On 30 December 2009, the U.S. Department of Health and Human Services released two regulations concerning the receipt of funds under the American Recovery and Reinvestment Act (ARRA) of 2009 promoting use by physicians of electronic health records (EHRs).

• "Proposed Rule: Medicare and Medicaid Programs: Electronic Health Record Incentive Program" sets criteria, policies and procedures for payments for "meaningful use" of "certified EHRs" under the ARRA.
• "Standards and Certification Interim Final Rule: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology" specifies standards for interoperability, security, and privacy that must be used to qualify for the payments.

The documents can be downloaded from the Federal Register at http://www.federalregister.gov/inspection.aspx#special . Both regulations will appear in the Federal Register on 13 January 2010. Comments will be accepted through 15 March 2010.

There is a lot of money in play here, perhaps as much as $38 billion, according to the U.S. Office of Management and Budget. The incentive payments can cover a substantial portion of the total costs of implementing an EHR. However, the criteria for getting the funds require meaningful use of some of the important features of EHRs such as physician order entry and quality measurement. That level of implementation requires substantial change management within the hospital or practice. The benefits of doing an EHR well far outweigh the incentive funds and so does the cost of a poor implementation.

Most hospitals that have not already selected an EHR will not be able to finish in time to get more than a fourth of the total incentive. Practices can complete implementation by 3Q12 to get maximum payments, provided that they have a cohesive commitment to achieving the real benefits of an EHR.

U.S. care delivery organizations (CDOs):

• Assume that the final versions of these regulations will be substantially the same as those contained in these proposed and interim releases.
• Do not treat the incentive funds as a reason to implement an EHR. Rather, treat the funds as potential assistance when implementing an EHR for its intrinsic benefits.
• Do not rush in an attempt to maximize incentive payments and risk failure.
• If there are provisions in the regulations that are roadblocks to your organization, be sure to file comments by 15 March 2010 explaining why and indicate why this may be a problem shared by other CDOs.

• "Meaningful Use and Certification of EHRs: Tracking Evolving Targets"— The processes and criteria by which meaningful use will be judged and certified are coming into focus. By Wes Rishel
• "Requirements for Helping U.S. Physicians to Adopt EHRs"— We provide advice to CDOs and other stakeholders that seek to provide financial and other support to physicians to facilitate their adoption of EHRs. By Wes Rishel

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