Groups back proposed electronic health record definition

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But many physicians voice skepticism about the use of digital patient files, a key initiative in the Obama administration's stimulus package.

Four of the nation's leading consumer advocate groups endorsed the Obama administration's definition of what constitutes an electronic health record, a requirement clinicians and facilities must meet to receive federal funds.

The Consumers Union and AARP have given their support to the proposed meaningful use rule as outlined by the Health and Human Services Department and the Centers for Medicare and Medicaid Services.

But the rule, as explained in a 556-page document, wasn't positively received by many doctors, who submitted most of the more than 1,000 comments received since Jan. 7. They zeroed in on the rule's complexity, length and lack of understanding of the realities of the challenges they face in their day-to-day work.

The comment period closed on Monday. Many health-related groups supported the rules. The Consumer Partnership for eHealth, which includes the National Partnership for Women and Families, and the Pacific Business Group on Health, a coalition of companies and public sector groups that work to improve quality of care and reduce costs, also urged CMS to keep the proposed rules, arguing they will reduce medical errors and improve patient safety.

If adopted, the rules will govern who receives federal incentive payments of up to $44,000 each for doctors and up to $2 million each for hospitals that follow the proposed meaningful use definition when establishing electronic health record systems. The subsidies are part of the economic stimulus package Congress passed in February 2009, which included about $20 billion for health information technology.

"We are convinced that CMS is on the right track to ensure that taxpayer money is well-spent," said Christine Bechtel, vice president of the National Partnership for Women and Families and a member of the Health Information Technology Policy Committee, which advises HHS. "These criteria are achievable because they are based on the capabilities of today's [electronic health records] and what is already being done by some providers."

CMS established 25 meaningful use standards and in a February letter to David Blumenthal, national health IT coordinator at HHS, the chairmen of the policy committee urged HHS and CMS to provide clinicians flexibility this year when meeting standards for deploying electronic health records.

If HHS adopts the recommendations, health care providers will be required to meet only one of the following standards:

--Record demographic information as structured data;

--Report quality of care measures to the Centers for Medicare and Medicaid Services;

--Use a computerized patient order entry system;

--Generate and transmit prescriptions electronically.

Dr. Christine Sinsky, an internist in Dubuque, Iowa, said the rules will "ultimately slow innovation" by subsidizing current products rather than encouraging the development of better systems, which would lead to better electronic health records.

"At this point we don't need more EHRs, we need better EHRs," Sinsky wrote about the proposed rule.

In her comments to CMS, Sharon Fox, executive director of the Children's Health Alliance, an association of pediatricians in Portland, Ore., said, "the rules are far too complex and lengthy. . . . It appears to me that there will be more money going to regulate the disbursement of dollars than actually going to provide incentives to physicians to adopt [electronic medical records]."

Troy Seagondollar, a health IT specialist at Kaiser Permanente, which completed the roll out this month of one of the largest private electronic health record systems in the nation serving 8.6 million patients and medical personnel, urged CMS to provide funds to educate clinicians on how to use and manage electronic health record systems.

The money would go toward education on basics such as file applications and management as well as database design and the skills needed to transition from paper to electronic systems, he said.

Dr. Maurice Stutzman, a family practitioner in Baltic, Ohio, said the proposed rules fail on one key point, "[The] regulations assume that robust IT infrastructure exists everywhere."

He said this doesn't apply to his practice, which "is located in a rural Appalachian area with a high percentage of elderly and poor who have minimal access to the Internet. Also, we have a large Amish population who shun technology."

Stutzman said he would like to use electronic health records, "but reliable, fast infrastructure has to happen first. We will eventually be penalized for practicing in a rural area because it has inferior IT infrastructure since we will be unable to meet your deadlines, due to infrastructure issues beyond our control."

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