After months of public debate, the Centers for Medicare and Medicaid Services today issued final rules for "meaningful use" criteria doctors will need to meet in order to earn stimulus money for adopting electronic health records.

The new, streamlined rules reduce the burden on health care providers and hospitals compared with proposed rules issued in January, which garnered massive criticism. Around 2,000 comments had been submitted on the proposed rule.

Dr. David Blumenthal, national coordinator gave some details on how the final rule offers more flexibility. For example, the proposed rule in January had a criteria of 23 objectives for hospitals and 25 objectives for eligible professionals that needed to be met. Now the objectives are divided into a set of 15 core objectives for eligible professionals and 14 for hospitals.

There is also a separate "menu" of 10 additional activities: professionals and hospitals can choose five of those to implement in the first two years; the rest would be deferred to stage two. (The meaningful use criteria are being implemented in three stages.)

Achievement levels in the criteria have also been reduced. In the proposed rule, eligible professionals had to tender 75 percent of their prescriptions electronically. The number has now been reduced to 40 percent. In addition, clinical quality measures have been reduced to six for eligible professionals and 15 for hospitals.

The Department of Health and Human Services announced the release of the final rule Tuesday morning during a press conference. HHS Secretary Kathleen Sebelius was accompanied at the event by Blumenthal and newly installed CMS Director Dr. Donald M. Berwick.

The Recovery Act of 2009 signed into law in 2009 included the Health Information Technology for Economic and Clinical Health Act, known as the HITECH Act. The HITECH Act established programs under Medicare and Medicaid to provide incentive payments for the "meaningful use" of EHR technology, beginning in 2011. CMS has since been crafting a set of rules by which to define meaningful use.

Officials express optimism over rules

In the conference, Sebelius stated that improving the quality of care necessitates the use of health information technology, and the use of electronic health records is the most significant part of HIT to better deliver care and help consumers. Sebelius noted that only 20 percent of doctors and 10 percent of hospitals are currently using basic EHRs.

Dr. Berwick then explained that EHRs are improving quality of care while helping health care costs. He said modernized health care through EHRs can bring "tremendous benefits" such as patient safety. He said he hoped to see EHRs available for all Americans by 2014 and that the country will "realize how much better off we are going to be...when we get through the awkwardness of the change process."



Dr. Blumenthal said he felt that almost no health care provider will go back once they use EHRs, and that the Office of the National Coordinator is planning to help health care providers overcome barriers to using EHRs. "I'm optimistic and confident we are going to be successful," Blumenthal said, adding he felt clinicians and hospitals will be the leaders in improving the health care system of the U.S. and will integrate EHRs into their core clinical practices. Blumenthal also announced a collateral final rule being released simultaneously, identifying the standards and certification criteria for EHR technology.