E9-31216 I B 1

1. Medicare and Medicaid EHR

Incentive Programs Proposed Rule

In writing the provisions of the HITECH Act, Congress fundamentally tied the standards, implementation specifications, and certification criteria adopted in this interim final rule to the incentives available under the Medicare and Medicaid EHR Incentive Programs by requiring the meaningful use of Certified EHR Technology.

Congress outlined several goals for meaningful use one of which includes the ‘‘use of certified EHR technology in a meaningful manner.’’ This means that to qualify for incentives, an eligible professional or eligible hospital must both adopt Certified EHR Technology and demonstrate meaningful use of this technology.

Congress further specified that Certified EHR Technology must be certified as meeting the standards adopted by the Secretary, which we adopt in this rule.

As referenced in the preamble to the Medicare and Medicaid EHR Incentives Program proposed rule the Medicare and/or Medicaid incentive payments are available to certain eligible professionals and eligible hospitals.

We have adopted standards, implementation specifications, and certification criteria in this interim final rule in part to assure that Certified EHR Technology is capable of supporting the achievement of meaningful use by eligible professionals and eligible hospitals under the Medicare and Medicaid EHR Incentive Programs.

The certification criteria, adopted by the Secretary, must be used to test and certify that Complete EHRs or EHR Modules have properly implemented the capabilities required by the certification criteria and, where appropriate, the standards and implementation specifications adopted by the Secretary.

ONC and the Centers for Medicare & Medicaid Services (CMS) have worked carefully to ensure that this interim final rule and the Medicare and Medicaid EHR Incentive Programs proposed rule are aligned.

To inform our collaborative rulemaking processes, ONC and CMS received input from hundreds of technical subject matter experts, health care providers, and other stakeholders who provided written comments to, testified before, and attended meetings held by three HHS Federal advisory committees:


 * the National Committee on Vital and Health Statistics,
 * the HIT Policy Committee,
 * and the HIT Standards Committee.

After several meetings of its workgroups and the full committee, the HIT Policy Committee presented and recommended to the National Coordinator at its July 16, 2009 meeting a matrix on meaningful use of Certified EHR Technology that contained:


 * Overall health outcome policy priorities;
 * health care goals;
 * draft objectives for eligible professionals and eligible hospitals for 2011 (beginning of meaningful use Stage 1), 2013 (beginning of meaningful use Stage 2), and 2015 (beginning of meaningful use Stage 3); and specific measures for each of those years.

With respect to this interim final rule’s relationship to the Medicare and Medicaid EHR Incentive Programs proposed rule, we have adopted certification criteria that directly support CMS’s proposed meaningful use Stage 1 objectives.

The stages of meaningful use are described and have been proposed by CMS in the Medicare and Medicaid EHR Incentive Programs proposed rule as the following:


 * Stage 1 (beginning in 2011):
 * The proposed 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.’’


 * Stage 2 (beginning in 2013):
 * CMS has proposed that its goals for the Stage 2 meaningful use criteria, ‘‘consistent with other provisions of Medicare and Medicaid law, expand upon the Stage 1 criteria to encourage the use of health IT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible,
 * such as the electronic transmission of orders entered using computerized provider order entry (CPOE)
 * and the electronic transmission of diagnostic test results (such as
 * blood tests,
 * microbiology,
 * urinalysis,
 * pathology tests,
 * radiology,
 * cardiac imaging,
 * nuclear medicine tests,
 * pulmonary function tests and
 * other such data needed to diagnose and treat disease).
 * Additionally we may consider applying the criteria more broadly to both the inpatient and outpatient hospital settings.’’


 * Stage 3 (beginning in 2015):
 * CMS has proposed that its goals for the Stage 3 meaningful use criteria are, ‘‘consistent with other provisions of Medicare and Medicaid law,
 * to focus on promoting improvements in quality, safety and efficiency,
 * focusing on decision support for national high priority conditions,
 * patient access to self management tools,
 * access to comprehensive patient data and
 * improving population health.’’