Analysis of the Final Rule on Meaningful Use

Inga from HIStalk provides a helpful summary of the changes between the preliminary and final rules for  Meaningful Use. Also John D Halamka has posted a very nice summary slide deck for those who need to present a synposis of the changes. Finally, Keith Boone's colleague, Dan Sepulvada helped compile a table summarizing the differences between the preliminary and final rules.

Two quick observations are below; look for a separate post in the coming days on how these new rules affect document management, particularly Release of Information.

• Across the board, the final rules are a lot less ambitious than the preliminary ones. This is mostly a good outcome because we still don't know the behavior these rules will motivate. More* on this at the end of the post. 
• The preliminary rules were written with an assumption that medical records will be mostly electronic by 2015. Several studies suggest this goal is not realistic, so it will be interesting to hear whether these rules will indeed prevail or whether there would be further changes down the road. A Bass Diffusion model applied to physician EMR systems by Prof. Eric W. Ford and others claims true adoption will take a decade longer than anticipated. And that's the optimistic scenario!

I look forward to hearing your thoughts in the comments section below.

*Why less ambitious rules may be a good thing: Rob Lamberts at The Health Care Blog draws an analogy between Meaningful Use rules and those in No Child Left Behind--another well intentioned legislation that introduced undesirable behavior on the part of the actors (the teachers). One would rather have rules that are realistic than those that are so strict everyone has to find workarounds.

EMR or EHR?

EMR (Electronic Medical Records) and EHRs (Electronic Health Records) refer to two very distinct concepts. Unfortunately, government officials, vendors, respected journalists, and consultants have used these terms interchangeably in order to refer to EMRs.

HIMSS Analytics provides clarity on the meaning of these terms:

• Electronic Medical Record: An application environment composed of the clinical data repository, clinical decision support, controlled medical vocabulary, order entry, computerized provider order entry, pharmacy, and clinical documentation applications. This environment supports the patient s electronic medical record across inpatient and outpatient environments, and is used by healthcare practitioners to document, monitor, and manage health care delivery within a care delivery organization (CDO). The data in the EMR is the legal record of what happened to the patient during their encounter at the CDO and is owned by the CDO.

• Electronic Health Record: A subset of each care delivery organization’s EMR, presently assumed to be summaries like ASTM s Continuity of Care Record (CCR) or HL7 s Continuity of Care Document (CCD), is owned by the patient and has patient input and access that spans episodes of care across multiple CDOs within a community, region, or state (or in some countries, the entire country). The EHR in the US will ride on the proposed National Health Information Network (NHIN). The EHR can be established only if the electronic medical records of the various CDOs have evolved to a level that can create and support a robust exchange of information between stakeholders within a community or region. While some forms of early EHRs exist today in limited environments, it will be difficult to establish effective EHRs across the majority of the US market until we have established clinical information transaction standards that can be easily adopted by the different EMR application architectures now available.

John at "EMR and HIPAA" argues that this distinction is irrelevant and that these terms will always be used interchangeably. He writes:

"My favorite in the EMR world is when people go crazy if you use the term EMR and not EHR. Let’s just get over it. The doctors I talk to really are. They use them interchangeably to mean everything that you might technically consider an EHR."

What do you think?