CMS and the Office of the National Coordinator of Health IT recently provided a critical clarification on meaningful use for hospitals and eligible professionals (EPs) that will make demonstrating the criteria more difficult. Their guidance states that hospitals and EPs must implement all the meaningful use functionalities of the certified electronic health record. While hospitals and EPs are afforded flexibility in determining which of the five out of 10 menu set requirements they will report on for the purposes of demonstrating meaningful use, they are not afforded this same flexibility as it relates to implementation of the certified EHR.
Background on Final Rule
CMS' final rule detailing the Stage 1 meaningful use requirements, released on July 14, requires hospitals and EPs to demonstrate meaningful use by achieving the following requirements:
- Utilize certified EHR technology;
- Meaningfully use the certified EHR in care delivery and for the exchange of information; and
- Report on clinical quality metrics.
Furthermore, the requirement to meaningfully use certified EHR technology is divided into five goals, each of which must be demonstrated by reporting performance on specific objectives. Based on public comments and concerns surrounding the meaningful use objectives listed in the proposed rule, CMS' final rule provided hospitals and EPs with some flexibility in meeting the criteria by designating certain objectives as part of the core set -- making them mandatory -- and others as part of the menu set -- providing options from which providers must report on any five of the 10 objectives.
Lack of Consistency Between CMS and ONC Requirements Will Delay Meaningful Use
CMS' final rule is limited to defining how hospitals must demonstrate meaningful use in accordance with the companion rule from ONC on standards, implementation specifications and certification criteria. To that end, ONC's recently released Frequently Asked Questions requires hospitals to implement all the 24 meaningful use functionalities of the certified EHR (14 core and 10 menu), as opposed to installing only the 19 requirements (14 core and five menu) that it intends to report on to demonstrate meaningful use. Similarly, EPs will be required to implement all the 25 meaningful use functionalities of the certified EHR (15 core and 10 menu), as opposed to installing only the 20 requirements (15 core and five menu) for demonstrating meaningful use.
In essence, ONC requires providers to meet the first major requirement, i.e. utilize certified EHR technology by acquiring and installing certified software (complete or modular) that supports all the meaningful use objectives, not just those functionalities that providers intend to report on for Stage 1 of meaningful use.
Consequently, hospitals and EPs now only have a choice in which five of the 10 menu objectives they report on, not on which functionality they implement. The pressure to implement all functionalities will delay achievement of meaningful use and also will financially burden several hospitals and EPs that have yet to purchase some of the EHR modules.
Recommendations for Health Care Executives
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Accelerate Vendor Selection: Hospitals with a best-of-breed or a best-of-suite environment will need to quickly select and purchase the remaining certified EHR modules to implement all the functionality necessary for meeting the meaningful use requirements. While providers need not have a fully certified EHR in place at the start of the EHR reporting period, hospitals and EPs must ensure all contracting includes commitments from the vendor to achieve certification on a timeline suitable for the hospital or EP to achieve meaningful use.
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Revise Meaningful Use Plans: Hospitals should evaluate their go-live date for demonstrating meaningful use to ensure they have allowed adequate time to implement the remaining certified EHR functionalities. The schedule revisions should incorporate any resource limitations that might delay acquisition or implementation of the remaining functionalities, as well as account for the vendor's expected timelines for certifying the pending modules. Similarly, hospitals assisting EPs will need to adjust EP meaningful use schedules and modify implementation plans to ensure that both the hospital and EPs can successfully meet meaningful use in a manner that maximizes the total incentive collection.
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Develop and Certify Key Interfaces: While some modules may contain the entire functionality required for meeting a specific meaningful use objective (and be certified as such), others may need to be interfaced with other certified systems (especially if purchased from different vendors) to demonstrate implementation of the required functionality. Hospitals will need to assess the need for such interfaces, develop them and get them certified in order to meet the certified EHR implementation requirements for meaningful use. IT departments should determine the requirements (timeline, costs, process, etc.) for interface certification.
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Drive Adoption of All Functionalities: While hospitals and EPs can report on any five of the 10 menu objectives, providers are encouraged to drive adoption of all the functionalities installed for meaningful use. Installation without adoption has no value and may lead to implementing IT functionalities without adequate user input and workflow redesign, only to necessitate numerous system changes upon adoption. Instead, driving adoption of all functionalities will give providers the opportunity to select which five menu requirements to report on based on adoption levels. Furthermore, ensuring high levels of adoption for all Stage 1 functionalities will prepare providers for Stage 2, wherein all menu requirements will be mandatory, and allow them to devote more time and resources to the new Stage 2 requirements, when released.
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Cash In on Medicaid Incentives Early: While hospitals and EPs need to implement all the functionalities of the certified EHR and report on all of the core and five of the 10 menu objectives to demonstrate meaningful use and collect Medicare incentives, providers only need to demonstrate tangible efforts to adopt, implement or upgrade to a certified EHR to be eligible for Medicaid incentives. Hospitals must submit appropriate evidence to their state to collect the Medicaid incentives in 2011, while continuing to push on implementing and adopting the certified EHR functionalities to meet the requirements for Medicare incentives. Ultimately, hospitals should only start demonstrating meaningful use for the purposes of Medicare incentives and year 2 Medicaid incentives when they are far enough along on all the known Stage 2 requirements because failure to achieve Stage 2 will result in Medicare penalties.