Physicians and privacy advocates aren't pleased with the newly proposed "meaningful use" requirements with which providers will likely have to comply to gain bonuses under the American Recovery and Reinvestment Act of 2009.

The Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health Information Technology proposed the rules on Dec. 30, and will take comments for 60 days before issuing a final rule.

The Medical Group Management Association said the requirements "are overly complex" and that medical groups will confront significant challenges trying to meet them.

“The Medicare and Medicaid incentive programs must be designed to facilitate the rapid deployment of health information technology,” said MGMA President and CEO William F. Jessee, MD. “Overly burdensome requirements and needlessly complex administration will only discourage physician participation in the program and the implementation of (electronic health records)."

Jessee encouraged the administration to simplify the meaningful use criteria and qualifying procedures.

According to the MGMA, the rules will create "significant barriers" for physicians trying to achieve meaningful use of EHR data, including:

• Unreasonable threshholds for some meaningful use criteria, including computerized prescription order entry, electronic claim submission and electronic insurance eligibility verification;
• Potentially difficult meaningful use attestation after the first year; and
• A requirement that physician offices provide patients and others with electronic copies of medical records.

"We were pleased to see that the CMS and ONC rules include some flexibility, especially in the areas of escalating stages of meaningful userequirements, straightforward first year attestation and reasonable 90-day reporting windows," Jessee said. “However, we firmly believe that the government should make additional changes to achieve widespread adoption by professionals in all types of clinical settings."

Privacy advocates are also displeased with the rule. Deborah C. Peel, MD, founder and chairwoman of Patient Privacy Rights, said the rule "does not contain the single most important criteria American patients and consumers demand to trust electronic health systems: control over personal health information." 

Comments submitted by the bipartisan Coalition for Patient Privacy, representing millions of Americans, were not  considered, Peel said.

The rule "guarantees that the stimulus billions will be wasted to purchase obsolete, unethical EHR 'clunkers' instead of EHRs with privacy-enhancing technologies that put patients in control of their sensitive health records, from prescriptions to DNA," Peel said.

Not everyone was displeased with the rules. Justin Barnes, chairman of the Electronic Health Record Association, said the basic EHR incentive funding for Medicare and Medicaid pathways, along with much of the specific clinical EHR meaningful use criteria, hasn't really changed from preliminary requirements published earlier in 2009.

John Halamka, chairman of the Healthcare Information Technology Standards Panel (HITSP) and Chief Information Officer of the Beth Israel Deaconess Medical Center, called the rule "well done."

"The recommendations are consistent with the work of thousands of experts over the past decade," he said. "They do not include all the detailed recommendations from HITSP or implementation profile writers such as IHE but they do include all the highly mature constructs that are deployable in 2011 without over burdening the industry."

"There is much more to applaud than criticize," added H. Stephen Lieber, president and CEO of the Healthcare Information and Management Systems Society. "We now have clarity of what technology functions constitute a qualified electronic health record, we now have a multi-year road map of future expectations, and we have certainty about many of the standards necessary to support practitioners’ ability to improve patient care."