On December 30, 2009, the Centers for Medicare and Medicaid Services issued a 556-page proposal detailing guidelines for determining which doctors' offices and hospitals will be eligible to tap nearly $20 billion in federal funds aimed at encouraging the use of electronic medical records.  The document will be officially published in the Federal Register on January 13, 2010, and includes a 60-day comment period.  A final rule is anticipated by late Spring.

Part of the American Recovery and Reinvestment Act passed into law last year set aside the cash for physician practices and hospitals that can show "meaningful use" of EMR technology, but didn't spell out how such use would be determined. That left the medical industry wondering who would be eligible to collect what could amount to $40,000 per doc over the course of a few years.

The new proposal (PDF), which is open to public comment, provides some detail. But it doesn't reveal which EMR solutions will be certified under the program or explain who and how those solutions will be certified.  Practices and hospitals will be able to tap the ARRA funds if they meet the following criteria:

1.       "Eligible professionals" (EPs - physicians) must use "computerized physician order entry" or EMRs for at least 80 percent of all orders. Hospitals must use CPOE for at least 10 percent of orders.

2.       The EP or hospital must be able to electronically check for drug-drug, drug-allergy and drug-formulary interactions to make prescribing drugs safer.

3.       Eighty percent of all patients must have at least one entry in a "problem list of current and active diagnoses," or " an indication of none as structured data."

4.       Eligibility requires electronic prescription capability; at least 75 percent of all prescriptions must be made using an eRx system.

5.       Eighty percent of all patients must have at least one eRx (or an indication of no prescription).

6.       Eighty percent of all patients must have at least one entry denoting an allergy to medication (or an entry indicating no allergies).

7.       At least 80 percent of all patients must have demographic data recorded (language, insurance, gender, race, ethnicity and dates of birth and death "in the event of mortality").

8.       At least 80 percent of all patients of 2 years old and older must have vital sign data recorded (height, weight, blood pressure, body mass index and growth charts for patients ages 2 to 20).

9.       At least 80 percent of all patients of 13 years or older must have their smoking status recorded.

10.    At least 50 percent of all patients must have their clinical lab tests recorded.

11.    Eligibility requires the generation of at least one list of patients with a specific condition "to use for quality improvement, reduction of disparities and outreach."

12.    EPs and hospitals must report ambulatory quality measures.

13.    Follow-up or preventive care reminders must be sent to at least 50 percent of patients aged 50 or more.

14.    EPs and eligible hospitals must implement five "clinical decision support rules relevant to specialty or high clinical priority," including diagnostics, and the ability to track compliance with the rules.

15.    Insurance eligibility must be able to be checked electronically for at least 80 percent of all patients.

16.    At least 80 percent of all insurance claims must be filed electronically.

17.    At least 80 percent of all patients requesting electronic copies of their health records must receive them within 48 hours.

18.    "At least 10 percent of all unique patients seen by the EP are provided timely electronic access to the health information."

19.    "Clinical summaries are provided for at least 80 percent of all office visits."

20.    Eligibility requires at least one test of the EMR system's ability to exchange clinical information with other EPs' or hospitals' systems.

21.    "Perform medication reconciliation for at least 80 percent of relevant encounters and transitions of care."

22.    "Provide summary of care record for at least 80 percent of transitions of care and referrals."

23.    Eligibility requires at least one test of the EMR system's ability to submit data to immunization registries."

24.    Eligibility requires at least one test of the EMR system's ability to submit lab reports to public health agencies - unless those agencies lack the ability to receive that data electronically.

25.    Eligibility requires a review of the data security of the EMR system and implementation of any security updates.