The Center for Medicare and Medicaid Services (CMS) has now published its Notice of Proposed Rulemaking (NPRM) for "meaningful use" and also the Initial Set of Standards and Certification Criteria Interim Final Rule (IFR) in the Federal Register. The Recovery Act of 2009 signed into law in 2009 includes the Health Information Technology for Economic and Clinical Health Act (the "HITECH Act"). The HITECH act established programs under Medicare and Medicaid to provide incentive payments for the "meaningful use" of electronic health record (EHR) technology.

The NPRM can be accessed at: http://edocket.access.gpo.gov/2010/pdf/E9-31217.pdf

The IFR can be accessed at: http://edocket.access.gpo.gov/2010/pdf/E9-31216.pdf

Both the NPRM and IFR have an open comment period for the public to 5 p.m. on March 15, 2010. Both documents contain instructions on how to comment electronically, by mail or by hand delivery.

CMS says it does not intend to have disparate definitions of meaningful use in Medicare and Medicaid, so the proposed rule would create a common definition of meaningful use that would serve as the definition for providers participating in both programs as a minimum standard. CMS would allow States to add additional objectives to the definition of meaningful use or modify how the existing objectives are measured, but CMS would not accept any State-proposed alternative that "does not further promote the use of EHRs and health care quality or that would require additional functionality beyond that of certified EHR technology."

CMS goes on to explain its decision to implement meaningful use criteria in a phased approach, stated that phasing in the criteria "encompasses reasonable criteria for meaningful use based on currently available technology capabilities and provider practice experience, and builds up to a more robust definition of meaningful use based on anticipated technology and capabilities development.

In Stage 1: the criteria focus on electronically capturing health information in a coded format; using that information to track key clinical conditions and communicating that information for care coordination purposes (in structured format whenever possible); implementing clinical decision support tools to facilitate disease and medication management; and reporting clinical quality measures and public health information.

In Stage 2: the criteria expand upon the Stage 1 criteria to encourage the use of health IT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible, including electronic transmission of orders entered using computerized provider order entry (CPOE) and the electronic transmission of diagnostic test results and data needed to diagnose and treat disease. Additionally CMS may consider applying the criteria more broadly to both the inpatient and outpatient hospital settings.

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