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D.C. Report: EHR Workflows, Insurance Industry Weighs in on ACA Rulings

March 15, 2011
by Sharon Canner, Sr. Director of Advocacy
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FAQs Address Workflows and Modifications to Certified EHRs. Earlier this week both the Office of the National Coordinator (ONC) and the Centers for Medicare and Medicaid Services (CMS) issued a frequently asked question (FAQ) on workflows. An FAQ on a similar topic is also discussed below. ONC’s FAQ 24 (also posted on the CMS website— FAQ 1043) asks if eligible providers are limited to demonstrating meaningful use in the exact way that electronic health record (EHR) technology was tested and certified. “In most cases,” says the response, "an eligible professional or eligible hospital is not limited to demonstrating meaningful use to the exact way in which the Complete EHR or EHR Module was tested and certified.” Further, ONC advises that “in doing so, care should be taken to ensure that such actions do not adversely affect the Complete EHRs or EHR Module's performance of the capabilities for which it was tested and certified, which could ultimately compromise an eligible professional or eligible hospital's ability to successfully demonstrate meaningful use.”

On the topic of modifications to certified EHRs, ONC FAQ 16 addresses an example of connecting to a patient registration system. In response, the FAQ states that one can reconfigure implementation of a certified system without compromising its certified status. Cautions are in order, however. Says the FAQ, “you assume the risks associated with modifying a certified system after it has been certified. You are also responsible for ensuring that these modifications do not adversely affect the performance of your certified system and, as a result, your ability to demonstrate meaningful use. We encourage eligible providers to use caution when modifying certified Complete EHRs or EHR Modules.”

Insurance Industry Weighs in on ACA Rulings. Among the flurry of legal actions regarding the Accountable Care Act (ACT), America’s Health Insurance Plans (AHIP) filed an amicus brief in the case brought by Virginia Attorney General Ken Cuccinelli. As reported earlier, U.S. District Court Judge Henry Hudson ruled in this case that the individual mandate was unconstitutional because it went beyond the power of Congress to regulate interstate commerce. While not siding with either the Administration or the plaintiff, the AHIP Brief “focuses solely on the economic consequences that would inevitably occur if the personal coverage requirement is removed from the law while the major insurance market reforms remain.” Furthermore, it points out the consequences of eliminating the mandate in that "guarantee issue and adjusted community rating requirements and the prohibition on pre-existing condition exclusions would not be economically and actuarially sound if the individual mandate were struck down.” Interestingly, the insurance industry worked closely in helping to craft the original legislation, but has stepped back in its support more recently.