There's a sense relief across the industry that the just-unveiled meaningful use criteria are less stringent than many had feared, striking the right note between rules-based accountability and the freedom needed to foster wider implementation.

As Beth Israel Deaconess Medical Center CIO, John Halamka, MD, wrote on his blog, "it's a tricky balance to ensure there is enough specificity to test and certify EHRs and modules for interoperability while at the same time encouraging innovation."

Charlie Jarvis, vice president of healthcare services and government relations at NextGen, notes that "the relaxation of a number of the goals to meet will help providers achieve meaningful use a little more easily."

At the same time, said Erica Drazen, managing director, emerging practices at consulting firm CSC, "clearly everyone has a lot of work to do."

She was speaking last week, in advance of Tuesday's announcement, about vendors.  Drazen said many have a substantial list of chores now that final rules – for meaningful use, and standards and certification – are in place.

The first item on Drazen's  list? "One of the key challenges will be the quality reporting requirements."

The final rule simplified proposals for quality reporting somewhat, "while still building toward a robust reporting capability," as National Coordinator for Health Information Technology David Blumenthal, MD wrote Tuesday in the New England Journal of Medicine.

The reduced  number of quality measures "will make it more practicable for folks to participate and enable us to move more quickly as vendors to integrate those measures into our applications," said Mark Segal, vice president of government and industry affairs for GE Healthcare IT.

Even so, Drazen noted, "in order to get the data to do the electronic reporting you have to have a lot of capabilities enabled… it's not so much the reporting that's the challenge, it's getting the data to report."

Under the new rule, clinicians will be required to report data on three core quality measures in 2011 and 2012: blood-pressure level, tobacco status, and adult weight screening and follow-up. In addition, they must also choose three other measures from lists of metrics that are ready for incorporation into  EHRs.

Drazen says the biggest hurdle ahead is simply related to vendors' implementation capacity in general.

"Even looking just at CPOE, the latest KLAS data says 14 percent of hospitals have implemented," says Drazen. "Well that means 86 percent need to implement in order to get to meaningful use. I think something like 200 hospitals came on board last year, which was a record number. Take 200 and divide it into more than 4,000 hospitals that aren't there yet, and we clearly need to do something different."

Ultimately, Drazen cautions, "I think some people have underestimated what is required" – adding that "there's a difference between certification and happy customers."

Certification uncertain

While "ONC did a great job reviewing the public comments and providing clear responses to each of these comments," said Jacob Reider, MD, chief medical informatics officer at Allscripts, the final rule may still prove too much for some vendors who "may choose to leave the market, as they realize they’re unable to meet the minimal requirements," Reider said. "Certification will no longer be optional."

Indeed, for some providers the ability for vendors to get certified in a timely fashion is a concern. The big challenge now, says Denni McColm, CIO at Citizens Memorial Hospital in Bolivar, Mo., is "not the meaningful use requirements as much as vendors in the market being able to be certified in the time frame. If we hospitals and physicians are required to implement major upgrades as a result of the certification versions –  that may be certified best case scenario by fall – that will be scary."

She adds that "our major vendors are ready if the certification bodies can get ready, but for niche vendors who may not have ever even contemplated certification – that’s where the difficulty may be."

Most vendors, however, are much more optimistic. "We're comfortable with where things are," said Jarvis. "We believe that we'll be able to apply for certification sometime in the next couple of months. With the approach we've taken with regard to being aggressively meeting all the standards to this point, we don't see any concern in being able to meet the government's certifying standards as well and being identified as a certified unit."

Meanwhile, many vendors are taking it upon themselves to assuage their customers' concerns as they educate them about the new rules.

Girish Kumar Navani, co-founder and CEO of eClinicalWorks, said his company is currently developing tools for customers, to help give them "the education needed to ensure they are utilizing their system in a manner consistent with the meaningful use criteria. Providers will need to be educated on the milestones and meaningful use criteria that has been set forth and the responsibility for that will be on the vendors."

Allscripts CEO Glen Tullman echoed that sentiment. With the final rule, "physicians can make informed buying decisions with a clear view into what exactly will be required of them and the electronic health record vendor they select," he said in a statement. "We look forward to helping our clients achieve meaningful use and, more importantly, meaningful value from the use of their electronic health record."

Now that the rules are set, in other words, the race is on.

"The tipping point is here and the time to act is now," said Tullman.