Rhapsody Health Solutions Team

Meaningful Use Debate

Last week The Office of the National Coordinator for Health Information Technology (ONC) announced the release of the meaningful use and standards final rules establishing the incentive program and standards guidelines for the meaningful use of electronic medical records.

Initial reactions to the final rule were mixed with some lauding the pace, metrics and future impact on the quality of patient care, while other distinct and contrasting views painted a less than enthusiastic picture of the meaningful use guidelines and their affect on the healthcare industry.

The debate: Are the meaningful use and standards final rules the right solution for EHR adoption?

View 1: Yes. They are in line with America’s healthcare needs.

Prior to the release of the final rule, there was a good deal of feedback (over 2,000 comments) on the interim final rules’ guidelines as being unachievable and too strict on healthcare organizations.

Feedback the DHHS received regarding the interim final rule included the following concerns:

  • the pace and scope of implementation of meaningful use that allows practices and hospitals to qualify for incentive payments;
  • the approach requiring 100% compliance with a broad set of objectives was too demanding and inflexible, an “all-or-nothing”
  • test that too few providers would likely pass; the complexity of the quality reporting process.

These comments were well received by law makers and clearly influential to the edits made on the final rules’ guidelines. One of the main voices advocating for the perspective that the final rules are in line with America’s healthcare needs is the National Coordinator for Health Information Technology, David Blumenthal, M.D., M.P.P.

His article, “The “Meaningful Use” Regulation for Electronic Health Records,” with the help of Marilyn Tavenner, R.N., M.H.A., responded to the meaningful use and standards final rules and was optimistic regarding the future of healthcare in America.

“The meaningful use rule strikes a balance between acknowledging the urgency of adopting EHRs to improve our health care system and recognizing the challenges that adoption will pose to health care providers. The regulation must be both ambitious and achievable.” (The New England Journal of Medicine)

View 2: No. They need improvement.

While it seems the majority of the initial reactions to the final rule were positive, there remain a tangible number of organizations and individuals who do not believe that the final rule is as realistic enough to implement, as Dr. Blumenthal suggests.

The American Medical Association (AMA), in particular, has expressed a deep concern for the process of incentive payments. “The [AMA] believes that it will be challenging for many physicians to participate successfully in the program. Especially for those physicians in solo or small group practices who have not previously utilized an EHR,” said the CEO of the AMA, Michael Maves.

The key issues with the final rule according to the AMA were nicely outlined in the iHealthBeat article, “AMA Cites Multiple Problems with Final ‘Meaningful Use’ Rule.”

Concerns identified by the AMA regarding the final rules include:

  • Not enough time for health care providers to comply with the requirements prior to the program’s January 2011 start date;
  • The total number of measures — 20 — that the rule requires physicians to meet is too high;
  • The exclusion of incentives for health care providers who see at least 90% of their patients in an inpatient or emergency department setting;
  • Short time frames for electronically furnishing patient information;
  • The lack of an appeals process for physicians to challenge any aspect of the incentive program (CMIO, 7/21); and
  • A dearth of any EHRs currently available that meet all of the requirements.

The AMA is not the only group expressing concern. On July 20, published an article, “Republicans attack new HIT ‘meaningful use’ rules,” recognizing a group of republicans and their concerns with the meaningful use final rule. The article pointed out that the main concern for this group regarding the final rule is that the final rules “aren’t strict enough to promote quick adoption of the equipment.”

Rep. Wally Herger (Calif.), senior Republican on the Ways and Means Health Subcommittee suggested that the leniency with the final rules could ultimately affect patient care. Herger suggests the DHHS’s final rules are essentially standards for physicians to ensure that they are using the tools available to improve patient services, and therefore must be considered as standards for the industry.

“’So each of the practices that experts have told this subcommittee are vital to improving patient safety and eliminating waste, are optional,’ Herger said. The lesser requirements, he warned, could lead to ‘a lower standard and lower compliance rates.’” (

For healthcare IT organizations, these opinions and viewpoints will have a dramatic effect on the rate of adoption of EHRs by healthcare organizations, regardless of incentives and estimated timelines by the ONC.

What do you think about the meaningful use and standards final rules?

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