As CIO of the 600-physician Muir Medical Group IPA in Walnut Creek, Calif., Tina Buop has been following the progress on meaningful use regulations for electronic health records closely. In a recent interview, she shared her thoughts on the implications for the final rule on independent physician practices—plus her concerns for the next steps going forward.

Buop says last month’s meaningful use final rule by the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator (ONC) satisfied her concerns that that many independent physicians would not be able to comply under the under the proposed rule. “I was quite impressed with the original bill,” she says. “They had the right measure. It’s just that they were going much too fast.”

In fact, in the months leading up to the July 13th final rule announcement, Buop sought to turn her initial concerns into a call for action. Following the release of the interim rules, Muir hosted several webinars and invited physicians from IPAs to participate—and to submit comments to the rulemaking committee. The IPA ultimately submitted 35 comments, she says.

Buop notes she was concerned that many independent physician practices lacked the resources to comply under the proposed rules. “I think about some of the rural physicians who can’t afford an EMR [system], and how they are going to afford implementing all of this,” she says. “For us, [the final rules] are achievable. The government made a significant effort to listen to the comments given. They modified the rules, and we are pleased with the outcome.”

Those changes are reflected not only in the quantity of rules but in the ease of compliance in the final rule. “You not only have a change in the quantity of rules, you also have a change in the ability to meet those rules,” she says. “They originally set the bar way too high, especially for physicians who aren’t engaged in the EHR process.”

All of which is not to say that new concerns haven’t cropped up. One has to do with measurement. Citing as an example a menu requirement that 40 percent of clinical laboratory test results that are in positive /negative or numerical format be incorporated into EHRs as structured data, she questions how that data will be measured. “I think it is the right goal, and we will get there,” she says. “It’s a question of how we will measure it. How will you actually test that you have completed that,” she asks.

Buop’s other area of concern is in the area of evidence-based guidelines for clinical decision support. “We presently have 13 specialties, and now we are going to have to go back and configure at least one clinical decision support guideline for each of those specialties,” she says. That is the largest volume of work she sees for 2011 and 2012, although she adds that the IPA is on track for making the changes.

On the other hand, she notes, that “looking at the broad perspective of healthcare IT, the one area that you don’t have an authoritative figure on is evidence-based guidelines.” She predicts that more vendors will enter this arena toward the end of this year and 2011. “I see them arguing about who should be on the certification panel for those,” she says. “It would be great if the Office of the National Coordinator had a certification program for them, just like they do for the EHRs.”