Last week the Centers for Medicare and Medicaid released the final rule on implementing criteria for "meaningful use" of electronic health record (EHR) technology that would enable health care providers to receive incentive payments.

Numbers from the EHR company Practice Fusion show that California, New York and Florida stand to earn the most money in incentive payments, with $4.6 billion, $3.52 billion and $2.39 billion respectively, said Practice Fusion's Hallema Clyburn.

The meaningful use criteria, which have been highly criticized for being too much too soon, will be implemented in three stages, beginning in 2011. Each stage has progressively stronger requirements for health care providers. The final rule has 15 measures for eligible health care professionals (EPs) and 14 for hospitals to demonstrate meaningful use in Stage 1.

The incentive criteria includes 15 mandatory tasks and 10 items, of which providers need to accomplish five, for a total of 20 criteria.

The Three Stages of Criteria

Stage 1: For 2011-2012, the criteria focus on establishing the functionalities in certified EHR technology to implement both quality improvement and ease with the exchange of information, including:

--Electronically collecting health information in a structured format;

--Using the collected information to track key clinical conditions and communicating that information for care-coordination purposes;

--Implementing clinical decision support tools to facilitate disease and medication management;

--Using EHRs to engage patients and families; and

--Reporting clinical quality measures and public health information to the Center for Medicare and Medicaid Services (CMS).

Stage 2: Likely to take effect in 2013, the criteria expand upon Stage 1 criteria to encourage using health IT for continuous quality improvement at the point of care, and the exchange of information in structured format, including:

--The use of health IT for continuous quality improvement at the point of care;

--The exchange of information in the most structured format possible, including electronic transmission of orders using computerized provider order entry (CPOE); and

--The electronic transmission of diagnostic test results and data needed to diagnose and treat disease (including blood tests, microbiology, urinalysis, pathology tests, radiology, cardiac imaging, nuclear medicine tests, pulmonary function tests, genetic tests, genomic tests).

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