Federal officials released the long-awaited final rule on meaningful use Tuesday, with Wednesday morning showing most major organizations still wading through the more than 800 pages of regulations for an in-depth reaction. Initial response seemed to be cautiously optimistic, but the American Hospital Association expressed concerns.

Leaders of the American Hospital Association said on Tuesday they are still conducting an in-depth review of the regulation. They are initally pleased with the added flexibility and removal of some of the "unnecessary administrative burdens" in the final rule, they said.

But that's where the positive reaction ends. Overall, AHA leaders said they remain concerned that the requirements may be out of reach for many hospitals. "Unfortunately, CMS continues to place some barriers in the way of achieving widespread IT adoption," AHA said in its statement.

AHA concerns include:

• Individual hospitals in multi-campus settings are unfairly excluded from incentive payments. Hospitals within a healthcare system should each be eligible for incentives;
• The rule may adversely impact rural hospitals and exacerbate the digital divide in healthcare;
• The rule requires hospitals to immediately use Computerized Provider Order Entry (CPOE), "which can be complicated, costly to implement and takes time to do right;"
• The rule, in combination with the certification process, "penalizes early adopters" by requiring them to upgrade or replace already functional systems;
• The rule limits how quickly hospitals can adopt a certified EHR that can benefit patient care.

"Given limited vendor capacity and workforce shortages, many hospitals will not have timely access to certified products, since no certified EHR systems are available today," AHA said. 

Others more optimistic

William F. Jessee, president and CEO of the Medical Group Management Association said MGMA is pleased the federal government acknowledged many of MGMA’s serious concerns regarding the proposed rule.

"While challenges remain, the final rule provides a better approach to the 'real-world' issues faced by practices as they move toward 'meaningful use' of EHRs," he said.

"Improvements sought by MGMA contained in the final rule include a reduction in the originally unrealistic thresholds related to e-prescribing, administrative transactions and computerized physician order entry, among others," Jessee said.

Jessee said MGMA will "work closely" with the Centers for Medicare and Medicaid Services to incorporate additional changes.

The Healthcare Information and Management Systems Society (HIMSS) is expected to have an initial reaction ready by sometime Wednesday, with an in-depth analysis forthcoming, HIMSS leaders said.

H. Stephen Lieber, HIMSS president and CEO said HIMSS members "appreciate and understand the cultural and technical challenges that healthcare providers face in meeting the requirements for meaningful use,"and "HIMSS will be a leader in the transformation."

Leaders of the College of Healthcare Information Management Executives (CHIME) said on Tuesday they are "actively reviewing" the final rule.

“It’s definitely time to begin a coordinated effort to implement electronic health records by providers nationwide,” said CHIME President and CEO Richard Correll. “We have been supportive of the federal government’s actions to encourage widespread implementation of EHRs, and we are increasing our educational programming in support of our members’ efforts to succeed in this new era of IT adoption”  

The Markle Foundation, the Center for American Progress, and the Engelberg Center for Health Care Reform at Brookings issued a joint statement backing health IT adoption incentives.

"The requirements must be ambitious enough to make the investments worthwhile, but not so onerous that they discourage large numbers of doctors and hospitals from participating," leaders of the organizations said. 
 
Carol Diamond, MD, managing director of the Markle Foundation said the final rule has added flexibility to encourage provider participation.

The organizations are still reviewing the regulation in detail, they said.