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The    NEW ENGLA ND JOURNAL                                                              of   MEDICINE




                                                                      Perspective

The “Meaningful Use” Regulation for Electronic Health Records
David Blumenthal, M.D., M.P.P., and Marilyn Tavenner, R.N., M.H.A.



         T   he widespread use of electronic health records
             (EHRs) in the United States is inevitable. EHRs
         will improve caregivers’ decisions and patients’
                                                                                         $44,000 (through Medicare) and
                                                                                         $63,750 (through Medicaid) per
                                                                                         clinician. This funding will pro-
                                                                                         vide important support to achieve
         outcomes. Once patients experience the benefits of                              liftoff for the creation of a na-
                                                                                         tionwide system of EHRs.
        this technology, they will demand       the health care community with               Equally important, HITECH’s
        nothing less from their provid-         a transformational opportunity to        goal is not adoption alone but
        ers. Hundreds of thousands of           break through the barriers to            “meaningful use” of EHRs —
        physicians have already seen            progress. The Health Information         that is, their use by providers to
        these benefits in their clinical        Technology for Economic and              achieve significant improvements
        practice.                               Clinical Health Act (HITECH)             in care. The legislation ties pay-
           But inevitability does not mean      authorized incentive payments            ments specifically to the achieve-
        easy transition. We have years of       through Medicare and Medicaid            ment of advances in health care
        professional agreement and bi-          to clinicians and hospitals when         processes and outcomes.
        partisan consensus regarding the        they use EHRs privately and se-              HITECH calls on the secretary
        potential value of EHRs. Yet we         curely to achieve specified im-          of health and human services to
        have not moved significantly to         provements in care delivery.             develop specific “meaningful use”
        extend the availability of EHRs            Through HITECH, the federal           objectives. With the Centers for
        from a few large institutions to        government will commit unprec-           Medicare and Medicaid Services
        the smaller clinics and practices       edented resources to supporting          (CMS) in the lead, the Department
        where most Americans receive            the adoption and use of EHRs. It         of Health and Human Services
        their health care.                      will make available incentive pay-       (DHHS) has used an inclusive and
           Last year, Congress and the          ments totaling up to $27 billion         open process to develop these cri-
        Obama administration provided           over 10 years, or as much as             teria, providing an extensive op-


                                                    10.1056/nejmp1006114   nejm.org                                      1

      Downloaded from www.nejm.org on July 14, 2010 . For personal use only. No other uses without permission.
                       Copyright © 2010 Massachusetts Medical Society. All rights reserved.
PERSPECTIVE                                                        The “Meaningful Use” Regulation for Electronic Health Records



                                                Summary Overview of Meaningful Use Objectives.*

    Objective                                                                                              Measure
    Core set†
    Record patient demographics (sex, race, ethnicity, date of birth,       More than 50% of patients’ demographic data recorded as struc-
       preferred language, and in the case of hospitals, date and pre-        tured data
       liminary cause of death in the event of mortality)
    Record vital signs and chart changes (height, weight, blood pres-       More than 50% of patients 2 years of age or older have height,
       sure, body-mass index, growth charts for children)                     weight, and blood pressure recorded as structured data
    Maintain up-to-date problem list of current and active diagnoses        More than 80% of patients have at least one entry recorded as struc-
                                                                              tured data
    Maintain active medication list                                         More than 80% of patients have at least one entry recorded as struc-
                                                                              tured data
    Maintain active medication allergy list                                 More than 80% of patients have at least one entry recorded as struc-
                                                                              tured data
    Record smoking status for patients 13 years of age or older             More than 50% of patients 13 years of age or older have smoking
                                                                              status recorded as structured data
    For individual professionals, provide patients with clinical summa-     Clinical summaries provided to patients for more than 50% of all of-
       ries for each office visit; for hospitals, provide an electronic         fice visits within 3 business days; more than 50% of all patients
       copy of hospital discharge instructions on request                       who are discharged from the inpatient department or emergency
                                                                                department of an eligible hospital or critical access hospital and
                                                                                who request an electronic copy of their discharge instructions are
                                                                                provided with it
    On request, provide patients with an electronic copy of their health    More than 50% of requesting patients receive electronic copy within
       information (including diagnostic test results, problem list,          3 business days
       medication lists, medication allergies, and for hospitals, dis-
       charge summary and procedures)
    Generate and transmit permissible prescriptions electronically          More than 40% are transmitted electronically using certified EHR
       (does not apply to hospitals)                                          technology
    Computer provider order entry (CPOE) for medication orders              More than 30% of patients with at least one medication in their med-
                                                                              ication list have at least one medication ordered through CPOE
    Implement drug–drug and drug–allergy interaction checks                 Functionality is enabled for these checks for the entire reporting period
    Implement capability to electronically exchange key clinical infor-     Perform at least one test of EHR’s capacity to electronically exchange
       mation among providers and patient-authorized entities                  information
    Implement one clinical decision support rule and ability to track       One clinical decision support rule implemented
       compliance with the rule
    Implement systems to protect privacy and security of patient data       Conduct or review a security risk analysis, implement security up-
       in the EHR                                                              dates as necessary, and correct identified security deficiencies
    Report clinical quality measures to CMS or states                       For 2011, provide aggregate numerator and denominator through at-
                                                                               testation; for 2012, electronically submit measures
    Menu set‡
    Implement drug formulary checks                                         Drug formulary check system is implemented and has access to at
                                                                               least one internal or external drug formulary for the entire report-
                                                                               ing period
    Incorporate clinical laboratory test results into EHRs as structured    More than 40% of clinical laboratory test results whose results are in
       data                                                                   positive/negative or numerical format are incorporated into
                                                                              EHRs as structured data
    Generate lists of patients by specific conditions to use for quality    Generate at least one listing of patients with a specific condition
       improvement, reduction of disparities, research, or outreach
    Use EHR technology to identify patient-specific education resourc-      More than 10% of patients are provided patient-specific education
       es and provide those to the patient as appropriate                     resources
    Perform medication reconciliation between care settings                 Medication reconciliation is performed for more than 50% of transi-
                                                                              tions of care




2                                                                 10.1056/nejmp1006114   nejm.org


                     Downloaded from www.nejm.org on July 14, 2010 . For personal use only. No other uses without permission.
                                      Copyright © 2010 Massachusetts Medical Society. All rights reserved.
PERSPECTIVE                                                    The “Meaningful Use” Regulation for Electronic Health Records



                                          Summary Overview of Meaningful Use Objectives (Continued.)

  Provide summary of care record for patients referred or transitioned        Summary of care record is provided for more than 50% of patient
     to another provider or setting                                              transitions or referrals
  Submit electronic immunization data to immunization registries or           Perform at least one test of data submission and follow-up sub-
     immunization information systems                                            mission (where registries can accept electronic submissions)
  Submit electronic syndromic surveillance data to public health agen-        Perform at least one test of data submission and follow-up submis-
     cies                                                                         sion (where public health agencies can accept electronic data)
  Additional choices for hospitals and critical access hospitals
     Record advance directives for patients 65 years of age or older          More than 50% of patients 65 years of age or older have an indica-
                                                                                tion of an advance directive status recorded
     Submit of electronic data on reportable laboratory results to pub-       Perform at least one test of data submission and follow-up sub-
        lic health agencies                                                      mission (where public health agencies can accept electronic
                                                                                 data)
  Additional choices for eligible professionals
     Send reminders to patients (per patient preference) for preven-          More than 20% or patients 65 years of age or older or 5 years of
        tive and follow-up care                                                 age or younger are sent appropriate reminders
     Provide patients with timely electronic access to their health in-       More than 10% of patients are provided electronic access to infor-
        formation (including laboratory results, problem list, medica-          mation within 4 days of its being updated in the EHR
        tion lists, medication allergies)

* This overview is meant to provide a reference tool indicating the key elements of meaningful use of health information technology. It does
  not provide sufficient information for providers to document and demonstrate meaningful use in order to obtain financial incentives from
  the Centers for Medicare and Medicaid Services. The regulations and filing requirements that must be fulfilled to qualify for the Health IT
  financial incentive program are detailed at www.cms.gov.
† These objectives are to be achieved by all eligible professionals, hospitals, and critical access hospitals in order to qualify for incentive pay-
  ments.
‡ Eligible professionals, hospitals, and critical access hospitals may select any five choices from the menu set.



            portunity for public and profes-               qualify for incentive payments in              activities from which providers
            sional input. The department                   the first 2 years of the program.              will choose several to implement
            published proposed meaningful                     The most important part of                  in the first 2 years (see table).
            use requirements on January 16,                this regulation is what it says                   Core objectives comprise ba-
            2010. The proposal prompted some               hospitals and clinicians must do               sic functions that enable EHRs
            2000 comments. This week, the                  with EHRs to be considered                     to support improved health care.
            DHHS is releasing a final regu-                meaningful users in 2011 and                   As a start, these include the
            lation for the first 2 years (2011             2012. In the original proposal,                tasks essential to creating any
            and 2012) of this multiyear in-                we identified a broad set of ob-               medical record, including the
            centive program. Subsequent rules              jectives, all of which would need              entry of basic data: patients’ vi-
            will govern later phases.                      to be met. This included 23 ob-                tal signs and demographics, ac-
               Although the intent of our                  jectives for hospitals and 25 for              tive medications and allergies,
            January proposals has been re-                 clinicians. The DHHS received                  up-to-date problem lists of cur-
            tained and indeed affirmed                     many comments that this ap-                    rent and active diagnoses, and
            through the rule-making process,               proach was too demanding and                   smoking status.
            the final regulation also incorpo-             inflexible, an all-or-nothing test                Other core objectives include
            rates significant changes — a re-              that too few providers would be                using several software applica-
            sponse to the comments and ex-                 likely to pass.                                tions that begin to realize the
            perience that diverse stakeholders                In the final regulation, we                 true potential of EHRs to im-
            shared with us. In particular, con-            have divided these elements into               prove the safety, quality, and ef-
            cerns about the pace and scope                 two groups: a set of core objec-               ficiency of care. These features
            of implementation of meaningful                tives that constitute an essential             help clinicians to make better
            use led us to adopt a two-track ap-            starting point for meaningful                  clinical decisions — and avoid
            proach regarding the objectives that           use of EHRs and a separate                     preventable errors. To qualify
            allow practices and hospitals to               menu of additional important                   for incentive payments, clini-


                                                               10.1056/nejmp1006114      nejm.org                                                      3

         Downloaded from www.nejm.org on July 14, 2010 . For personal use only. No other uses without permission.
                          Copyright © 2010 Massachusetts Medical Society. All rights reserved.
PERSPECTIVE                                       The “Meaningful Use” Regulation for Electronic Health Records


       cians must start employing such       care — but are also achievable          strikes a balance between ac-
       clinical decision support tools.      by average practices and provid-        knowledging the urgency of
       They must also start using the        ers in the early years.                 adopting EHRs to improve our
       capability that undergirds much           The HITECH legislation fur-         health care system and recogniz-
       of the value of EHRs: using rec-      ther requires that meaningful           ing the challenges that adoption
       ords to enter clinical orders and,    use include electronic reporting        will pose to health care provid-
       in particular, medication pre-        of data on the quality of care. In      ers. The regulation must be both
       scriptions. Only when providers       the final regulation, we have           ambitious and achievable. Like
       enter orders electronically can       simplified the January proposals        an escalator, HITECH attempts
       the computer help improve deci-       for quality reporting, while still      to move the health system up-
       sions by applying clinical logic      building toward a robust report-        ward toward improved quality
       to those choices in light of all      ing capability that will inform         and effectiveness in health care.
       the recorded patient data. And        providers about their own perfor-       But the speed of ascent must be
       to begin extending the benefits       mance and will eventually inform        calibrated to reflect both the ca-
       of EHRs to patients themselves,       the public as well. Clinicians will     pacities of providers who face a
       the meaningful use require-           have to report data on three core       multitude of real-world challeng-
       ments will include providing pa-      quality measures in 2011 and            es and the maturity of the tech-
       tients with electronic versions of    2012: blood-pressure level, tobac-      nology itself.
       their health information.             co status, and adult weight                As part of this process, the
          In addition to the core ele-       screening and follow-up (or alter-      DHHS is establishing a nation-
       ments, the rule creates a second      nates if these do not apply). Cli-      wide network of Regional Exten-
       group: a menu of 10 additional        nicians must also choose three          sion Centers to assist providers
       tasks, from which providers can       other measures from lists of met-       in adopting qualified EHRs and
       choose any 5 to implement in          rics that are ready for incorpora-      making meaningful use of them.
       2011–2012. This gives providers       tion into electronic records.           The DHHS is committed to the
       latitude to pick their own path           The meaningful use rule is          support, collaboration, and on-
       toward full EHR implementation        part of a coordinated set of reg-       going learning that will mark
       and meaningful use.                   ulations to help create a private       our progress toward electroni-
          For example, the menu in-          and secure 21st-century elec-           cally connected, information-
       cludes capacities to perform          tronic health information sys-          driven medical care. We hope
       drug-formulary checks, incorpo-       tem. On June 18, 2010, the              that providers and consumers
       rate clinical laboratory results      DHHS issued a rule that laid out        will now join us in the effort to
       into EHRs, provide reminders to       a process for the certification of      assure that we make the best
       patients for needed care, identi-     electronic health records, so that      possible use of our most precious
       fy and provide patient-specific       providers can be assured they           health care resource: information
       health education resources, and       are capable of meaningful use.          about the patients we serve.
       employ EHRs to support the pa-        The department has also issued             Disclosure forms provided by the au-
                                                                                     thors are available with the full text of this
       tient’s transitions between care      still another regulation that lays      article at NEJM.org.
       settings or personnel.                out the standards and certifica-
          For most of the core and           tion criteria that EHRs must            Dr. Blumenthal is the national coordinator
       menu items, the regulation also       meet in order to be certified. Fi-      for health information technology at the
                                                                                     Department of Health and Human Ser-
       specifies the rates at which pro-     nally, realizing that the privacy       vices, and Ms. Tavenner is the principal
       viders will have to use particular    and security of EHRs are vital,         deputy administrator of the Centers for
       functions to be considered            the DHHS has been working               Medicare and Medicaid Services — both in
                                                                                     Washington, DC.
       meaningful users. Reflecting          hard to safeguard privacy and
       the views and experiences shared      security by implementing new            This article (10.1056/NEJMp1006114) was
       during the comment period,            protections contained in the            published on July 13, 2010, at NEJM.org.
       these rates will enable signifi-      HITECH legislation.                     Copyright © 2010 Massachusetts Medical Society.

       cant progress toward improving            The meaningful use rule




4                                                10.1056/nejmp1006114   nejm.org


           Downloaded from www.nejm.org on July 14, 2010 . For personal use only. No other uses without permission.
                            Copyright © 2010 Massachusetts Medical Society. All rights reserved.

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NEJM EMR Overview

  • 1. The NEW ENGLA ND JOURNAL of MEDICINE Perspective The “Meaningful Use” Regulation for Electronic Health Records David Blumenthal, M.D., M.P.P., and Marilyn Tavenner, R.N., M.H.A. T he widespread use of electronic health records (EHRs) in the United States is inevitable. EHRs will improve caregivers’ decisions and patients’ $44,000 (through Medicare) and $63,750 (through Medicaid) per clinician. This funding will pro- vide important support to achieve outcomes. Once patients experience the benefits of liftoff for the creation of a na- tionwide system of EHRs. this technology, they will demand the health care community with Equally important, HITECH’s nothing less from their provid- a transformational opportunity to goal is not adoption alone but ers. Hundreds of thousands of break through the barriers to “meaningful use” of EHRs — physicians have already seen progress. The Health Information that is, their use by providers to these benefits in their clinical Technology for Economic and achieve significant improvements practice. Clinical Health Act (HITECH) in care. The legislation ties pay- But inevitability does not mean authorized incentive payments ments specifically to the achieve- easy transition. We have years of through Medicare and Medicaid ment of advances in health care professional agreement and bi- to clinicians and hospitals when processes and outcomes. partisan consensus regarding the they use EHRs privately and se- HITECH calls on the secretary potential value of EHRs. Yet we curely to achieve specified im- of health and human services to have not moved significantly to provements in care delivery. develop specific “meaningful use” extend the availability of EHRs Through HITECH, the federal objectives. With the Centers for from a few large institutions to government will commit unprec- Medicare and Medicaid Services the smaller clinics and practices edented resources to supporting (CMS) in the lead, the Department where most Americans receive the adoption and use of EHRs. It of Health and Human Services their health care. will make available incentive pay- (DHHS) has used an inclusive and Last year, Congress and the ments totaling up to $27 billion open process to develop these cri- Obama administration provided over 10 years, or as much as teria, providing an extensive op- 10.1056/nejmp1006114 nejm.org 1 Downloaded from www.nejm.org on July 14, 2010 . For personal use only. No other uses without permission. Copyright © 2010 Massachusetts Medical Society. All rights reserved.
  • 2. PERSPECTIVE The “Meaningful Use” Regulation for Electronic Health Records Summary Overview of Meaningful Use Objectives.* Objective Measure Core set† Record patient demographics (sex, race, ethnicity, date of birth, More than 50% of patients’ demographic data recorded as struc- preferred language, and in the case of hospitals, date and pre- tured data liminary cause of death in the event of mortality) Record vital signs and chart changes (height, weight, blood pres- More than 50% of patients 2 years of age or older have height, sure, body-mass index, growth charts for children) weight, and blood pressure recorded as structured data Maintain up-to-date problem list of current and active diagnoses More than 80% of patients have at least one entry recorded as struc- tured data Maintain active medication list More than 80% of patients have at least one entry recorded as struc- tured data Maintain active medication allergy list More than 80% of patients have at least one entry recorded as struc- tured data Record smoking status for patients 13 years of age or older More than 50% of patients 13 years of age or older have smoking status recorded as structured data For individual professionals, provide patients with clinical summa- Clinical summaries provided to patients for more than 50% of all of- ries for each office visit; for hospitals, provide an electronic fice visits within 3 business days; more than 50% of all patients copy of hospital discharge instructions on request who are discharged from the inpatient department or emergency department of an eligible hospital or critical access hospital and who request an electronic copy of their discharge instructions are provided with it On request, provide patients with an electronic copy of their health More than 50% of requesting patients receive electronic copy within information (including diagnostic test results, problem list, 3 business days medication lists, medication allergies, and for hospitals, dis- charge summary and procedures) Generate and transmit permissible prescriptions electronically More than 40% are transmitted electronically using certified EHR (does not apply to hospitals) technology Computer provider order entry (CPOE) for medication orders More than 30% of patients with at least one medication in their med- ication list have at least one medication ordered through CPOE Implement drug–drug and drug–allergy interaction checks Functionality is enabled for these checks for the entire reporting period Implement capability to electronically exchange key clinical infor- Perform at least one test of EHR’s capacity to electronically exchange mation among providers and patient-authorized entities information Implement one clinical decision support rule and ability to track One clinical decision support rule implemented compliance with the rule Implement systems to protect privacy and security of patient data Conduct or review a security risk analysis, implement security up- in the EHR dates as necessary, and correct identified security deficiencies Report clinical quality measures to CMS or states For 2011, provide aggregate numerator and denominator through at- testation; for 2012, electronically submit measures Menu set‡ Implement drug formulary checks Drug formulary check system is implemented and has access to at least one internal or external drug formulary for the entire report- ing period Incorporate clinical laboratory test results into EHRs as structured More than 40% of clinical laboratory test results whose results are in data positive/negative or numerical format are incorporated into EHRs as structured data Generate lists of patients by specific conditions to use for quality Generate at least one listing of patients with a specific condition improvement, reduction of disparities, research, or outreach Use EHR technology to identify patient-specific education resourc- More than 10% of patients are provided patient-specific education es and provide those to the patient as appropriate resources Perform medication reconciliation between care settings Medication reconciliation is performed for more than 50% of transi- tions of care 2 10.1056/nejmp1006114 nejm.org Downloaded from www.nejm.org on July 14, 2010 . For personal use only. No other uses without permission. Copyright © 2010 Massachusetts Medical Society. All rights reserved.
  • 3. PERSPECTIVE The “Meaningful Use” Regulation for Electronic Health Records Summary Overview of Meaningful Use Objectives (Continued.) Provide summary of care record for patients referred or transitioned Summary of care record is provided for more than 50% of patient to another provider or setting transitions or referrals Submit electronic immunization data to immunization registries or Perform at least one test of data submission and follow-up sub- immunization information systems mission (where registries can accept electronic submissions) Submit electronic syndromic surveillance data to public health agen- Perform at least one test of data submission and follow-up submis- cies sion (where public health agencies can accept electronic data) Additional choices for hospitals and critical access hospitals Record advance directives for patients 65 years of age or older More than 50% of patients 65 years of age or older have an indica- tion of an advance directive status recorded Submit of electronic data on reportable laboratory results to pub- Perform at least one test of data submission and follow-up sub- lic health agencies mission (where public health agencies can accept electronic data) Additional choices for eligible professionals Send reminders to patients (per patient preference) for preven- More than 20% or patients 65 years of age or older or 5 years of tive and follow-up care age or younger are sent appropriate reminders Provide patients with timely electronic access to their health in- More than 10% of patients are provided electronic access to infor- formation (including laboratory results, problem list, medica- mation within 4 days of its being updated in the EHR tion lists, medication allergies) * This overview is meant to provide a reference tool indicating the key elements of meaningful use of health information technology. It does not provide sufficient information for providers to document and demonstrate meaningful use in order to obtain financial incentives from the Centers for Medicare and Medicaid Services. The regulations and filing requirements that must be fulfilled to qualify for the Health IT financial incentive program are detailed at www.cms.gov. † These objectives are to be achieved by all eligible professionals, hospitals, and critical access hospitals in order to qualify for incentive pay- ments. ‡ Eligible professionals, hospitals, and critical access hospitals may select any five choices from the menu set. portunity for public and profes- qualify for incentive payments in activities from which providers sional input. The department the first 2 years of the program. will choose several to implement published proposed meaningful The most important part of in the first 2 years (see table). use requirements on January 16, this regulation is what it says Core objectives comprise ba- 2010. The proposal prompted some hospitals and clinicians must do sic functions that enable EHRs 2000 comments. This week, the with EHRs to be considered to support improved health care. DHHS is releasing a final regu- meaningful users in 2011 and As a start, these include the lation for the first 2 years (2011 2012. In the original proposal, tasks essential to creating any and 2012) of this multiyear in- we identified a broad set of ob- medical record, including the centive program. Subsequent rules jectives, all of which would need entry of basic data: patients’ vi- will govern later phases. to be met. This included 23 ob- tal signs and demographics, ac- Although the intent of our jectives for hospitals and 25 for tive medications and allergies, January proposals has been re- clinicians. The DHHS received up-to-date problem lists of cur- tained and indeed affirmed many comments that this ap- rent and active diagnoses, and through the rule-making process, proach was too demanding and smoking status. the final regulation also incorpo- inflexible, an all-or-nothing test Other core objectives include rates significant changes — a re- that too few providers would be using several software applica- sponse to the comments and ex- likely to pass. tions that begin to realize the perience that diverse stakeholders In the final regulation, we true potential of EHRs to im- shared with us. In particular, con- have divided these elements into prove the safety, quality, and ef- cerns about the pace and scope two groups: a set of core objec- ficiency of care. These features of implementation of meaningful tives that constitute an essential help clinicians to make better use led us to adopt a two-track ap- starting point for meaningful clinical decisions — and avoid proach regarding the objectives that use of EHRs and a separate preventable errors. To qualify allow practices and hospitals to menu of additional important for incentive payments, clini- 10.1056/nejmp1006114 nejm.org 3 Downloaded from www.nejm.org on July 14, 2010 . For personal use only. No other uses without permission. Copyright © 2010 Massachusetts Medical Society. All rights reserved.
  • 4. PERSPECTIVE The “Meaningful Use” Regulation for Electronic Health Records cians must start employing such care — but are also achievable strikes a balance between ac- clinical decision support tools. by average practices and provid- knowledging the urgency of They must also start using the ers in the early years. adopting EHRs to improve our capability that undergirds much The HITECH legislation fur- health care system and recogniz- of the value of EHRs: using rec- ther requires that meaningful ing the challenges that adoption ords to enter clinical orders and, use include electronic reporting will pose to health care provid- in particular, medication pre- of data on the quality of care. In ers. The regulation must be both scriptions. Only when providers the final regulation, we have ambitious and achievable. Like enter orders electronically can simplified the January proposals an escalator, HITECH attempts the computer help improve deci- for quality reporting, while still to move the health system up- sions by applying clinical logic building toward a robust report- ward toward improved quality to those choices in light of all ing capability that will inform and effectiveness in health care. the recorded patient data. And providers about their own perfor- But the speed of ascent must be to begin extending the benefits mance and will eventually inform calibrated to reflect both the ca- of EHRs to patients themselves, the public as well. Clinicians will pacities of providers who face a the meaningful use require- have to report data on three core multitude of real-world challeng- ments will include providing pa- quality measures in 2011 and es and the maturity of the tech- tients with electronic versions of 2012: blood-pressure level, tobac- nology itself. their health information. co status, and adult weight As part of this process, the In addition to the core ele- screening and follow-up (or alter- DHHS is establishing a nation- ments, the rule creates a second nates if these do not apply). Cli- wide network of Regional Exten- group: a menu of 10 additional nicians must also choose three sion Centers to assist providers tasks, from which providers can other measures from lists of met- in adopting qualified EHRs and choose any 5 to implement in rics that are ready for incorpora- making meaningful use of them. 2011–2012. This gives providers tion into electronic records. The DHHS is committed to the latitude to pick their own path The meaningful use rule is support, collaboration, and on- toward full EHR implementation part of a coordinated set of reg- going learning that will mark and meaningful use. ulations to help create a private our progress toward electroni- For example, the menu in- and secure 21st-century elec- cally connected, information- cludes capacities to perform tronic health information sys- driven medical care. We hope drug-formulary checks, incorpo- tem. On June 18, 2010, the that providers and consumers rate clinical laboratory results DHHS issued a rule that laid out will now join us in the effort to into EHRs, provide reminders to a process for the certification of assure that we make the best patients for needed care, identi- electronic health records, so that possible use of our most precious fy and provide patient-specific providers can be assured they health care resource: information health education resources, and are capable of meaningful use. about the patients we serve. employ EHRs to support the pa- The department has also issued Disclosure forms provided by the au- thors are available with the full text of this tient’s transitions between care still another regulation that lays article at NEJM.org. settings or personnel. out the standards and certifica- For most of the core and tion criteria that EHRs must Dr. Blumenthal is the national coordinator menu items, the regulation also meet in order to be certified. Fi- for health information technology at the Department of Health and Human Ser- specifies the rates at which pro- nally, realizing that the privacy vices, and Ms. Tavenner is the principal viders will have to use particular and security of EHRs are vital, deputy administrator of the Centers for functions to be considered the DHHS has been working Medicare and Medicaid Services — both in Washington, DC. meaningful users. Reflecting hard to safeguard privacy and the views and experiences shared security by implementing new This article (10.1056/NEJMp1006114) was during the comment period, protections contained in the published on July 13, 2010, at NEJM.org. these rates will enable signifi- HITECH legislation. Copyright © 2010 Massachusetts Medical Society. cant progress toward improving The meaningful use rule 4 10.1056/nejmp1006114 nejm.org Downloaded from www.nejm.org on July 14, 2010 . For personal use only. No other uses without permission. Copyright © 2010 Massachusetts Medical Society. All rights reserved.