There are a TON of meaningful use resources for those physicians and clinics interested in showing meaningful use of an EMR in order to get the EMR stimulus money. Here’s one such resource that I thought gave a nice summary of what’s required. Here’s a small sample of the content they offer about meaningful use:

Core Set Measures

• Use CPOE (Computerized Physician Order Entry) to order medications for more than 30% of all unique patients with at least one medication in their medication list.
• Enable drug-drug and drug-allergy interaction check functionality on the EHR for the entire reporting period.*
• Maintain an up-to-date problem list of current diagnoses for 80% of all patients. If there are no problems, indicate no problems are known.
• Maintain an up-to-date list of active medications for 80% of all patients.
• Maintain an up-to-date problem list of medication allergies for 80% of all patients.
• Generate and transmit prescriptions electronically for 40% of prescriptions written by the provider.
• Record demographics for at least 50% of patients.*
• Record and chart changes in vital signs for at least 50% of patients.*
• Record smoking status for 50% of patients 13 and older.*
• Report ambulatory clinical quality measures to CMS.*
• Implement one clinical decision support rule relevant to the provider’s specialty.
• Provide at least 50% of patients with an electronic copy of their health information, upon request, within 3 business days.*
• Provide at least 50% of patients with clinical summaries of their office visit within 3 business days.*
• Perform at least one test of the certified EHR technology’s capacity to electronically exchange key clinical information.*
• For the EHR and its related IT network, conduct a security risk analysis and implement security updates as necessary; correct security deficiencies.*

Menu Set Measures

• Enable drug-formulary checking functionality and have access to a formulary for the EHR reporting period.*
• Incorporate clinical lab-test results into the EHR as structured data for at least 40% of all lab test results.*
• Generate at least one report listing patients with a specific condition.*
• Send reminders to 20% of all patients, 65 years or older, per patient preference for follow-up care.*
• Provide at least 10% of all unique patients timely access to health information within 4 business days of the information being available to the provider.*
• Provide patient-specific education resources to at least 10% of all unique patients.*
• Perform medication reconciliation at least 50% of the time for patients transitioned from another setting of care.
• Provide a summary care record for at least 50% of patients for patients being transitioned to another setting of care.
• Perform at least one test of the certified EHR’s capability to submit electronic data to immunization registries.*
• Perform at least one test of the certified EHR’s capability to submit syndromic surveillance data to public health agencies.*

*These functions may be performed by nursing, administrative or IT staff

It is expected that EHR vendors will provide the capability to generate much of the above mentioned information within their software and they will also assist physicians in conducting data exchange testing.

In another great comment from BobbyG (who works for a REC), he talks about the realization that states have the option to opt out of doing the Medicaid part of the EMR stimulus if they want. The following is the full explanation of the discovery and why they’d make such a decision. Plus, it highlights the challenge of understanding all the regulations around the HITECH act.

Here’s just one example of the difficulty you run across. Yesterday we were on a CMS conference call MU incentives presentation in which they said that states’ participation on the Medicaid side was “voluntary.”

We all went “WHAT?! How did we miss that?”

Sure enough: on the CMS website you see “The Medicaid EHR incentive program is voluntarily offered and administered by States and territories. States can start offering their program to eligible professionals (EPs) as early as 2011″

“voluntarily”, “can start”

Not “shall” or “must”.

Now, we knew from the IRF that (paraphrasing here) “there is no statutory basis for the manner via which states disburse incentive payments” but it somehow escaped us that states could simply opt out entirely.

I went back to the ARRA legislation itself (on the assumption that the FR cannot, beyond operational implementation mechanics, mandate additional requirements not in the legislation). Beginning on page 375 you see “Subtitle B—Medicaid Incentives SEC. 4201. MEDICAID PROVIDER HIT ADOPTION AND OPERATION PAYMENTS; IMPLEMENTATION FUNDING.”

You get to page 380 and then only see stuff about the administrative and reporting “requirements” for states getting the “FFP” money (Federal Financial Participation).

And that’s it.

I searched ARRA from beginning to end and found NO explicit wording that states’ Medicaid participation is “voluntary.” You just have to infer it from the Section 4201 language.

What is one potential adverse upshot? Your REC could be signing up a boatload of providers coming in on the Medicaid side, and if your state opts out, well you now have what’s known as “Reputation Risk” writ large (not to mention a torpedo below the waterline in your Ops plan and its milestone payments assumptions).

Why would a state opt out? Because they are only federally funded for 90% of their “reasonable” administrative expenses for the EHR incentive program. They have to find the other 10%. My state (NV) is currently wrestling with a three BILLION dollar budget gap. Similar relative woes exist elsewhere in statehouses (can you say KAHL-EE-FOR-NEEYA?).

You better know where your state stands before recruiting Medicaid providers if you’re a REC or a consultant or VAR, etc.

The AMA has finally weighed in on the meaningful use final rule and it’s not a glowing recommendation for meaningful use and the changes that were made. Here’s a short summary from the Wall Street Journal healthcare blog.

Now, after “careful review,” the AMA is weighing in. In a memo [PDF] to its board of trustees, the group’s CEO, Michael Maves, says that while “the Administration did move on several points, the [AMA] believes that it will be challenging for many physicians to participate successfully in the program. This will be especially true for those physicians in solo or small group practices who have not previously utilized an EHR.” (That refers to an electronic health record — the Health Blog has traditionally used “electronic medical record.” Tomatoes, tomahtoes.)

The AMA had pressed for reducing the number of criteria physicians needed to meet in order to get the first round of incentives from the original mandated 25 to a choice of any five of those. The final requirements include a “core” group of 15 requirements; providers must choose an additional five from the remaining items. That “is still too high,” the group says.

In addition, the group says no currently available EMR does everything that docs will need to do to meet the requirement — though products should be available this fall — making it tough to ramp up before the beginning of the incentive program. Also included on the list of what the AMA calls “remaining challenges”: high threshold requirements for many of the requirements, a lack of focus on how usable the systems are and the absence of an appeals process for docs if they are declared ineligible for incentives.

A favorite topic of this blog has been Meaningful Use and it will likely continue to be a popular topic well into the future. As such, we’re all sitting around waiting to hear the word from CMS on the final rule for Meaningful Use. Doctors are waiting for it so they can select an EMR or modify their current EMR to meet the guidelines. EMR vendors are waiting for it so they can say that their EMR software can meet the meaningful use guidelines. RECs are waiting for it so that they can help doctors reach meaningful use. We’re all just waiting to see what’s going to come out.

Fierce EMR reported that the Meaningful Use final rule will be published by July 14th. Here’s a couple quotes from that report:

FierceEMR spoke with a CMS official directly involved in writing and publishing the final regulation, and she assures us that although there’s no “official” publication date (CMS missed its own self-imposed June 30 deadline), “I would be very surprised if it’s published any later than July 14.”

Not a very firm commitment to July 14th, but it should be around that date I imagine.

“We hoped to have it out by the end of June, but it’s looking more like mid-July,” the official told us this week. “There are so many moving parts and so many people are involved. This is a long regulation.” No doubt! The proposed rule was thicker than many novels. We expect nothing less from the final reg.

That wasn’t quite the novel I was hoping to read this summer, but it will be nice to have something final.

All of this said, we may be waiting for nothing. First, because I don’t think that we’ll see any real meaningful changes to the regulation. Plus, I think the regulation will still be missing much of the meat and potatoes that will be involved in managing that regulation. There will still be a lot of practical details needed and interpretation of the regulation to be done. At least if it’s the government process that I know.

There’s a lot of interesting speculation going on right now around what HHS is going to do in regards to meaningful use. There’s no doubt that a lot of the feedback given to HHS on meaningful use surrounded the idea that it was too much and had too many objectives. The question remains, what will HHS do with this feedback?

A number of people have suggested that the meaningful use objectives will be relaxed. In this company is past healthcare IT czar, David Brailer. The interesting part of this chorus is that it includes a large number of providers that say it’s going to be relaxed. Then, they follow up that statement with something like, “If it’s not relaxed, then doctors won’t show meaningful use and will not worry about the EMR stimulus money.” Basically, it will become a failed government initiative if the meaningful use bar is too high.

Other people are suggesting that meaningful use is going to stay the same. Carol Flagg of HITECH Answers quotes the following from David Blumenthal as indication that meaningful use will not substantially change:

“Introducing change in health care is never easy. Historically, adopting our most fundamental medical technologies, from the stethoscope to the x-ray, were met with significant doubt and opposition. So it comes as no surprise that in the face of change as transformational as the adoption of health IT – even though it carries the promise of vastly improving the nation’s health care – some hospitals and providers push back….The question health care providers are facing today is whether we are pushing too hard, too fast to make this important change. I respectfully submit, no. In turn, I ask, ‘Can we make these changes expeditiously enough?… Every provider, every patient throughout our nation will benefit from the goals envisioned by the HITECH Act. Yes, this will be a challenge. While large hospital networks and smaller providers may be stretched to meet national health IT goals, it is not beyond their capacity for growth.”

Little by little I’m leaning this direction. I’m not sure exactly why, but I’m getting the feeling that HHS either can’t or won’t change the meaningful use criteria. It’s basically going to be similar to what we have now with maybe one or two items of note.

What do you think? What will happen with the MU final rule?