CMS Revises ‘Meaningful Use’ Criteria for Electronic Records

The Department of Health and Human Services (HHS) published a final rule in August that gives health care providers a longer adoption timeline and more flexibility in the certified electronic health record technology (CEHRT) that they use to meet “meaningful use” criteria for the 2014 EHR Incentive Program reporting.

The incentive program, created in the 2009 Health Information Technology Act, provides physicians and hospitals with stimulus funding to encourage them to implement electronic health records (EHRs).

The new rule pushes back the beginning of the third stage of meaningful use for the first cohort of adopters from January 1, 2016, to January 1, 2017. Also, some providers struggling to adopt 2014 certified EHRs will now have an extra year to use 2011 Edition software. (The government has certified certain software products that can be used for each phase of implementing EHR systems in a physician practice; information about those products is available on the CMS website. Deadlines for implementing the software products have been established for each phase of the incentive program.)

By providing this flexibility, more providers will be able to participate and meet important meaningful use objectives such as checking for drug-drug and drug-allergy interactions, providing clinical summaries to patients, prescribing electronically, and reporting on key public-health data and quality measures, according to the Centers for Medicare and Medicaid Services (CMS).

“We listened to stakeholder feedback and provided CEHRT flexibility for 2014 to help ensure that providers can continue to participate in the EHR Incentive Programs forward,” said CMS Administrator Marilyn Tavenner on the CMS website.

APA, the AMA, and other medical groups have consistently expressed concern about the EHR criteria and urged the government to adjust them to ensure an orderly transition so that EHRs can be widely adopted throughout the health care system.

Earlier this year, APA joined the AMA, the College of Healthcare Information Management Executives, and 45 other physician and hospital organizations in calling on the federal government to add more time and flexibility in the Medicare and Medicaid EHR Incentive Program.

In a February 21 letter to then Health and Human Services Secretary Kathleen Sebelius, the organizations noted that “additional time and new flexibility are vitally important to ensure that hospitals and physicians continue moving forward with technology to improve patient care. By making such changes, HHS would be demonstrating needed flexibility to maximize program success, without compromising momentum toward interoperability and care coordination supported by health information technology” (Psychiatric News, March 21).

In comments to Psychiatric News, Laura Fochtmann, M.D., a former member of APA’s Committee on Mental Health Information Technology, explained that “meaningful use” is the term developed by the government to describe criteria for implementation of electronic records that would qualify clinicians, hospitals, and health systems to receive the incentive payments established under the government’s program for providers of Medicare and Medicaid services.

But she said the standards—including both the performance thresholds and the timelines for meeting them—are considered by many in the medical field as too rigid to account for the variations in typical clinical activities across differing clinical specialties and types of physician practices.

For example, Fochtmann said, the standards include having patients use a “patient portal” so they can check on lab reports, office appointments, and other data from their home computers. “But not all patients are able to use computers or wish to use them to communicate with their physicians,” she pointed out.

Also, some states have regulations about parental access to information about children or adolescents, she noted, making it impossible for some child and adolescent psychiatric practices to meet the criteria on patient portal use. Other criteria, such as implementation timetables, have been challenging to meet for solo practitioners and those in small-group, office-based practices, which are common in psychiatry, due to the significant start-up costs and training required to adopt an EHR.

Fochtmann said that the newly revised criteria are a step in the right direction. “My primary concern is that the criteria still don’t go far enough in making meaningful use more flexible,” she said. “Overall, the meaningful use program has driven EHR use, but it is much more cumbersome and confusing than it has needed to be to achieve the ultimate goal of enhanced patient care.” ■

Information about the revised criteria and timeline can be accessed here. APA’s Committee on Mental Health Information Technology has posted information for psychiatrists here.