The EMR Federal Requirements of Physicians

In 2004, the Bush administration introduced a bold plan to ensure the medical profession, as a whole, completely converts to electronic health records (EHR). This plan was passed into law in the Health Information Technology for Economic and Clinical Health (HITECH) Act provisions of the American Recovery and Reinvestment Act (ARRA)of 2009. HITECH provides medical professionals with tens of thousands of dollars in financial incentives to participate starting in 2011.

Participating Medical Professionals

• The rules for the HITECH Act are spread across Title 42 CFR §§ 412, 413, 422 & 495, and Title 45 CFR § 170. The rules for the incentive payments apply to eligible professionals (EPs), eligible hospitals and critical access hospitals (CAHs) that participate in Medicare and Medicaid programs and "meaningfully use" health information technology (HIT) under the direction of the new Office of the National Coordinator (ONC) for HIT.

  The law defines EPs under two different set of instances. If the EP participates in Medicare, the EP will be a legally, licensed, non-hospital-based physician that has either a doctor of medicine, doctor of dental medicine, doctor of dental surgery, doctor of podiatric medicine, doctor of optometry or a doctor of chiropractic medicine. If the EP participates in Medicaid, the EP will be either a physician as previously described or a physician assistant, or the EP will be a certified nurse midwife or a nurse practitioner who practices in a federally-qualified health center (FQHC) or rural health clinic (RHC).

Meaningful Use

• ONC certifies the HIT meaningful use of the EP using EHR. This certification is done in three phases: Stage 1 core criteria has15 mandatory core objectives that must be met; Stage 1 menu sets criteria with 10 voluntary objectives, of which five must be met; and Stage 2 with one mandatory objective that must be met.

  Once the ONC certifies that a Medicare EP is compliant, that EP can receive up to $44,000 in incentive payments. Once the ONC certifies that a Medicaid EP is compliant, that EP can receive up to $63,750 in incentive payments.

Core Criteria

• The 15 mandatory core objectives that must be met in total are: computerized provider order entry (CPOE) usage for medication orders for EPs that write 100+ prescriptions annually; drug-drug and drug-allergy interaction check implementation; maintenance of a problem list of current and active diagnoses that is kept up-to-date; generation and transmission of permissible prescriptions electronically (eRx) for EPs that write 100+ prescriptions annually; maintenance of an active medication list; maintenance of an active medication allergy list; recordation of the demographic of every patient by preferred language, gender, race, ethnicity and date of birth; recordation and charting on growth charts of vital sign changes for patients between two and 20-years-old in height, weight, blood pressure and body mass index (BMI); recordation of smoking status of patients older than 12 years; reporting of ambulatory clinical quality measures to the Centers for Medicaid & Medicare Services (CMS); implementation of at least one relative clinical decision support rule along ability to track compliance; providing to any patient, upon request, an electronic copy of their health information (including diagnostics test results, problem list, medication lists, medication allergies); providing all patients with clinical summaries during every office visit; electronically exchanging of key clinical information with other health care providers; and protection of EHRs.

Other Criteria

• Menu set criteria include: implementation of drug-formulary checks; incorporation of clinical lab-test results into EHRs; generation of patient lists by specific conditions to be used for quality improvement, reduction of disparities, research or outreach; send patient reminders for preventive/followup care for patients under five-years-old and 65 years and older; provide patients with timely electronic access to their EHRs; certified usage of HIT to identify and suggest patient-specific education resources; performing medication reconciliation with new patients; providing other health care providers with summary care record when referring patients; submission of electronic data to immunization registries or immunization information systems; and submission of electronic syndromic surveillance data to public health agencies.

  The Stage 2 criterion is for EPs that write 100+ prescriptions annually to use CPOE for medication orders.