Health providers should find it easier to qualify for Medicare and Medicaid bonus payments for adopting electronic health records under the final version of a regulation governing the program.

The rule both reduces the number of requirements providers must meet and also lowers the thresholds for how often electronic technologies must be used versus an earlier proposed rule.

CMS issued the final rule July 13; the agency's proposed rule was released in January. Many commenters on the proposal focused on what they called its one-size-fits-all approach, which could have made it difficult for certain providers to qualify for added payments (Also see "Health IT Strategic Framework Aims To Create A "Learning Health System"" - Pink Sheet, 29 March, 2010.).

The rule implements provisions of the American Recovery and Reinvestment Act of 2009 that create a financial reward program for physicians and hospitals that adopt EHRs. The statute conditions the rewards on providers showing "meaningful use" of the electronic technology (Also see "Adoption Of E-Health Records Gets Stimulus Of Medicare Rewards, Penalties" - Pink Sheet, 2 March, 2009.). A major component of the new rule is defining what providers must achieve to demonstrate such meaningful use.

As in the proposal, the final rule opts to follow a three-stage approach to adoption; the rule specifically outlines the goals for Stage 1, covering the years 2011 to 2012 (Also see "Health IT "Meaningful Use" Definition To Evolve In Stages, CMS Rule Says" - Pink Sheet, 11 January, 2010.).

The original proposal identified 23 meaningful use objectives for hospitals and 25 for clinicians, and said the providers needed to meet all of them. The final rule instead lays out a "core set" of 14 required objectives for hospitals and 15 for clinicians. In addition to the core objectives, there is a "menu set" of 10 tasks, from which providers can choose any five to implement. This is designed to give providers flexibility in choosing how best to reach full implementation and meaningful use, CMS said.

In addition, CMS has in many cases lowered the threshold for the percentage of transactions that must be conducted electronically to show meaningful use. For example, the proposed rule said 75 percent of prescriptions should be transmitted electronically to show meaningful use of e-prescribing. The final rules drops that to 40 percent.

The required core set includes several objectives that deal directly with prescription drugs. Providers must:

· Maintain an active medication list - more than 80 percent of patients have at least one entry recorded as structured data;

· Maintain an active medication allergy list - more than 80 percent of patients have at least one entry recorded as structured data;

· Generate and transmit permissible prescriptions electronically (does not apply to hospitals) -more than 40 percent are transmitted electronically using certified EHR technology;

· Use computer provider order entry for medication orders - more than 30 percent of patients with at least one medication in their medication list have at least one medication ordered through CPOE; and

· Implement drug-drug and drug-allergy interaction checks - functionality is enabled for these checks for the entire reporting period.

The menu set of objectives includes implementing drug formulary checks and performing medication reconciliation between different settings of care.

Stage 2 and 3 requirements will be described in two subsequent rules, expected in 2011 and 2013, respectively. The Stage 1 rule notes that it expects Stage 2 requirements to include "rigorous expectations for health information exchange," such as "more demanding requirements for e-prescribing."

The Office of the National Coordinator for Health Information Technology on the same day issued a related final rule establishing the required capabilities and related standards and implementation specifications that certified EHR technology will need to include to support the achievement of meaningful use by providers in Stage 1. Product developers can have their products tested and certified as meeting ONC standards.

Berwick Makes First Public Appearance As CMS Administrator

An event held at HHS headquarters to unveil the rules served as the backdrop for Don Berwick's first public appearance as CMS administrator. Berwick was sworn in as administrator on July 12 after President Obama made a recess appointment, bypassing Senate review of his nomination (Also see "CMS Finally Gets An Administrator; Berwick In Until Late 2011, At Least" - Pink Sheet, 12 July, 2010.).

Each of the government speakers at the event, which included HHS Secretary Kathleen Sebelius, Surgeon General Regina Benjamin and National Coordinator for Health Information Technology David Blumenthal, prefaced her or his remarks by welcoming Berwick to his new post.

Berwick said the day's announcement represents "real progress" to get where the health care system needs to be and added that "I really like the phrase meaningful use," since EHRs will be meaningful to care, to patients and to those who provide care. Although Berwick was not on duty during the development of the initial EHR rule, he will be responsible for overseeing the continuing implementation of the rule along with a host of mandates under the Affordable Care Act.

-Scott Steinke (s.steinke@elsevier.com)

CMS Reduces Criteria To Qualify For Electronic Health Record Financial Incentives In Final Rule

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