRs. Several years ago, the government decided that by certifying that EHR systems could do what was promised, some level of risk would be removed, and physicians would begin to adopt these systems more rapidly. Now, in order to receive financial incentives and to avoid penalties, physicians and hospitals that participate in Medicare and Medicaid programs must adopt EHRs that have been certified. With the new laws, the meaning of certification has shifted. Instead of a form of consumer support, certification is as much a required attribute of the software as whether or not it can manage various types of clinical documentation or report quality measures. Previous certifications done by the Certification Commission for Health Information Technology (CCHIT) will not be grandfathered into the new system. Instead, organizations that wish to do the business of certifying EHR systems must apply to become a certification body. This includes CCHIT.

Incentives for meaningful use of EHR systems become effective October 1, 2010 for hospitals and January 1, 2011 for physicians. Between now and then, new organizations must be deemed capable of certifying EHRs, the systems must be certified, and previously certified systems must be re-certified. The current focus in the US regarding medicine and technology centers around, and will continue for a few years to be centered around, achieving meaningful use and avoiding penalties. Meaningful use will not be determined based on how creatively a hospital or physician is applying technology for the benefit of the patient or the community. It will be determined by meeting the requirements spelled out in a checklist of functions and features. Call this “No EHR Left Behind,” as the medical community scrambles to “pass the test.”

By the way, CMS has a new site that organizes all of its EHR incentives-related activities. Find it here:

Artificial Intelligence

At another end of the spectrum, the cover feature in the New York Times Magazine Sunday asked: “Who is Watson?” This I.B.M. project created a computer that is designed to think like a Jeopardy contestant and can, on one hand, appear incredibly intelligent. On the other hand, it can completely miss the mark, which is easy to do considering the range of wordplay the game entails. It’s interesting reading, even provocative at times. It’s especially provocative when John Kelly, head of I.B.M.’s research labs says he wants to create “a medical version” of the computer for use in hospital emergency departments. Armed with what would amount to every medical paper ever written, the computer would be able to come up with rapid-fire answers to help doctors make decisions.

Cool idea, but how we get there is more complicated than that, and raises a few questions. For example:

• At what point does research become fact or “knowledge”?

• What process determines which research becomes part of the computer’s knowledge base?

• What is the “peer review” process for new ideas generated by a computing system?

• Is it ethical to ignore patient narrative solely in favor of clinical fact?

• What power will a physician retain to overrule, modify or concur?

“The problem right now is the procedure, the new procedures, the new medicines, and new capability is being generated faster than physicians can absorb on the front lines and it can be deployed,” says Kelly. This might not be the best reason to employ technology. Simply having “everything” in a database does not mean you have information. There is a fine line between using technology to distribute information we know to be helpful, and allowing technology to make those decisions for us. With the former, we remain accountable to patients and society; with the latter, we abdicate responsibility. Somewhere in the middle lies the art of medicine and technology.

The NYT article is here:

-Rod Piechowski

Copyright © 2010, Rod Piechowski, Inc., Consulting

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