The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) have issued two regulations regarding electronic health record (EHR) technology. The first is of particular significance, as it is the CMS proposed rule regarding the concept of "meaningful use" of EHR technology, which directly impacts the incentive programs under the American Recovery and Reinvestment Act of 2009 (Recovery Act). The agencies are encouraging public comment on the regulation.

The Recovery Act of 2009 signed into law earlier this year includes the Health Information Technology for Economic and Clinical Health Act (the "HITECH Act"). The HITECH act established programs under Medicare and Medicaid to provide incentive payments for the "meaningful use" of EHR technology.

The proposed rule CMS issued defines the central concept of "meaningful use." In the fact sheet CMS provides, the agency says its goal is for the definition of meaningful use to be "consistent with applicable provisions of Medicare and Medicaid law while continually advancing the contributions of certified EHR technology" to improve health care quality, efficiency, and patient safety.

The CMS proposed rule would implement criteria for demonstrating meaningful use in three phases, as the agency considers a phased approach most appropriate, based on public and stakeholder input.

The proposed rule states that Stage 1 meaningful use criteria "focuses on electronically capturing health information in a coded format; using that information to track key clinical conditions and communicating that information for care coordination purposes (whether that information is structured or unstructured, but in structured format whenever feasible); consistent with other provisions of Medicare and Medicaid law, implementing clinical decision support tools to facilitate disease and medication management; and reporting clinical quality measures and public health information."

For Stage 1, beginning in 2011, CMS proposes 25 objectives/measures for eligible professionals (EPs) and 23 objectives/measures for eligible hospitals that must be met to be deemed a meaningful EHR user. In 2011, EPs and hospitals would report all of the results for all objectives/measures to CMS, or in the case of Medicaid, report to the states, through attestation.

In 2012, CMS proposes requiring the direct submission of clinical quality measures to CMS (or to the states for Medicaid EPs and hospitals) through certified EHR technology.

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