Standards Issued for Electronic Health Records

Published: July 13, 2010 - New York Times

WASHINGTON — The federal government issued new rules Tuesday that will reward doctors and hospitals for the “meaningful use” of electronic health records, a top goal of President Obama.

The rules significantly scale back proposed requirements that the health care industry had denounced as unrealistic.

The Department of Health and Human Services said doctors and hospitals could receive as much as $27 billion over the next 10 years to buy equipment to computerize patients’ medical records. A doctor can receive up to $44,000 under Medicare and $63,750 under Medicaid, while a hospital can receive millions of dollars, depending on its size.

Starting in 2015, hospitals and doctors will be subject to financial penalties under Medicare if they are not using electronic health records.

Dr. Donald M. Berwick, who was sworn in Monday as administrator of the Centers for Medicare and Medicaid Services, said electronic health records would lead to “better, smoother care, more reliable care.”

Even though American health care is known for the use of advanced technology in treating patients, doctors and hospitals have been slow to replace paper records with electronic records.

“Only 20 percent of doctors and 10 percent of hospitals use even basic electronic health records,” said Kathleen Sebelius, secretary of health and human services.

Richard J. Umbdenstock, the president of the American Hospital Association, said the final rules were an improvement over the proposal. But he said he was still concerned that a majority of hospitals could not jump over the hurdles to get federal aid.

Dr. Ralph G. Brindis, president of the American College of Cardiology, applauded the rules, saying they promised to “increase the quality of care while reducing cost.” Cardiologists have been “early adopters” of electronic records, he said.

Dr. David Blumenthal, the national coordinator for health information technology, said doctors and hospitals would be defaulting on their “professional responsibilities” if they did not use electronic health records. Such technology can reduce medical errors, including mistakes that kill people, he said.

The main criticism of the rules proposed by the Obama administration in January was that they took an “all or nothing” approach. Doctors could not have received any federal bonus payments unless they met 25 criteria, or objectives, and hospitals would have been required to meet 23.

Standards in the new rules are less demanding and more flexible. Doctors will have to meet 15 specific requirements, plus 5 chosen from a list of 10 objectives. Hospitals will have to meet 14 requirements, plus 5 chosen from a menu of 10 goals.

Doctors, for example, will have to use electronic systems to record patients’ demographic data (sex, race, date of birth); their height, weight and blood pressure; their medications; and their smoking behavior.

To meet the new standards, doctors will have to transmit 40 percent of prescriptions electronically. Under the proposal, 75 percent of prescriptions had to be sent electronically.

“We are delaying some of the more ambitious requirements,” Dr. Blumenthal said. He described the new standards as “ambitious but achievable” and said they would put doctors “on an escalator” toward full adoption of electronic records.

Even pioneers in the use of electronic records, like Kaiser Permanente, Intermountain Healthcare in Utah and the Partners HealthCare System in Boston had said they could not meet all the proposed standards.

The final rules do not guarantee that doctors and hospitals can electronically exchange clinical information on patients. The rules do require health care providers to work toward that goal, widely seen as a way to improve the coordination of care and avoid the duplication of tests.