Final Rules for Meaningful Use Announced

Ken Terry

October 07, 2015

The US Department of Health and Human Services has released its final rules for changes to stages 1 and 2 of the electronic health record (EHR) incentive program, stage 3 requirements, and 2015 EHR certification criteria. None of these rules, which are included in a single document, appears to include major departures from the department's proposals made earlier this year.

Although the Centers for Medicare & Medicaid Services (CMS) did not yield to industry and Congressional critics who had called for a postponement of stage 3, the agency did provide an additional 60-day comment period. According to a CMS fact sheet, the feedback it receives in this comment period will help the agency transition from the meaningful use program to the new merit-based incentive program authorized by the Medicare Access and CHIP Reauthorization Act of 2015. The fact sheet said nothing about possible future changes in stage 3.

The changes to earlier stages of the meaningful use program include the following:

  • In 2015, providers must attest to their use of EHRs for any 90-day period by February 29, 2016. This date may be extended to the end of March if providers need more time.

  • For 2016 and 2017, providers who are new to the EHR incentive program have a 90-day reporting period.

  • In 2017, providers who choose to start attesting in stage 3 have a 90-day reporting period.

  • Starting in 2016, the number of objectives eligible professionals have to meet in stages 1 and 2 drops from 18 to 10. The number of objectives for eligible hospitals decreases from 20 to 9.

  • In stage 2, instead of requiring that 5% of patients view, download, or transmit their electronic health records, the rule stipulates that only one patient seen by a provider or discharged from a hospital must do so.

  • Instead of attesting that 5% of patients have exchanged secure electronic messages with providers, eligible professionals and hospitals must only attest that they have the capability to do this messaging.

In stage 3, providers must meet eight objectives, five of which have components of interoperability. The objectives include protection of patient health information, electronic prescribing, clinical decision support, computerized provider order entry, patient electronic access to health information, coordination of care through patient engagement, health information exchange, and public health and clinical data registry reporting.

To facilitate the sharing of electronic records with patients, stage 3 allows the use of application programming interfaces as an alternative to patient portals. The CMS fact sheet states, "[Application programming interfaces] support the patient's ability to access their health information in increasingly flexible ways, including by being able to enable easier access to health data for patients via mobile devices."

All eligible professionals and eligible hospitals must start reporting in stage 3 by January 1, 2018. Providers have the option of beginning stage 3 attestation in 2017.

ONC's Final Rule

Under the 2015 EHR certification rule, announced by the Office of the National Coordinator for Health IT, EHR vendors will have 27 months (until January 1, 2018) to develop products that meet the new criteria. In a separate fact sheet, the Office of the National Coordinator for Health IT said the certification rule:

  • improves interoperability by adopting new and updated vocabulary and content standards for documentation and exchange;

  • facilitates accessibility and exchange of data by adding capabilities for enhanced data export, transitions of care, and application programming interfaces;

  • establishes a framework that will lead to certification of additional types of health information technology used in a variety of care and practice settings;

  • supports the EHR incentive program by adopting certification criteria aligned with meaningful use requirements;

  • supports exchange of sensitive health info by including data segmentation in privacy criteria; and

  • improves patient safety by applying user-centered design principles, enhancing patient matching, and making more information about certified products publicly available.

Mixed Response

The initial response of the healthcare industry to the final rules on meaningful use was mixed, and the leading associations continued to demand changes in stage 3.

The American Medical Association praised CMS for addressing the delay in releasing the final rule on stage 1 and 2 modifications by allowing a hardship exception for physicians who are unable to attest this year. The association also lauded the relaxation in the view-download-transmit requirement in stage 2. However, it reiterated its belief that stage 3 requires further changes and said it hoped CMS would improve the program after the additional comment period.

The American Hospital Association made a similar statement, noting that "more than 60% of hospitals and about 90% of physicians have yet to attest to stage 2. The stage 3 rule is too much too soon."

The College of Health Information Management Executives, which represents chief information officers, praised CMS for switching from a full-year to a 90-day reporting period this year. However, as fewer than 90 days remain in 2015, it urged CMS to add a hardship exemption for hospitals unable to meet that requirement. The college also said it hoped the extra comment period would ensure that the stage 3 criteria "advances interoperability and takes into account new payment models being advanced by Medicare."

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