Problems with Modular Solutions for Electronic Health Records

I have posted the following comment on the ONC Health IT Blog (I'd be interested in your thoughts):

I’m not so sure that taking a modular approach to achieving meaningful use is going to work with the latest guidance from ONC. It seems that they are taking a back door approach towards reinstating the all or nothing requirements that were scaled back from the proposed rule to the final rule.

ONC posted on its website an FAQ stating that hospitals must have EHRs that have been certified against all 24 objectives of meaningful use, not just the 19 they plan to use to demonstrate meaningful use. This means that hospitals will need to purchase and implement technology beyond that required to comply with the meaningful use requirements, delaying many hospitals’ efforts to become meaningful users.

The ONC FAQ takes away the flexibility to defer objectives and requires hospitals and physicians to have in place EHRs certified against all 24 objectives of meaningful use. http://healthit.hhs.gov/portal/server.pt/community/onc_regulations_faqs/3163/faq_17/20779

It reads:

Question [9-10-017-1]:

Under the Medicare and Medicaid EHR Incentive Programs Final Rule, eligible health care providers are permitted to defer certain meaningful use objectives and measures and still receive an EHR incentive payment. However, it is our understanding that in order for us to have our EHR technology certified, we must implement all of the applicable capabilities specified in the adopted certification criteria regardless of whether we intend to use all of those capabilities to qualify for our EHR incentive payment. Is our understanding correct?

ONC Answer:

Yes, this understanding is correct. The flexibility offered as part of the Medicare and Medicaid EHR Incentive Programs Final Rule is not mirrored in the Initial Set of Standards, Implementation Specifications, and Certification Criteria Final Rule because we believe that it is important to accommodate eligible health care providers’ ability to achieve meaningful use. We recognize that in some circumstances an eligible health care provider may not know which meaningful use measures they will seek to defer until they begin implementation and in others an individual provider (even within a specialty) will want to choose different measures to defer based on their local situation and implementation experience. Thus, in order to possess EHR technology that meets the definition of Certified EHR Technology, it must be tested and certified by an ONC-ATCB to all applicable certification criteria adopted by the Secretary.


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So, to qualify for the incentive payments, hospitals must have an EHR certified against all 24 objectives of meaningful use, while demonstrating meaningful use against only 19 objectives. Thus, they will need to buy now technology that CMS does not require them to use until later, and which may need to be replaced or upgraded when new certification criteria are adopted for later stages of meaningful use. As an example we will need to purchase or upgrade to the technology to support reporting of biosurveillance and immunization data to public health departments directly from the EHR, even if the public health departments in our state are not capable of receiving the data in the standardized electronic formats required by ONC and CMS. This guidance has seriously muddied the water towards using modular EHR solutions…

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