Federal officials responsible for writing the meaningful use rule defended it before a wary congressional panel on Tuesday, that had questions for most every facet of the rule.

Members of the House Ways and Means Subcommittee on Health grilled David Blumenthal, MD, National Coordinator for Health Information Technology and Tony Trenkle. director of the Office of E-Health Standards and Services at the Centers for Medicare and Medicaid Services (CMS) on aspects of the meaningful use rule, particularly focusing on interoperability requirements, costs, privacy and health disparities.

Congress footed the bill on more than $36 billion on incentive payments for the adoption of healthcare IT in American Recovery and Reinvestment Act,  and with the July 13 release of the final meaningful use rule, the committee made it clear they want to know if they will get their money's worth.

According to Trenkle and Blumenthal, some of the questions asked showed that congress members were not totally aware of certain aspects of adoption, particularly the policy and infrastructure needed to support health information exchange and the limited number of doctors and pharmacies ready for interoperability.

Some committee members wanted the interoperability requirements to be more strenuous. Blumenthal defended the stage method included in the meaningful use rule that will allow the use of "dummy data" for testing purposes. He reiterated again and again the  interoperability requirements – and all requirements  – would become more robust through Stages 2 and 3.

Trenkle addressed the hospital multi-campus issue; a heated concern of hospitals.

Hospitals want the meaningful use rule to grant incentives to each hospital in a hospital system. The proposed rule, and the final rule, kept all hospitals within a system as one system, for purposes of earning incentives.

"CMS carefully reviewed these comments and met with interested stakeholders, including the two largest hospital associations, the American Hospital Association and the Federation of American Hospitals, to hear their concerns with the policy described in the proposed rule," Trenkle said.

"Taking this input as well as the legislative language of the Recovery Act into account, we came to the conclusion in our final rule that we should define "subsection (d) hospital" in alignment with how we have defined that term in other situations."

Trenkle said CMS would need a law from Congress to change how hospitals are defined for reimbursement purposes. And, it is what the Premier healthcare alliance is advocating for its 2,300 community hospital members.

Trenkle said, CMS and the Office of the National Coordinator have worked closely together for the past 17 months as CMS has developed the policies to implement the Medicare and Medicaid EHR incentive programs. "The process has been extensive and provided many opportunities for stakeholder input," he said. "We believe that the final HIT regulations capture the intent of the legislation and reflect a balance between promoting adoption and ensuring the meaningful use of EHRs."

Most of the providers who testified at the hearing said the meaningful use Stage 1 requirements are doable, but challenging, striking the balance between keeping the bar where the regulators hoped it would be, low enough for participation, yet high enough to press adoption forward.

Phyllis Teater, chief information officer at the Ohio State University Medical Center, Columbus, Ohio, said she appreciated the added flexibility in the final rule. Ohio State Medical Center  has been using electronic health records for 20 years, but would not be ready to achieve meaningful use until 2012.

Eugene Heslin, MD, a small-practice family physician from Saugerties, New York, a rural area 100 miles north of New York City, said showing meaningful use is "definitely achievable for a practice like mine. "

"It's not going to be easy though," Heslin said.

Jonathan Hare, chairman of the Resilient Network Systems, Inc., a San Francisco-based software company said the health information exchange requirements in the rule "are not good enough." He said the government should move toward building a patient centric network on a national scale, which could provide robust security and disclosure management.