Meaningful use rules exempt doctors, not EMR systems

Physicians who want to qualify for stage 1 meaningful use incentives need to have electronic medical record systems that can accomplish all the tasks mentioned under the stage 1 rules -- even the tasks doctors plan to defer accomplishing until a later time.

David Blumenthal, MD, national coordinator for health information technology at the Dept. of Health and Human Services, posted a blog entry on Dec. 23, 2010, that he hoped would clear up confusion about the level of flexibility built into stage 1 requirements to receive bonuses from Medicare or Medicaid.

Under the final rules, physicians were given the flexibility to defer up to five of the 10 objectives on a menu set. But even if physicians have no plans to use certain functions of the EMR system, they must have a system that is certified to do them all.

Erica Drazen, managing partner at the consulting firm CSC, said once the final rules came out and the health IT office said it made them more flexible, many people turned their focus to the meaningful use objectives and didn't carefully read the certification portion of the rules, which did not change.

Those rules state that the EMR system physicians use to qualify for incentive pay must be certified to perform all the functions listed under the stage 1 rules.

Even though the statement issued by Dr. Blumenthal may have raised the anxiety level for some, Mark Segal, vice president of government and industry affairs for GE Healthcare IT, said he doesn't expect it to have much impact on individual physicians on the road to meeting meaningful use.

Most practices have adopted what are considered "complete" EMRs that already would contain all the needed functionality, he said.

Karen Bell, MD, chair of the Certification Commission for Health Information Technology, agrees that if practices have adopted a system that has been certified as a complete EMR, "they don't have to worry about a thing."

Segal expects that the groups most affected by the rule will be those that have developed their own EMR systems, or those that have implemented multiple systems, each carrying a different function -- usually hospitals.

Dr. Bell said physicians whose systems won't qualify can go to the website of the Office of the National Coordinator for Health Information Technology to register for the incentive program. There is a function that allows practices to click on all the certified pieces they have, and the system will tell them if they have all the pieces they need (link).

Analysts say some specialists might run into issues. Under the rules, physicians are eligible to defer certain objectives that do not apply to their area of practice. Even if a physician plans to qualify for an exception for e-prescribing, for example, he or she still must have the capability to e-prescribe. Some specialists may have adopted systems before meaningful use entered the lexicon, and those systems may not include certain functions.

Drazen said one solution to this problem is to use a Web-based system, many of which offer an a la carte-type subscription package that allows users to turn off functions they may not need. Because the function is available, the EMR system will meet the requirement without the burden of purchasing a costly system, she said.