The New England Journal of Medicine published an article by David Blumenthal, M.D., M.P.P. – the national coordinator for health information technology at the Department of Health and Human Services, and Marilyn Tavenner, R.N., M.H.A. – the principal deputy administrator of the Centers for Medicare and Medicaid Services; the article was issued in parallel with the announcement of the final regulations. The article – The "Meaningful Use" Regulation for Electronic Health Records – provides an excellent summary of the essential elements of what to do to meet Stage 1 Meaningful Use requirements.

The most valuable piece to the article is the table entitled Summary Overview of Meaningful Use Objectives. This table should be printed as a poster and hung in every hospital and clinic pursuing the Meaningful Use requirements. If there is one page you read, this table should be it.

Remember, however, this is only for Stage 1 requirements to be achieved in 2011 and 2012. Stage 2 requirements will not be issued until the end of 2011.

The final regulation has a blend of Core requirements and a menu of requirements in which a provider can select five. This is the Core plus Choice approach taken which attempts to make the objectives “ambitious and achievable."

As stated in the article:

“In the final regulation, we have divided these elements into two groups: a set of core objectives that constitute an essential starting point for meaningful use of EHRs and a separate menu of additional important activities from which providers will choose several to implement in the first 2 years."


“Core objectives comprise basic functions that enable EHRs to support improved health care. As a start, these include the tasks essential to creating any medical record, including the entry of basic data: patients' vital signs and demographics, active medications and allergies, up-to-date problem lists of current and active diagnoses, and smoking status." “In addition to the core elements, the rule creates a second group: a menu of 10 additional tasks, from which providers can choose any 5 to implement in 2011–2012. This gives providers latitude to pick their own path toward full EHR implementation and meaningful use."

The reason for this approach is to address the comments and concerns about the “pace and scope" of the preliminary rule. Many of the percentages for achievement in the various categories were lowered in Stage 1 so that it is more “achievable by average practices and providers in the early years." To read through an overview, Inga at HISTalk provides a good comparison of the changes.

All in all, there is more balance and flexibility in the approach to achieve Meaningful Use and the goals of HITECH. The unknown is what escalation of requirements will occur in Stages 2 and 3. Regardless, this approach may get more providers and hospitals on board initially. Most would agree there is an absolute need to bring healthcare into a more electronic age and usher in an integrated healthcare generation.

The goal is reiterated over and over again:

“Equally important, HITECH's goal is not adoption alone but "meaningful use" of EHRs — that is, their use by providers to achieve significant improvements in care. The legislation ties payments specifically to the achievement of advances in health care processes and outcomes."


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