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New government regulations covering meaningful use of electronic medical records (EMR) are winning kudos from EMR and healthcare providers alike, with very few discouraging attitudes.

New regulations governing how healthcare providers can prove meaningful use of electronic medical records technology, a hallmark of President Barack Obama's healthcare reform law, are winning praise from both EMR and healthcare providers.

To tap into the $27 billion being made available over the next decade to promote EMR adoption, healthcare providers must demonstrate meaningful use of an EMR system. Exactly what that entailed, however, wasn't clear until the U.S. Dept. of Health & Human Services issued MU regulations yesterday.

The finalized rules require that providers meet 14 to 15 core requirements and choose five more from a menu of 10 options. Mark Segal, vice president of government and industry affairs for GE Healthcare, told MassDevice that the new rules accomplish "two very important things."

"One was that core and menu. The other was that, for a number of the items, they substantially reduced the numerical thresholds," Segal told us. "For example, they eliminated two items that had been proposed for Stage 1 that were really more revenue-cycle-focused. We think those are very important, electronic eligibility checks and electronic claims submission and we've got products that are focused on that, but many EHRs don't have those as part of their core functionality. Keeping them in would have complicated the rollout of the program."

Dr. Tom Giannulli is chief medical information officer for Epocrates, which is developing its own EMR offering slated for release some time this fall. Giannulli told us that he's "very positive" about the new regulations.

"I commend the group under [national HIT coordinator] Dr. David Blumenthal. They did a great job. They really executed well against a really short timeframe and used a lot of common sense," he said. "From a physician's perspective, they've really metered down the more burdensome requirements and they've created this staged approach where a user can use the EMR in a very basic way and solve the meaningful use puzzle for the first two years. Once they've had that runway and the chance to get used to the technology, they can become more sophisticated users and solve the meaningful use concerns for Stages 2 and 3."

That said, there are some unaddressed issues remaining, Giannulli noted, including usability standards.

"The usability standards for these products need to be looked at, because most of the EMRs that are out there are unusable in the production environment. They have to be struggled with in order to be productive and often don't fulfill the requirements of going through a real-time [patient] encounter," he explained. "They have to be done after the fact and add additional time to the encounter flow. In reality, if they're designed correctly they can be operated in real time and actually enhance the efficiency of the doctor."

Poor or non-existent infrastructure is another problem, Giannulli said, citing the immunization reporting requirement."

There are these registries for immunizations. Those registries are state-region-by-state-region controlled. A lot of states don't even have registries and some states, like California, have four registries. The interface used to report data to these registries is not standardized, so even though there's a spec that says you have to submit to a state registry, that may be impossible or near-impossible based on that infrastructure. There are a lot of connectivity and interoperability assumptions built into the guidelines that are going to be really hard to implement until the infrastructure gets to a state where it's more streamlined," he said. "I would really appreciate it if the government spent some of that $27 billion to create a hub that every EMR could talk to to facilitate immunization or other types of data submission. If I'm a nationwide system and I want to satisfy every state or regional user's immunization registry requirement, I'd have to build something like 80 different interfaces. They really need to step up their game and say, 'Look, we understand there are these roadblocks and there isn't a lot of infrastructure. We're going to patch that infrastructure by spending a little bit of this money and building these kind of interfaces.'"

John Hallock, director of corporate communications for Athenahealth Inc. called his company "neutral" on the new rules.