Thursday, December 23, 2010

Affirming Flexibility…With Certified EHR Systems

 by David Blumenthal

Today on our FAQ page, we are posting a revised Question and Answer regarding an issue that has recently caused confusion in our meaningful use regulations: namely, the flexibility that providers have to defer performance on some Stage 1 meaningful use objectives; and how that squares with the requirement that providers must nonetheless possess fully-certified EHR systems.

The new FAQ is meant to clarify this two-part requirement. But we should make it equally clear that our policy has not changed:

As stated in our final regulations, providers are given the flexibility to defer as many as five “menu set” objectives during Stage 1 and still achieve meaningful use. That means providers have flexibility to stage their adoption and implementation of EHRs in sync with their plans to defer certain menu set objectives.
But as also stated in our final regulations, we require EHR systems themselves be certified against all criteria adopted by the Secretary. So even though a provider has the option of deferring some objectives during Stage 1, the EHR system in the provider’s possession must be certified against all functions. Possession means having a legal right to access and use, at the provider’s discretion, all of the Stage 1 functions of a fully-certified system – but it does not imply that the provider must fully implement every one of these functions.
To understand this two-part approach, we need to look back to the development of the meaningful use regulations. From the beginning, this process was aimed at achieving the right balance – a balance between the need to achieve effective and rapid adoption of EHRs throughout the United States; and at the same time to be realistic about the challenges facing providers on the road to meaningful use.

In our final regulations, I believe HHS achieved the needed balance:

We identified the objectives that constituted meaningful use in Stage 1. These objectives are part of a coherent, longer-range plan for EHR adoption and meaningful use. We will build on these objectives as we graduate through Stage 2 and 3 of the transition process.
But at the same time, for these initial years, we recognized the challenge that this transition will pose to providers. For that reason, we gave providers flexibility in their own “staging” choices, permitting them to defer performing on as many as five of the 10 “menu set” objectives. This guarantee of flexibility, provided in our final regulations, has not been changed.
Why did we require that EHRs be certified as capable of meeting all of the certification criteria for meaningful use, even though we allowed flexibility concerning which criteria providers actually had to meet? There were several reasons.

First, our regulation stated that in Stage 2 of Meaningful Use, we will require that providers meet all the requirements laid out in Stage 1, including all 10 of objectives on the options menu. Having records capable of meeting all 10 objectives allows providers to get a head start on Stage 2 of meaningful use.

Second, we expect that some providers may try and fail to meet meaningful use objectives on one or more of the menu criteria. If their records are not capable of meeting the other optional objectives, they may be unable to obtain and implement the capabilities they lack in time to qualify for meaningful use. Thus, the requirement that certified EHRs possess the capability to meet all requirements actually gives providers the flexibility to experiment with multiple approaches to meeting meaningful use– and guarantees that if they fall short, they will not be left high and dry. This flexibility is only possible when the provider has access to certified technology for all Stage 1 functions.

The details of these requirements can be found in the new FAQ , and I invite you to read and comment. I hope it will be clear that these two elements are not in conflict, but rather represent the balance that has characterized the evolution of the meaningful use process. Finally, I hope it will be clear that there has been no change in the guarantee of provider flexibility during Stage 1.

To achieve EHR-based health care, we need to build a strong technology foundation. But at the same time, we need to recognize that providers have varying circumstances and different needs, and we seek to accommodate those differences as we support the transition to EHRs. In that spirit, we are delivering on the promise in our final regulations to give providers the flexibility they require to succeed in adoption and meaningful use of EHRs.

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