Third time's the charm: Committee accepts ‘meaningful use' criteria

Third time's the charm: Committee accepts ‘meaningful use' criteria

By Joseph Conn / HITS staff writer

Another month, another matrix in the development of definitions of “meaningful use,” the key criteria providers must meet to unlock tens of billions of dollars of federal healthcare information technology subsidies under the American Recovery and Reinvestment Act of 2009.

The Health Information Technology Policy Committee, a creature of the new law, also known as the stimulus law, received a third set of recommendations from its meaningful-use work group. The recommendations were again detailed, as were their predecessors handed over by the group in June and July, in a spreadsheet or “matrix” format.

The HIT Policy Committee accepted the recommendations, which under the order of events set out in the stimulus law the committee will forward to the Office of the National Coordinator for Health Information Technology at HHS, which will hand them over to the CMS for official rulemaking. All of these hand-offs will occur fairly seamlessly since David Blumenthal, the physician head of the ONC, is the chairman of the HIT Policy Committee and Tony Trenkle, director of the Office of eHealth Standards and Services at the CMS, is a policy committee member. Both men attended Friday's meeting.

This latest batch also stuck to the original staging schedule first proposed by the work group in June of creating three sets of increasingly more complex meaningful-use criteria, which hospitals and office-based physicians must meet to qualify for the subsidy payments. The matrix includes a dozen broad goals, more specific objectives and proposed metrics by which compliance with the goals and objectives can be measured. The lowest bar is set for 2011, the first year electronic health-record subsidy payments can be made under the Medicare portion of the technology funding program.

For example, one care goal is to provide a patient healthcare team access to “comprehensive patient health data.” In 2011, one objective proposed for meeting that goal is a requirement that all hospitals use computerized physician order entry, or CPOE, systems for at least 10% of orders by doctors, nurses and physician assistants. By 2013, the work group proposed raising the bar, requiring that 100% of hospital orders be initiated using CPOE. In 2015, the objective switches from using a specific system, CPOE, to achieving “minimal levels of performance” that can be measured using clinical outcomes standards to be agreed upon sometime between now and then.

The other highlight of the meeting was the report and recommendations by the policy committee work group on EHR system certification and adoption. Under the stimulus law, only certified EHR systems qualify for federal subsidies, and only if they are used in a “meaningful manner.” In the past, the federal government deemed the certification of an EHR by the not-for-profit Certification Commission for Health Information Technology as good enough to meet its certification requirements for Stark and anti-kickback exceptions for EHR subsidies made by hospitals to office-based physicians. CCHIT took its cues on certification criteria from the American Health Information Community, the Bush administration's counterpart to the HIT Policy Committee, and developed a program that tested vendors' products on their ability to perform more than 300 functions.

But the stimulus act, which became law in February, did not specify that CCHIT would be even an acceptable certification body for EHRs for stimulus law subsidies, much less the only certification body with deeming authority as in the past.

To guide the new way forward, the certification and adoption work group made five recommendations, which were accepted by the policy committee.

First, the group recommended that certification under the stimulus law should focus solely on the functions needed to meet the meaningful-use standards. The statute provides eight specific areas that the HIT Policy Committee must consider in making its recommendations on meaningful use, plus 10 other areas that the policy committee might also consider. Still, at least initially, the number of criteria against which systems will be tested under the stimulus law is likely to be far fewer than the 300 or so in the most recent CCHIT testing regime. In June, CCHIT announced its intention to continue to offer its comprehensive testing program, but also would add new testing and certification schemes tailored to the meaningful-use criteria as they are developed.

Second, according to the recommendations, progress needs to be made on testing and certifying systems that have the functionality to meet privacy, security and interoperability requirements called for in the stimulus act. Those include some amendments to the federal privacy law under the Health Insurance Portability and Accountability Act of 1996, such as the requirement that the systems be able to produce and report audit trails of where and when disclosures of patient information has been made, and to manage patient consents to release information, including a new authority that patients can block the release of their treatment information to their insurance company if they pay for treatment out-of-pocket.

Third, the work group recommended generally that the certification process be made more objective and transparent, with a specific recommendation that the federal National Institute of Standards and Technology, an agency of the Commerce Department, be tasked with helping the ONC develop a process to establish a separate and independent accreditation procedure for certification organizations such as CCHIT and any additional organizations that might join CCHIT in certifying EHRs to stimulus law criteria.

Fourth, the work group suggested that the certification process needs to be standardized so there is a level playing field for all seekers of EHR certification, whether they are commercial vendors of proprietary software systems, provider organizations that have developed home-grown systems, or communities or service providers of open-source EHR systems.

Finally, the work group recommended that the ONC and the CMS leverage as much as possible the work that has been done to date developing a certification program. Since an initial, official definition of meaningful use isn't expected from the CMS until early next year, the work group recommended establishing a “preliminary certification process” so vendors can begin preparing their systems to what will be a likely set of criteria. CCHIT, for example, has prepared an analysis of its current testing and certification criteria and how they stack up against what might be expected to meet meaningful use under a new certification regime.