Federal Officials Unveil Final 'Meaningful Use' Rule, EHR Standards

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On Tuesday, federal officials announced the release of the final rule defining how hospitals and health care providers can demonstrate "meaningful use" of electronic health records to qualify for federal incentive payments, Reuters reports.

The incentive plan was outlined in the 2009 federal economic stimulus package as part of a broad government effort to spur adoption of health information technology.

Incentive Payments

Health care providers and hospitals that demonstrate meaningful use of certified EHRs would be able to tap into $27 billion in incentive payments through Medicaid and Medicare over five years.

However, providers that do not adopt the technology would face reduced payments in 2015 (Lentz, Reuters, 7/13).

The requirements for demonstrating meaningful use of health IT will be phased in over three stages through 2015 (Adams, CQ HealthBeat, 7/13).

EHR Standards, Certification

Officials also released the final rule describing the required standards and certification criteria for EHRs.

The new regulation updates the interim final rule on EHR certification that Office of the National Coordinator for Health IT released in January (Mosquera, Government Health IT, 7/13).

Details of the Final Meaningful Use Rule

According to National Coordinator for Health IT David Blumenthal, the final rule offers health care providers more flexibility than the proposed regulations that were released in January. Under the January proposal, physicians would have been required to meet 25 core objectives, and hospitals 23 core objectives (CQ HealthBeat, 7/13).

However, the final rule for the first stage of the reimbursement program stipulates that physicians must meet 15 core objectives and hospitals must meet 14 (Reuters, 7/13).

In addition, doctors and hospitals must comply with five additional objectives out of a "menu" of 10 options -- for a total of 20 objectives for physicians and 19 for hospitals (CQ HealthBeat, 7/13).

One of the core objectives requires providers to handle at least 40% of prescriptions electronically. The requirement was relaxed from the earlier proposal, which called for a 75% electronic prescribing rate (Alonso-Zaldivar, AP/Atlanta Journal-Constitution, 7/13).

Hospitals and physicians also would have to use computerized physician order entry systems for at least 30% of their medication orders. Under the earlier proposal, doctors would have been required to use CPOE systems for 80% of medication, laboratory and diagnostic orders (Robeznieks, Modern Healthcare, 7/13).

The final meaningful use rule also defines a hospital-based eligible professional as someone who performs nearly all services in an inpatient hospital setting or emergency department, and it expands the definition of acute care hospital to include designated critical access hospitals for the Medicaid incentive program (Health Imaging & IT, 7/13).

Additional Information in NEJM

Blumenthal and Marilyn Tavenner, principal deputy administrator of CMS, offered additional explanations of the final meaningful use rule in a New England Journal of Medicine perspective piece.

In the perspective piece, Blumenthal and Tavenner explained that HHS considered 2,000 outside comments before making changes to the earlier meaningful use regulations.

They also provided the full list of the core objectives and the menu of options for the new final rule (Hobson, "Health Blog," Wall Street Journal, 7/13).

A companion piece by U.S. Surgeon General Regina Benjamin about the new rule also appeared in NEJM (Versel, FierceEMR, 7/13).


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