In case you hadn't heard--and if you hadn't, shame on you (or good for you for taking a vacation)--the final rules for "meaningful use" of EMRs came out last week. As readers of FierceEMR know, I got a flood of comments and offers to comment from many vendors, consultants, industry groups and self-styled pundits, most of them positive.

If you're looking for a general overview of the regulations, I direct you to the New England Journal of Medicine article by national health IT coordinator Dr. David Blumenthal and Principal Deputy CMS Administrator Marilyn Tavenner. You may also want to view this slide deck from Jim Tate of EMRAdvocate.com. But there are plenty of nuances in the 864-page CMS rule and companion 228-page rule from ONC on standards and certification of EMRs that have some constituencies jumping for joy and others screaming bloody murder.

Of particular note, according to high-acuity EMR vendor Picis, emergency departments now are considered separate places of service for the purpose of meaningful use. "One of the most important distinctions for the ED--and one of the biggest hurdles for hospitals--is that they are now therefore eligible for inclusion in computerized physician order entry (CPOE) for medication orders entered by any licensed healthcare professional," writes Dr. Mark Crockett, president of emergency care at Picis.

On the other side of the spectrum, the Pharmaceutical Care Management Association is disappointed by the perceived lack of attention to e-prescribing safeguards. According to Washington insider publication The Hill, the PCMA would like CMS to require physicians to perform safety checks in order to get credit for e-prescribing and to apply Part D e-prescribing rules to certified EHRs. "We hope that regulators will do more down the road to ensure that the full safety and savings benefits of e-prescribing are realized on behalf of America's patients," PCMA President and CEO Mark Merritt says.

As the saying goes, "You can't please all of the people all of the time." (That phrase apparently comes from poet John Lydgate, in case you were wondering.) Personally, I would have liked to have seen criteria for Stage 2 (2013-14) and Stage 3 (2015-16) defined or at least outlined. But it seems as if the majority of those that have opined publicly are mostly pleased with what CMS and ONC produced. for that, HHS officials should be satisfied.

Now the hard part begins: installing certified technology and meeting the criteria. Good luck to all. The health of millions--including myself--is at stake. - Neil