On Tuesday the Centers for Medicare and Medicaid Services (CMS) delivered up the long-awaited final rule describing the first stage of meaningful use requirements for electronic health records (EHRs). As CIOs and health IT analysts and consultants work through the details of the 864-page document, most will probably express relief that CMS has built some flexibility into the definition and deferred some requirements.

CMS had initially proposed a definition of meaningful use on Dec. 30, 2009, and the final rule released July 13 modifies that proposal in several important ways based on more than 2,000 comments from stakeholders.

As National Coordinator for Health IT David Blumenthal, M.D., described in a Tuesday morning presentation, CMS responded to criticism that the proposed rule would be too difficult for many physicians and hospitals to meet. He spoke about trying to find a balance between the urgency of adopting EHRs and recognizing the challenges that adoption will pose to providers.

Many of the comments CMS received stated that the proposed rule was “too inflexible and all-or-nothing,” Blumenthal said. In response, the Stage 1 final rule breaks down the requirements into a core set of objectives, 15 for eligible providers and 14 for hospitals, and an “à la carte” menu option of 10 additional items. Providers can choose to meet any five of those and defer the other five. “That way, providers can take different paths to meaningful use,” Blumenthal said.

As an example, the menu includes performing drug-formulary checks, incorporating clinical laboratory results into EHRs, providing reminders to patients for needed care, identifying and providing patient-specific health education resources, and employing EHRs to support the patient’s transitions between care settings or personnel.

Just as important, some of the thresholds for measurement levels have been lowered, Blumenthal noted. For instance, in the proposed rule, eligible providers would have had to use e-prescribing for 75 percent of prescriptions. That number has been ratcheted down to 40 percent in Stage 1.

Stage 1 also finalizes a threshold for CPOE of 30 percent for physicians and hospitals.

Tony Trenkle, director of the CMS Office of e-Health Standards and Services, added that several requirements related to administrative transactions have been deferred to Stage 2 and the number of clinical quality measures required in Stage 1 has also been cut back. (According to CMS, clinicians will have to report data on three core quality measures in 2011 and 2012: blood-pressure level, tobacco status, and adult weight screening and follow-up (or alternates if these do not apply). Clinicians must also choose three other measures from lists of metrics that are ready for incorporation into EHRs.)

The Office of the National Coordinator for Health Information Technology also published a final rule that adopts standards, implementation specifications, and certification criteria to test and certify complete EHRs or EHR modules that will allow providers to meet Stage 1 guidelines. For instance, it details changes in EHR problem list and medication list certification criteria. It details minimum code set standards such as LOINC. ONC chose not to require specific transport standards such as SOAP or REST.

Healthcare Informatics will be interviewing CIOs and industry analysts and will provide ongoing coverage of the reaction to the new rules online as well as in upcoming print editions.