Proposed federal rules for "meaningful use" of electronic health records among health care providers are either too strict or too vague, according an analysis from consultancy Manatt Health Solutions. The report was commissioned by the California HealthCare Foundation, the Colorado Health Foundation and the United Hospital Fund.

The American Recovery and Reinvestment Act of 2009 allocated $46.8 billion in incentive payments to health care providers to adopt EHRs, provided they make meaningful use of the technology. Medicare payments to individual providers will start to drop in 2015 unless providers demonstrate meaningful use.  

An notice of proposed rulemaking outlines steps providers must take in the first of what the Centers for Medicare & Medicaid Services says will be three phases that will eventually define meaningful use. CMS will update the rule with phase 2 criteria by the end of 2011 and with stage 3 criteria by the end of 2013, according to the notice.

That lack of certainty over what future stages will bring is one criticism report authors level at the notice. CMS "is effectively requiring providers to adopt EHRs now with no regard for the functionality that will be required to demonstrate meaningful use in the future," they state. Likewise, vendors of EHRs cannot design systems to encompass future meaningful use requirements since they don't know what they will be, the report adds.

Stage 1 criteria could leave small- and medium-sized physician practices behind, the report states. Meaningful use as now defined in the notice requires providers to use EHRs to improve quality, a requirement that could require significant workflow changes and resources to achieve, the report states. Providers in rural areas could also suffer from lack of broadband connectivity to share information.

The notice also takes an "all-or-nothing approach" to compliance with meaningful use, the report states. The authors suggest a model that allows providers to receive incremental payments as they make progress. They also suggest that CMS release a full meaningful use roadmap by the end of 2010 and adopt an incremental approach to achieving meaningful use over a longer time period. There's nothing in the law for EHR adoption that requires stage 3 meaningful use by a specific date, they state, "leaving CMS the ability to adopt a more flexible, incremental approach to achieving meaningful use." 

The stimulus bill also provided $2 billion for development of a nationwide health information technology infrastructure, but the notice mostly encourages point-to-point exchanges of data rather than an exchange that would allow providers to access patient data from multiple sources, the authors state.

Report authors also support reform of health care system payment, stating that payment should be tied to outcomes rather than volume. "The relationship between health IT and payment reform is a symbiotic one," the report states.

"Health IT enables care delivery improvements that are rewarded by value-based provider payment systems, which in turn provide strong, sustainable financial incentives for the continued adoption and use of health IT," it adds.

For more:
- read the Manatt Health Solutions report (.pdf)
- see this HHS web page on meaningful use, with a link to the notice of proposed rulemaking

Related Articles:
HHS urges on health data app development
Panel optimistic, apprehensive about "meaningful use" of health IT