The release of the CMS Medicare & Medicaid EHR Incentive Program Final Rule [link] on July 14 marked the end of the Stage 1 process for defining “meaningful use.” The final steps of that process involved reviewing, synthesizing, analyzing and reacting to more than 2,200 comments received from the public. The comments addressed big-picture principles and arcane details, and just about everything in between. We were very grateful for the public input and are very excited to announce the Stage 1 Meaningful Use requirements.

Having been part of the team at ONC and CMS that got to review thousands of pages of input, I wanted to share some thoughts on four principles that shaped decisions around changes from the Notice of Proposed Rule Making to the Final Rule. In the end, the changes to meaningful use boiled down to four themes: 

• Flexibility: We were convinced by commenters that the all-or-nothing approach was not a practical solution for getting the majority of providers on the escalator to meaningful use of EHRs. Building flexibility into the program makes allowances for providers facing a wide variety of external challenges to achieve Stage 1 meaningful use. As a former Surgeon General said about medication adherence, “Medications don’t work in patients who don’t take them.” Likewise, EHRs have no benefits if providers don’t implement them.
• Simplicity: We increased feasibility of calculating HIT functionality measures by substantially reducing the reporting burden for providers. This was primarily achieved by eliminating manual chart review requirements and using electronic calculation of denominators for the HIT functionality measure denominators.
• Consistency: Wherever we could, we tried to align the program requirements—hospitals and professionals, Medicare and Medicaid. Registration for the Medicare incentive programs will begin in January 2011, and State Medicaid agencies will launch any time, beginning in January 2011. With the possible exception of a very limited set of public health functionalities, the Medicare and Medicaid will have the same meaningful use objectives and measures.
• Quality & Patient-Centeredness: We always evaluated the three principles above with an eye toward the fundamentals of meaningful use: making care delivery more patient-centered and improving the quality, safety and efficiency of health care. We never lost sight of the laser focus that the meaningful use principle provided: It’s not about the technology; it’s about transforming health care delivery for the benefit of patients and everybody else involved in their care.
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  Thanks to Blackford Middleton whose tweet brought this to my attention.