Meaningful use to require 5 CDS rules but not progress notes in 2011

Healthcare providers will have to keep up-to-date problem lists, write electronic prescriptions, have electronic drug interaction checking, incorporate data from test results into their electronic health records, keep patient vitals and implement at least five rules for clinical decision support to be eligible for federal Medicare or Medicaid bonus payments beginning in 2011, according to proposed federal rules for "meaningful use" of EHRs. A previous plan would have only required one CDS rule.

CMS released the long-awaited proposal for meaningful use late Wednesday afternoon, beating the statutory deadline of Dec. 31 by one day. The Office of the National Coordinator for Healthcare Information Technology issued a companion interim final regulation relating to electronic data standards and certification of EHR products. The agencies will accept public comments on the respective plans for the next 60 days before finalizing the regulations in the spring.

The lengthy rules published today several subtle differences from earlier plans. Physician practices will only have to enter 80 percent of orders electronically, down from the 100 percent called for in recommendations issued last summer. The threshold for hospital use of computerized physician order entry is just 10 percent. In a brief conference call with reporters, CMS officials did not explain this discrepancy. For 2011 and 2012, hospitals would not have to be able to transmit orders electronically to pharmacies, labs or imaging centers and physicians will not have to record progress notes in the EHR. The standards will ratchet up in 2013 and 2015, however.

Federal officials now estimate the total cost of the program at $14.1 billion to $27.3 billion over the next 10 years, depending on provider participation. "I think that it's important to understand that this is a voluntary program," Jonathan Blum, director of CMS' Center for Medicare Management, said during the conference call. CMS says the figures are based on expected gross outlays minus any payment reductions for not achieving meaningful use in later years. The range does not consider expected efficiency gains from EHR usage.

For more information:
- read this HHS press release
- see the CMS proposed rule on meaningful use of EHRs (.pdf)
- see the ONC interim final rule on standards and certification (.pdf)