Meaningful Use: ACR Advocates for Improvements

by Chris Gaerig

In 2010, in accordance with the American Reinvestment and Recovery Act of 2009, the Centers for Medicare and Medicaid Services (CMS) and Office of the National Coordinator for HIT (ONC) individually released final rules implementing meaningful use. The CMS’ final rule addressed requirements for physicians and hospitals. The ONC’s final rule addressed the certification criteria, standards, and implementation specifications for certified electronic health records (EHR) technology. And as the agencies approach the writing of Stage 2 of meaningful use, several organizations and stakeholders, such as the American College of Radiology (ACR), are actively pushing for changes to the program.

One of the largest areas of concern for the ACR with regard to the ONC’s Stage 1 rule is its implementation as a one-size-fits-all program. As the rule currently stands, practices can have certified EHR technology in one of two ways: through the implementation of a complete EHR or through a modular approach that requires comprehensiveness that may not be pertinent or necessary to specialties.

“Basically, before you can be a meaningful user, you need access to what meets the ONC’s regulatory definition of certified EHR technology,” said Mike Peters, ACR director, legislative and regulatory affairs. “You can have it one of two ways: one is a certified complete EHR, which is a product that has met all of the certification criteria, and the other is a combination of individually certified EHR modules. To be certified as an EHR module, a product must cover the basic privacy and security criteria and one or more of the other certification criteria in the ONC regulations. There are many HIT products that are not traditional EHRs that could be certified via the modular pathway.”

While the ACR is generally supportive of the modular approach, the current implementation of it—primarily ONC’s requirement that combinations of individually certified EHR modules comprehensively cover all certification criteria, including functions associated with meaningful use requirements in the CMS rule that are optional or provide exclusions to specialists—is impractical for specialty physicians.

“We and other groups opposed this comprehensiveness requirement in the ONC’s regulations because specialists should not have to implement any unused technologies,” said Peters. “If this requirement was removed, which they could do—there’s nothing stopping ONC from allowing for more flexibility for combinations of certified EHR modules—then it would be a big help to many specialties that rely entirely on non-traditional EHR technologies.”

Given time and manpower constraints, Peters believes it’s unlikely that CMS and ONC will adopt specialty-specific meaningful use requirements or product certification criteria. That won’t stop the ACR from advocating for improvements throughout the evaluation period and as the ONC and CMS begin to draft the proposed Stage 2 requirements for meaningful use later this year.

“The Stage 2 rules have yet to be written by both agencies, so this is just a guess based on the deliberations of the advisory committee and other documentation that has been released recently related to draft advice for future stages of meaningful use,” said Peters. “We will probably not see a radiologist-exclusive pathway to meaningful use because I don’t think they’re going to be able to establish separate requirements for each specialty. I think the two agencies might continue their Stage 1 approach of a single set of cross-cutting requirements for all participants, including radiologists and other specialists. My best guess is that Stage 2 will be more of the same in terms of inclusion of specialists through exclusions from certain unrelated objectives, zero denominator reporting for clinical quality measures, discretionary measures, and the other flexibility provisions that also exist in Stage 1.”