TECHNOLOGY AND THE BUSINESS OF GOVERNMENT

The Health and Human Services Department on Wednesday set preliminary terms dictating who will and will not get billions of dollars in stimulus funds for buying electronic health records systems.

One proposed rule outlines criteria for the e-health records incentive program, including the core concept of "meaningful use" of e-records technology. Medical professionals who make "meaningful use" of e-records by 2011 or 2012 will be eligible for up to $44,000 in Medicare payments spread out over five years.

The proposal would define "meaningful EHR user" as a medical professional or hospital that complies with specific measures, including the use of a certified technology in ways that improve the quality and safety of health care delivery, reduce health care disparities, engage patients and families, enhance care coordination, improve public health and ensure privacy and security protections.

The rule would phase in the specific measures, based on the present state of technological capabilities and providers' practice experience. HHS officials will demand stricter and more extensive criteria for demonstrating meaningful use over time, as technologies and providers' expertise advance.

The 2009 American Recovery and Reinvestment Act allocated about $20 billion to encourage doctors and hospitals to install e-records systems by 2014. The definition of meaningful use and certification standards have sparked controversy, especially among innovative companies, including Microsoft and Google, who contend that the government's strategy won't work because funding is tied to the adoption of electronic health records, not to management of data by clinicians.

A top Google official argued the administration's plan will result in hospitals and physicians using outmoded databases in the increasingly Web-focused world.

HHS Office of the National Coordinator for Health Information Technology (ONC) also released an interim final rule that sets initial standards, implementation specifications and certification criteria for e-records technology.

Both sets of proposals are open to public comment for 60 days.

Under the Recovery Act, HHS must adopt an initial set of standards for electronic health records by Dec. 31. So, the interim final rule will actually go into effect next month, before the period for comment and refinement is over. A final rule will be issued in 2010.

"These regulations are closely linked," Charlene Frizzera, acting administrator at the Centers for Medicare & Medicare Services, stated in a press release. "CMS's proposed regulation would define and specify how to demonstrate 'meaningful use' of EHR technology, which is a prerequisite for receiving the Medicare incentive payments. Our rule also outlines the proposed payment methodologies for the Medicare and Medicaid EHR incentive programs. ONC's regulation sets forth the standards and specifications that will enhance the interoperability, functionality, utility and security of health information technology."

David Blumenthal, HHS national coordinator for health IT, said in an e-mail update to the public, "Great care was taken in the development of these criteria, with input from the public and federal advisory committees every step of the way." The resulting standards and certification criteria are organized into four categories:

• Content Exchange Standards (i.e., standards used to share clinical information such as clinical summaries, prescriptions, and structured electronic documents);
• Vocabulary Standards (i.e., standard nomenclature used to describe clinical problems and procedures, medications, and allergies);
• Transport Standards (i.e., standards used to establish the communication protocol between systems); and
• Privacy and Security Standards (e.g., authentication, access control, transmission security/encryption) which relate to and span across all of the other types of standards. "

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