News

At least six groups apply to be authorized EMR certification bodies, ONC says

Neil Versel — Thu, 29 Jul 2010 13:35:49 -0400

There should be more than just a little competition in the EMR certification arena, as the Office of the National Coordinator for Health Information Technology says it has sent out applications for its temporary certification program to 30 different organizations that have requested them this month. As of last week, ONC had received completed applications from at least six entities, national coordinator Dr. David Blumenthal told the federal Health IT Policy Committee, Government Health IT reports.

"We are optimistic that we will have a new landscape in the certification realm in which, instead of having a single certification body, there will be more opportunity, a broader pipeline for certification, hopefully more price competition and shorter waiting times to get certification," Blumenthal reportedly said at a committee meeting.

The incumbent Certification Commission for Health Information Technology says it is one of those that has turned in its application, and CCHIT is moving ahead with new certification programs for behavioral health, for standalone systems and as an optional add-on to standard ambulatory EMR certification or to EMRs used in skilled nursing facilities and home-health environments.

The presence of multiple entities in the temporary phase will help ONC learn which certification processes work best, Blumenthal said. The temporary certification process--through the end of 2011--is intended as a short-term fix so CMS can start its Medicare and Medicaid EMR incentive program as scheduled on Oct. 1, 2010. ONC expects certifying bodies to begin testing EMRs by late summer or early fall, and for products to be certified in the fall.

ONC will issue final rules on a permanent certification plan at an unspecified time this fall, according to Government Health IT.

For more:
- check out this Government Health IT story on multiple certifiers
- see this CCHIT statement about the submission of its application
- read this CCHIT press release about its programs for behavioral health

CMS says 'meaningful use' Stage 2 will make optional measures mandatory

Neil Versel — Thu, 29 Jul 2010 13:05:39 -0400

A lot of people were disappointed that the recently released standards for meaningful use of EMRs only covered Stage 1 of the program--2011-12--leaving them without much of a roadmap to plan for compliance in later years. But some clues about Stage 2, which begins in 2013, are evident in the new rule, a key HHS official says.

At the most recent meeting of the advisory HIT Policy Committee, Tony Trenkle, director of the CMS Office of e-Health Standards and Services, said that comments included in the Stage 1 rules indicate that items on the menu of 10 optional requirements will become part of the "core standards" in Stage 2, and that several administrative requirements included in a previous proposal but dropped from the final rule will be part of the next phase.

"We would also like to look at higher thresholds for other measures," Trenkle said, according to InformationWeek. "That is our intent, and it will be framed by feedback and recommendations that come from the Policy Committee."

For example, CMS lowered the e-prescribing requirement to 40 percent from the proposed level of 75 percent and said that eligible providers only needed to implement a single rule for clinical decision support in Stage 1, down from five rules in the proposal.

CMS has not offered much guidance about Stage 3 (2015-16), though, because the Medicare and Medicaid sides of the incentive program are much different starting in 2015. Medicare penalties for noncompliance begin in 2015 and bonus payments for EMRs end in 2016, while the Medicaid incentives could continue until 2021, and there are no penalties specified in the American Recovery and Reinvestment Act.

Meanwhile, as CMIO reports, CMS and the Office of the National Coordinator for Health Information Technology have started a series of audioconferences as a way of educating healthcare providers about meaningful use and EMR certification and helping providers enroll in the HHS program.

For greater detail:
- check out this InformationWeek story on Stage 2
- read this CMIO story about enrollment

CSC: 90 percent of hospital execs say meaningful use is top or second priority

Neil Versel — Thu, 29 Jul 2010 12:41:18 -0400

Though they may have many other IT and reform-related efforts underway, 90 percent of hospital executives count achieving meaningful use of EMR among their top two priorities, and two-thirds consider it their top priority, according to a survey by Computer Sciences Corp. Additionally, 42 percent of all respondents said that helping their organizations' networks of owned or affiliated physicians achieve meaningful use of an ambulatory EMR was their No. 2 priority right now.

About half of the 60 respondents were CIOs or other IT leaders, and there were some differences between them and other executives interviewed. Just 48 percent of non-IT leaders named meaningful use as their top concern, 84 percent of the health IT executives did.

"Achieving meaningful use is clearly top of mind among hospital executives, but the CSC survey also reveals there are many competing priorities, including changes to payment models, that are slowing the progress," David Hampshire, managing director of Health Delivery for CSC's Global Healthcare Services Group, says in a company press release. Other things on the minds of hospital executives include the coming expansion of health insurance to more than 30 million Americans and the formation of accountable care organizations.

"The next few years are filled with opportunities and challenges for hospitals, and success will depend on starting early and building the right infrastructure," Hampshire adds.

Six in 10 respondents said that the absence of a final rule for meaningful use was preventing them from moving forward, but that changed two weeks ago when HHS released its standards for Stage 1, starting in 2011. Still, many executives were concerned they would not have enough IT staff to achieve meaningful use or that other priorities or tight budgets might hold them back.

For more data:
- read this InformationWeek story
- have a look at this CSC press release

Multi-hospital systems, rural providers feel slighted in 'meaningful use' rule

Neil Versel — Thu, 29 Jul 2010 12:14:42 -0400

Now that the rules for "meaningful use" of EMRs are out, Congress has moved in to serve as watchdog of sorts over HHS with regards to the HITECH portion of the American Recovery and Reinvestment Act.

On Tuesday, the House Energy and Commerce Committee held a hearing on HITECH implementation in which lawmakers heard criticisms from multi-site health systems that the stipulation that they be counted as a single entity for the purpose of calculating incentive payments was unfair to them. Rural providers also expressed concern that they may not be able to avoid penalties for not achieving meaningful use of EMRs by 2015.

According to iHealthBeat, CQ HealthBeat reported that committee member Rep. Zach Space (D-Ohio) said that more than 240 lawmakers have signed a letter to HHS contending that each hospital should be counted as its own facility under the final rule, regardless of whether it is part of a multi-hospital system.

Others questioned whether the EMR certification program would be ready in time for them to qualify for Stage 1 incentives, which, for hospitals, begin in just over three months.

Last week, HHS officials, including national health IT coordinator Dr. David Blumenthal, told the House Ways and Means Committee's health subcommittee that the rules were a work in progress, meant to evolve over the life of the incentive program. There will be two more sets of regulations, covering Stage 2 (2013-14) and Stage 3 (2015-16).

For more information:
- see this House Energy and Commerce Committee page on the hearing, with links to written testimony
- read this AHA News brief
- take a look at this iHealthBeat summary of the hearing
- here's a NextGov story on last week's Ways and Means hearing

SPOTLIGHT: Cable companies could help providers adopt EHR

Neil Versel — Thu, 29 Jul 2010 11:41:53 -0400

Now that HHS has finally defined "meaningful use," we all can expect a push for adoption. Or can we? Blogger and HIT consultant Joseph Ingemi has his doubts. He believes coordinators are needed to provide planning and implementation guidance to providers in an unbiased way, just as Ingemi saw when he was a project manager for the first phase of the Nationwide Health Information Network. "So who should sponsor these coordinators? Providers won't want to pay for these services. Medicare and Medicaid are going through a lot of churn with healthcare reform and the stimulus. Plus, their sponsorship may lead to accusations of 'government takeover' of healthcare," Ingemi writes. His answer? Cable companies. "It's a natural fit. Cable companies or any telecommunication company offering non-wireless access would have a lot to gain from EHR. Health IT creates an increased demand for secure bandwidth. Thus, as more providers adopt EHR, the market for cable companies' services will grow." Hospital Impact

HIE activity picks up, but sustainability remains a problem

Neil Versel — Thu, 29 Jul 2010 11:21:54 -0400

After a bit of a lull in the late 2000s, health information exchange--to no one's surprise--is picking up again. (Funny how a massive national incentive program that requires HIE can do that.)

According to the multi-stakeholder eHealth Initiative, there are 234 active HIEs nationwide, up from 193 a year ago. Of that total, 56 are state-designated entities that have been awarded nearly $548 million in federal stimulus money to help promote interoperability of EMRs.

Still, most of the HIEs are in the start-up phase, as only 73 are considered operational this year, though that is up from 57 in 2009. And sustainability remains a major issue. While 107 of the 199 HIEs that responded to the eHealth Initiative survey do not depend on federal funding, most still rely on start-up grants or other subsidies; a mere 18 have broken even on operational income, the organization says.

Many of the HIEs that are transmitting live data have shown some early successes. According to the survey, 33 of the HIEs say they are reducing clinical administrative and filing times for participants, and 30 report that they are saving users time with processing lab and radiology results. Twenty-eight percent say their HIEs have helped contain costs by reducing redundant testing.

For more data:
- take a look at this Health Data Management story
- download the report (.pdf)
- find out more about the survey on this eHealth Initiative page

Blumenthal calls meaningful use a 'one-time offer'

Neil Versel — Thu, 22 Jul 2010 13:06:24 -0400

If you aren't going to achieve meaningful use this time around, don't expect the federal government to give you another shot at Medicare and Medicaid subsidies for EHRs.

"[The] federal government is making a one-time offer. We'll put money on the table to help you now but we're not going to put money on the table later," national health IT coordinator Dr. David Blumenthal says in an interview with CMIO, shortly after last week's release of the final rules for Stage 1 of the bonus program.

While HHS only specified the requirements for Stage 1, Blumenthal offers some hints about what to expect in Stage 2, which begins in 2013. For example, some of the measures that are optional in 2011 and 2012 will become "core objectives" later. "We also, I suspect, will be looking at more demanding forms of health information exchange and probably more decision support, more robust use of physician order entry and also administrative simplification," Blumenthal says. "All those things are possible targets for 2013 and beyond."

He believes the federal incentive program will drive improvement in EHRs themselves, thanks to increased demand for better systems. "As physicians and other health professionals adopt EHRs, they are going to become increasingly demanding of vendors for better functionality, better usability and more comprehensive capabilities, and I think they will move the market using their professional understanding of what their patients need," Blumenthal explains. "I also think they will demand of the hospitals that the systems they use work for them and work for their patients."

For more:
- read this CMIO interview with Blumenthal

Survey: Providers confused about ambulatory EHR certification

Neil Versel — Thu, 22 Jul 2010 12:38:54 -0400

The Office of the National Coordinator for Health Information Technology has made it clear that it wants multiple EHR certification bodies, but that message apparently has not made it out to many physician practices. According to a survey by Burlington, Vt.-based consulting firm CapSite, 69 percent of healthcare providers are unaware that there will be alternatives to the Certification Commission for Health Information Technology in terms of certifying ambulatory EHR systems.

Additionally, 52 percent of the 850 providers surveyed incorrectly believe that CCHIT certification is a prerequisite to receiving Medicare and Medicaid bonus payments for meaningful use of EHRs. In reality, ONC will designate authorized testing and certification bodies, which then will test and certify EHRs on behalf of vendors. CCHIT says it submitted its application on Tuesday to gain ONC authorization. At least one other entity, the Austin, Texas-based Drummond Group, has indicated a desire to certify EHRs.

"The study provides clear evidence that there is considerable confusion in the market in terms of the certification requirements for ambulatory EHRs," CapSite Research Director Brendan FitzGerald says, according to Healthcare IT News.

"The recent release of the final rule on meaningful use of an electronic health record by the U.S. Health and Human Services Department represents an important step in addressing the market confusion related to certification requirements for ambulatory EHRs," FitzGerald adds. "Our study indicates that providers would greatly benefit from additional education and guidance to fully understand certification expectations."

Though 66 percent of those surveyed said certification was a very important part of their evaluations of ambulatory EHR systems, 33 percent are less concerned about who certifies the product their purchase than they are about receiving stimulus money.

To learn more:
- check out this Healthcare IT News story
- request a copy of the CapSite report
- see this statement from CCHIT Executive Director Alisa Ray

EMR mining unlocks personalized healthcare marketing

Dan Bowman — Thu, 22 Jul 2010 12:17:38 -0400

The "automation of data" through EMRs, physician referrals and other sources is opening the door for targeted marketing, similar to techniques used by websites such as Amazon.com, to make its way into the healthcare sector. In other words, based on your recent purchase of Product A (a car, a telephone, a widget), you may be interested in Product B (tires, an extension cord, a widget adapter); likewise, based on your recent hospital visit for heart disease or a broken leg, you may be interested in a new heart-assessment test or a walking boot.

Customer relationship management (CRM) software--offered by companies like Atlanta-based ALT-Invest--actually brings the concept to life, reports American Medical News. Until now, most CRM in healthcare has been geared toward physicians and other healthcare professionals. But with the growing number of organizations employing EMRs, patient data is becoming easier than ever to access and mine. HIPAA does allow patient-specific data to be used for marketing purposes in limited instances.

"Anything we can do to stay in touch with our patients and keep them informed is certainly positive," Dr. James Lengemann of the Naperville, Ill.-based Edward Medical Group tells AMNews. The affiliated Edward Hospital & Health Services uses CRM technology that encourages patients to sign up for a personalized URL with the hospital's website. Patients who register receive messages specific to their needs in the form of web advertisements and emails based on data pulled from the medical history contained in their EMRs.

"Tailored patient education and reminders about screenings are exciting tools that help keep healthcare top-of-mind and give us the chance to identify serious or life-threatening conditions," Lengemann says.

Still, Josh Sweeney, ALT-Invest's CEO, knows that not all patients are keen on the idea of their personal health information being used for marketing purposes, emphasizing that trust is the key to continuing such a practice. "Most people have a certain amount of leeway that they give for people to make mistakes in general environments, but not with their personal healthcare knowledge," Sweeney says. "They don't allow many mistakes in that area, if any."

To learn more:
- read this American Medical News piece

Neil Versel contributed to this article.

SPOTLIGHT: VA expects VLER to be nationwide by 2012

Neil Versel — Thu, 22 Jul 2010 11:43:08 -0400

The Department of Veterans Affairs plans to have the Virtual Lifetime Electronic Record (VLER)--a seamless EMR shared by the VA and Defense Department to track each service member from enlistment through retirement--deployed nationwide by 2012, according to the VA's latest strategic plan. "VA Strategic Plan 2010-2014" spells out details regarding VLER development and how the VA and DoD seek leverage the Nationwide Health Information Network for data sharing. It does not, however, discuss modernization of the VistA EMR system, Federal Computer Week reports. Article

HIMSS: Reluctant prescribers are the biggest barrier to e-prescribing adoption

Sandra Yin — Thu, 22 Jul 2010 11:19:16 -0400

After the DEA officially lifted the restrictions against the use of electronic prescribing for controlled substances in June, it eliminated the single greatest barrier to e-prescribing in a decade.

The next obstacle may be the prescribers themselves, according to a HIMSS survey of healthcare IT professionals. Nearly three in 10 (29 percent) of those surveyed said the biggest barrier to implementing e-prescribing technology in healthcare organizations is prescribers' unwillingness to integrate the e-prescribing technology into their work processes. One-quarter of those surveyed said the cost of the technology is an obstacle.

Another study from the Center for Studying Health System Change backs up this finding that physicians and other authorized prescribers are holding up wider use of the technology. Though more than 40 percent of office-based physicians had access to e-prescribing systems in 2008--the year before Medicare started paying modest bonuses for e-prescribing--a quarter of those who could write electronic prescriptions seldom or never did, HSC says.

And only about 60 percent of those with e-prescribing systems had access to at least three of the advanced features required by Medicare and Medicaid incentive programs. Less than one-fourth of this group regularly used such features as checking for potential drug interactions, viewing patient formularies and electronically transmitting orders to pharmacies, according to the study.

In the HIMSS survey, nearly all 483 respondents said that clinicians should be allowed to e-prescribe controlled substances and 45 percent said they thought improved workflow would be the biggest benefit of allowing clinicians to prescribe controlled substances using e-prescribing technology. Another third said better patient safety would be an advantage.

A little over half (55 percent) of those surveyed said that the March 2010 interim final rule that addresses e-prescribing for controlled substances will lead to a slight increase in the use of e-prescribing. Another third believe that it will lead to a significant uptick in e-prescriptions.

Forty percent of respondents said that their organizations are using e-prescribing technology.

To learn more:
- see the HIMSS survey
- read this statement from the American Pharmacists Association
- take a look at this Center for Studying Health System Change issue brief
- see this GE Healthcare press release about approval of its e-prescribing system in Ohio, the only state currently requiring two-factor authentication

Neil Versel contributed to this story

Related Stories:
DEA releases long-awaited rule on e-prescribing of controlled substances
Senators urge end to fight over e-prescribing controlled substances
Massachusetts hospital to send first e-Rx for controlled substances
Tracking of controlled substances

Survey: 85 percent of HIT professionals planning EHR implementation by end of 2011

Neil Versel — Thu, 22 Jul 2010 10:59:58 -0400

Clinical information technology has arrived.

According to a newly released report from San Francisco-based Embarcadero Technologies, EHR implementation is the top priority of health IT professionals, named by 61 percent of survey respondents. At No. 2 (52 percent) was building health data warehouses, followed by health information exchange, listed in the top three of 47 percent of respondents.

Though Embarcadero conducted the survey in March and April--several months before HHS finalized its rules on "meaningful use" of health IT, 85 percent of those surveyed said they either had an EHR implementation underway or planned to start one in the next 18 months, suggesting that the majority of healthcare organizations are aiming for the Medicare and Medicaid subsidies for EHRs. Furthermore, 74 percent of health IT professionals--including software developers, database administrators, architects, consultants and executives--said they had "adequate" information about meaningful use and EHR certification to move ahead with implementation.

Major challenges in health IT include data integration and achieving interoperability with other systems, according to the survey. Many of the 111 respondents also said they were working on adapting to Health Level Seven International communication standards and the coming transition to ICD-10 coding.

Embarcadero also found that there were no truly dominant EHR vendors, at least among the survey pool. About 13 percent said their organizations would be using an Epic Systems EHR, while 11 percent indicated they had chosen Cerner and 7.5 percent were Siemens customers.

For more data:
- read this Healthcare IT News story
- see this Embarcadero Technologies press release
- download the survey report

Knowledge Networks says half of docs now use EMRs

Neil Versel — Thu, 15 Jul 2010 13:05:20 -0400

Hard to believe, but 52 percent of specialists and 50 percent of primary-care physicians claim to be using EMRs, up from 42 percent and 38 percent, respectively, two years earlier, a new survey indicates. The survey does not specify what EMR usage means.

"While use of this technology will soon be mandated, these 'early adopter' levels suggest a desire for digital convenience at a time when patient record keeping promises to become exponentially more complex," reports New York-based survey firm Knowledge Networks. The company conducted the study of nearly 11,000 healthcare professionals through the Physicians Consulting Network, which maintains a research panel of physicians and other caregivers.

(We quibble with whether 50 percent is "early adopter" level--or even accurate--and that technology will "soon be mandated." CMS will penalize those that haven't gotten to "meaningful use" by 2015, but won't exclude non-compliant providers. For that matter, participation in Medicare and Medicaid is voluntary.)

One possible explanation for the increased EMR use is the fact that physicians continue to be crunched for time, a situation that will only get worse as 32 million newly insured patients enter the healthcare system in coming years, thanks to the Patient Protection and Affordable Care Act. Supporting this theory is the finding in the survey that 14 percent of primary-care docs and 12 percent of specialists expect to spend less time with pharmaceutical sales representatives in the next six months. Those numbers compare with 9 percent (PCP) and 8 percent (specialists) in the 2008 survey.

Meanwhile, physicians seem to be embracing smartphones to improve their efficiency. The survey found that 62 percent of specialists and 55 percent of primary-care physicians have such devices, and that at least 17 percent of these smartphone owners are using their phones for e-detailing from pharma reps.

"Healthcare professionals are embracing new technologies that promise more control and convenience; we cannot help but see a connection between the use of smartphones for e-detailing and an anticipated drop in time spent with sales reps," Knowledge Networks Senior VP Jim Vielee tells Healthcare IT News. "These trends seem destined to magnify as healthcare reform takes effect, creating dramatic upswings in doctors' case loads."

To learn more:
- see this Healthcare IT News story
- view this Knowledge Networks press release

U of Missouri builds integrated EHR for long-term care

Neil Versel — Thu, 15 Jul 2010 12:36:45 -0400

There are inpatient EMRs, ambulatory EMRs and EMRs for home health, but for some reason, we don't hear too much about EMRs for long-term care. University of Missouri researchers, representing the Sinclair School of Nursing, University Hospital, School of Medicine and College of Engineering, are trying to prove the value of EMRs and EHRs in long-term care by building a system that will integrate traditional clinical information systems with data from "passive" patient monitors to help improve nursing care coordination and reduce costs for the rapidly aging population.

In a paper published in the Journal of Gerontological Nursing, the research team report on their development of a comprehensive EHR at TigerPlace, an independent-living facility for seniors in Columbia, Mo., that's partly owned by the nursing school. "The key to continued function and independence is to identify problems (e.g., acute illness, exacerbation of chronic illness) earlier and offer timely interventions designed to improve functional decline," they write. "This kind of monitoring could be accomplished with diligent and consistent human observation; however, for the majority of older adults in the United States, this is neither feasible nor cost effective and could be viewed as undesirably intrusive.

"Technology, in the form of sensor networks, offers an alternative approach that may be more feasible, more cost effective, and less intrusive."

An unidentified commercial EHR was installed when TigerPlace opened in 2004, but users had to manually record standardized assessments, and often just skipped the process. The university built its own database to integrate data from patient monitors and sensors. "No one system met all of the needs of the interdisciplinary research and healthcare teams," the paper says. But that may be changing.

"New technologies to passively monitor older adults' health are being developed and are increasingly commercially available," Marilyn Rantz, professor in the MU Sinclair School of Nursing, says, according to Healthcare IT News. "The challenge remains to integrate clinical information systems with passive monitoring data, especially in long-term care and home health settings, in order to improve clinical decision making and ensure patient records are complete."

To learn more:
- check out this story in McKnight's Long Term Care News
- see this Healthcare IT News article
- read the full study from the Journal of Gerontological Nursing (.pdf)

Canadian doc embraces flexible EMR after shunning template-based system in U.S.

Neil Versel — Thu, 15 Jul 2010 12:00:54 -0400

Is the design of the American health system to blame for low EMR adoption? That seems to be the implication in a Technology for Doctors story headlined, "How I learned to stop worrying and love my EMR."

The story chronicles the EMR experiences of Dr. Ronald Eliosoff, 65, a primary-care physician in Ottawa who moved to the Canadian capital from the U.S. four years ago, in part because he couldn't stand the EMR he used in the States. "I had a major problem with it and it was part of the reason that I left the U.S.," Eliosoff tells the Canadian publication. "I had to enter all my clinic notes into point-and-click templates. It didn't allow me tell a narrative story, using the patient's words, which to me is critical."

Eliosoff believes templating is useful for collating information, but not for the practice of medicine. "Almost 90 percent of the information you need comes from the patient's history. But the design of the program was likely mandated by American insurance companies," he says. (The coding and documentation functions help improve billing and allow providers to justify higher reimbursements.)

He moved north of the border in part because he thought he was going into a paper-based practice at Appletree Medical Group, which runs a chain of walk-in clinics. As it turned out, Appletree had an EMR, but it's one that Eliosoff has embraced. The system, developed by an Appletree affiliate and sold as EMR Advantage, offers multiple input and documentation options, including handwriting, dictation, speech recognition and free-text typing, with everything stored in digital format. Eliosoff personally prefers dictation; he edits his own notes after staff transcribe his spoken words.

He's also become a fan of EMR Advantage's clinical messaging and referrals process. "The EMR lists all the ENTs in the Ottawa area, for example, and I can just push a button for the one I want, I can note why by pushing another button, and I can see relevant lab results by pushing another," Eliosoff says.

"The way the system is laid out, it follows the logical processes and steps a doctor would go through to collect information and make decisions about the patient. It's very clear to me it was designed by doctors," Eliosoff says. "I'm a convert now. I find the EMR extremely helpful to the point that I would find it very difficult to practice medicine without it."

So perhaps the lesson here isn't that the U.S. health system is a mess--which it is--but that EMRs must be user-friendly and work the way doctors work.

To learn more:
- take a look at this Technology for Doctors story

'Most Wired' hospitals see patient portals as part of wider EMR strategy

Neil Versel — Thu, 15 Jul 2010 11:28:07 -0400

A key element of meaningful use of EMRs--and of health reform in general--is providing patients access to their own records. Conversely, patient access to records shouldn't be viewed in isolation, but as part of the wider EMR strategy. That's the lesson we learn from Atlantic Health in Morristown, N.J., and other "Most Wired" health systems, as named by Hospitals & Health Networks. (We'll have more about the annual "Most Wired" list Monday in FierceHealthIT.) Atlantic Health's patient portal actually is an outgrowth of a plan to provide remote EMR service to independent physicians who still kept paper records. Now, some 26,000 patients have registered for the portal, which allows them to view lab results, communicate securely with their doctors and update medication lists. Article

HHS dials back requirements, offers flexibility in final meaningful use rule

Neil Versel — Tue, 13 Jul 2010 11:52:29 -0400

In releasing the final rules for Stage 1 of the "meaningful use" Medicare and Medicaid EHR incentive program on Tuesday, federal officials have pulled back from the more aggressive plan outlined in an earlier proposal.

CMS has broken up the approximately two dozen objectives into two groups, a set of required "core objectives" and a list of "additional important activities" that providers may choose from in meeting the new standards. "The DHHS received many comments that this approach was too demanding and inflexible, an all-or-nothing test that too few providers would be likely to pass," national health IT coordinator Dr. David Blumenthal and Marilyn Tavenner, principal deputy CMS administrator, explain in a New England Journal of Medicine article published Tuesday.

The core set contains 14 measures for hospitals and 15 for physicians and other "eligible professionals," including recording patient demographics, maintaining problem lists, computerized physician order entry for some medication orders and reporting on clinical quality measures to CMS or state Medicaid programs. The second category lists 10 additional elements from which providers must choose five to implement in the first two years of the program, 2011-12.

Some of the objectives themselves also have been relaxed, in response to the more than 2,000 comments HHS received on the proposal. For example, providers will only have to write 40 percent of their prescriptions electronically; the proposed rule called for a 75 percent rate. And they will need to implement just a single rule to meet the requirement for clinical decision support, down from five rules in the earlier plan. "It was purely a matter of what was reasonable to ask of an average provider," Blumenthal said of the new e-prescribing requirement at a press conference Tuesday morning. He said HHS wants the rules to be "aggressive but achievable."

In addition, CMS has reduced the number of quality measures providers must report on. "We deferred some of the administrative transactions" to Stage 2, said Tony Trenkle, director of the CMS Office of e-Health Standards and Services.

HHS Secretary Kathleen Sebelius called meaningful use a key part of overall healthcare reform. "Electronic health records are the foundation of a robust healthcare system," Sebelius said. "Electronic health records make all of these transformations possible."

She mentioned the corresponding ONC final rule on standards and certification of EHRs--also released Tuesday--and the recently published proposal to tighten HIPAA privacy protections an important elements of the overall plan.

HHS officials did not, however, say when to expect more clarity on Stage 2 (2013-14) and Stage 3 (2015-16) of the incentive program.

To learn more:
- see the final rule on meaningful use (.pdf)
- find the final rule and associated fact sheets on standards and certification of EHRs
- read Blumenthal and Tavenner's article in the New England Journal of Medicine
- take a look at this companion NEJM piece from Surgeon General Dr. Regina Benjamin
- read this HHS press release

CMS: Final meaningful use, certification rules sent to OMB

Neil Versel — Thu, 08 Jul 2010 12:45:54 -0400

How do we know the rules for meaningful use will be out any day now? CMS has sent its regulatory language to the White House Office of Management and Budget for review, the final stage in the rulemaking process.

Health Data Management reports that OMB has received the regulations for meaningful use and the related final EHR certification criteria, the latter developed by the Office of the National Coordinator for Health Information Technology. Once OMB signs off, both rules will be released for viewing at the Federal Register Public Inspection Desk while they await official publication. HHS officials publicly released proposed criteria for meaningful use and an interim final rule on certification Dec. 30, but they were not published until Jan. 13.

With the rules at OMB, CMS can't give an exact date for release, but the Medicare and Medicaid agency stands by its forecast of early summer, according to Health Data Management. CMS had slipped from its earlier targets of late spring, then the end of June. FierceEMR reported last week that the final rules will be out by July 14, which is next Wednesday.

For more:
- read this Health Data Management update

States, providers still sorting out myriad HIE issues

Neil Versel — Thu, 08 Jul 2010 12:31:14 -0400

Anyone involved in health information exchange--and that should be just about everyone working with an EMR, if Uncle Sam has anything to say about it--would do well to heed the advice of Jason Hess, general manager of clinical research at KLAS Enterprises.

"Laying pipe isn't enough," Hess, tells CRM Buyer, in the first of a series on HIE. "You still need some ground rules related to data access, data safety, other legal issues and ease of use."

HIE, of course, is one of the stated goals of the American Recovery and Reinvestment Act and a key component of meaningful use. "The whole idea is to be able to get the data to follow the patient, whether it's within a local or regional setting or around the country," explains Chris Muir, senior program analyst with the Office of the National Coordinator for Health Information Technology. ONC and other HHS divisions are promoting HIE via cooperative agreements with states, the network of Regional Extension Centers and the Beacon Communities program.

While there are national standards for interoperability, HIEs are free to operate on their own terms, with whatever technology they choose. This potentially creates compatibility issues, as anyone who's ever tried to send data from one healthcare organization to another that has a different EMR vendor is acutely aware. Overlapping HIE entities also could pose a challenge. "There's a risk of too many cooks in the kitchen," Hess says.

And then there are the related issues of privacy and consumer trust. A lawsuit by the American Civil Liberties Union against a Rhode Island HIE called Currentcare clearly shows that trust is far from assured.

For more:
- check out this CRM Buyer story, via E-Commerce Times

eHealth Initiative finds significant gains in EMR adoption since 2007

Neil Versel — Thu, 08 Jul 2010 12:00:01 -0400

Health IT adoption is gaining steam, but many have been unable to articulate the value of EMRs within their organizations and, significantly, to the public, a new report suggests. Still, people are optimistic about the future, but worry that the transition to ICD-10 coding and HIPAA 5010 transactions could slow momentum.

The "National Progress Report on eHealth," supported by the Commonwealth Fund and released by the broad-based, nonprofit eHealth Initiative, is an update on a 2007 study meant to identify trends that have emerged since passage of the American Recovery and Reinvestment Act in February 2009. For the report, the eHealth Initiative surveyed more than 100 healthcare professionals in each of five focus areas: aligning incentives; engaging consumers; improving population health; managing privacy, security & confidentiality; and transforming care delivery.

"Contributors to the report found that, while considerable progress has been made over the past three years, challenges remain," eHI CEO Jennifer Covich Bordenick says in a press release. "Coordinating public- and private-sector efforts, and communicating the true value of HIT and HIE to consumers will be critical as we move forward."

Specifically, 61 percent of respondents said "significant" progress has been made in EMR and HIT adoption since 2007, but 55 percent disagreed with the statement that the value of health IT is clearly understood. In fact, two-thirds said that efforts to educate the public about EMRs and health information exchange have been ineffective, though nearly as many thought Regional Extension Centers and the related National Health Information Technology Research Center would be important to educating providers about the value of health IT.

For greater detail:
- read this TMCnet story
- see this eHealth Initiative press release
- view the full report (.pdf)

Certification may have to change to keep up with evolving meaningful use, CHIME says

Neil Versel — Thu, 08 Jul 2010 11:28:16 -0400

As the criteria for meaningful use are likely to evolve over time, certification of EMRs will have to change, too, resulting in the need for ongoing certification, the College of Health Information Management Executives says. The new, temporary certification program, effective for at least the next year and a half, does not require vendors to re-certify their products after updates and fixes that don't adversely affect user compliance with meaningful use. But CHIME interprets the rule as allowing for CMS to toughen Stage 1 meaningful use criteria even before Stage 2 begins in 2013, and any such changes would necessitate tweaks to certification. Article

Public health benefits from EMR network at Rhode Island safety-net clinics

Neil Versel — Thu, 08 Jul 2010 11:15:34 -0400

Recent flooding in Rhode Island illustrated why public-health officials are excited about the potential EMRs represent to improve disease surveillance and disaster response.

"The public-health authorities in the state immediately recognized that, after the short-term needs of those affected by the flood were addressed, a potential for exacerbation of such chronic illnesses as asthma and acute illness caused by contaminated water or food might occur," Dr. Jerald Fingerut, medical director of Blackstone Valley Community Health Care, a federally qualified health center in Pawtucket, R.I., writes in the Providence Journal.

"Although databases and health-information exchanges that derive their utility from electronic health records are being developed in the state, these potential tools were not ready to provide the information needed by the Department of Health to monitor the immediate post-flood health effects on Rhode Islanders."

State Health Director David Gifford subsequently issued a request for information about how the department could harness EMR technology in the future. In response, the Rhode Island Health Center Controlled Network, based at the Blackstone Valley clinic, started monitoring its EMR to provide the Department of Health with real-time surveillance of presenting complaints by patients--with all patient-specific identifiers stripped out. It's a function that was built into the network when it launched in 2007.

"Having this infrastructure in place when the recent floods struck Rhode Island provided the added benefit of providing certain surveillance unavailable from any other source in the state. The statewide coverage of network members provided the necessary control on the data, as ZIP codes affected by the disaster could be readily compared with those that were not impacted," Fingerut writes.

"The HCCN was not created to provide a platform for disaster management," he adds. "However, the increasing use of clinical data for routine and emergency care of individuals can now be supplanted with a vehicle allowing for study of the public-health needs of broad segments of the state's population."

To learn more:
- read Fingerut's commentary in the Providence Journal

Mental health advocates continue to push for ARRA expansion

Neil Versel — Thu, 08 Jul 2010 10:46:31 -0400

Mental health advocates continue to press for psychologists, licensed clinical social workers, substance abuse professionals, psychiatric hospitals and related providers to be included in the federal EMR incentive program.

The American Recovery and Reinvestment Act "inadvertently restricts mental health practitioners from using most of the incentives that help healthcare providers and hospitals establish a nationwide health information technology (HIT) system," according to the National Council for Community Behavioral Healthcare, NextGov reports. The group is pushing lawmakers to pass the Health IT Extension for Behavioral Health Services Act (H.R. 5040), a bill introduced by Reps. Patrick Kennedy (D-R.I.) and Tim Murphy (R.-Pa.), that would expand eligibility for Medicare and Medicaid bonuses for EMR usage. Murphy himself is a child psychologist and co-chair of both the 21st Century Healthcare Caucus and Mental Health Caucus in Congress.

"People with mental health and substance use conditions are in desperate need of more coordinated, integrated healthcare," Linda Rosenberg, president and CEO of the National Council, told NextGov. "Having an interoperable system of electronic health information is critical to achieving greater coordination among addiction, mental health, and other healthcare providers, and to helping consumers manage their own care."

For more information:
- see this NextGov story
- read the text of the bill being considered

CMS: We'll publish our 'Meaningful Use' final rule by July 14

Wendy Johnson — Thu, 01 Jul 2010 12:49:29 -0400

Many dates have been thrown around regarding when CMS plans to publish its final rule for meaningful use. This highly anticipated regulation, of course, will spell out how providers and organizations can become eligible for HITECH's electronic health record incentive payments.

Some news outlets have reported that July 13 is the magic date. That sounds about right, give or take a few days. FierceEMR spoke with a CMS official directly involved in writing and publishing the final regulation, and she assures us that although there's no "official" publication date (CMS missed its own self-imposed June 30 deadline), "I would be very surprised if it's published any later than July 14."

"We hoped to have it out by the end of June, but it's looking more like mid-July," the official told us this week. "There are so many moving parts and so many people are involved. This is a long regulation." No doubt! The proposed rule was thicker than many novels. We expect nothing less from the final reg.

CMS also plans to unveil its plan for aligning its Physician Quality Reporting Initiative (PQRI) with the EHR incentive program in mid-July. "We propose to include many ARRA core clinical quality measures in the PQRI program, to demonstrate meaningful use of EHR and quality of care furnished to individuals," CMS states in an advanced copy of the proposed reg, CMIO magazine reports. "We propose the selection of these measures to meet the requirements of planning the integration of PQRI and EHR reporting."

For more information:
- read this Government Health IT article
- read the CMIO article
- bookmark the Federal Register's Table of Contents, where the final rule will appear

CSC tells providers to press their vendors on EMR certification readiness

Neil Versel — Thu, 01 Jul 2010 09:12:23 -0400

Hot on the heels of a Computer Sciences Corp. report telling private health insurers to get with the federal EMR and quality-reporting incentive program, the same consulting firm has issued a paper advising hospitals and doctors to start assessing whether their chosen systems will meet newly published rules governing EMR certification in the short term.

"Given that the process of certifying systems will start soon, providers should ask their vendors when they plan to apply for certification," write Erica Drazen, managing partner of CSC's Healthcare Group, and Jim D'Itri, a partner in the Falls Church, Va.-based company's Healthcare Strategy and Operations Group. "Because meaningful use incentives require a currently certified system, and the requirements will increase in 2013, system purchases and implementation plans should consider current and expected future requirements," they add.

"For example, bedside medication administration with bar code verification was not proposed as a Stage 1 requirement; however, it is almost certainly a future requirement for meaningful use incentives. Therefore, this capability should be included in any IT strategy or selection. Any vendor contracts should have provisions that include updates to meet future certification criteria as part of regular covered maintenance."

Providers must use certified technology to earn Medicare and Medicaid bonus payments.

ONC two weeks ago issued final rules for a temporary program that will govern EMR certification through the end of 2011. Private entities, including the Certification Commission for Health Information Technology, must apply to be authorized certification bodies based on ONC's testing criteria. National health IT coordinator Dr. David Blumenthal expects the first batch of certified EMRs to be ready by the fall.

For more:
- see this CSC "Update on Certification" issue brief (.pdf)
- take a look at this Healthcare IT News story

PwC survey: Eight in 10 CHIME members concerned about long-term meaningful use

Neil Versel — Thu, 01 Jul 2010 08:50:39 -0400

With July now upon us, the start of the federal EMR incentive program is looming just three months down the road for hospitals and six months for physician practices. Financial penalties for failing to achieve "meaningful use" of EMRs don't start for four more years after that, yet eight in 10 hospital CIOs are concerned that they won't be able to meet the 2015 deadline, a new PricewaterhouseCoopers survey indicates.

Overwhelming majorities of CIOs also wonder if they'll be able to meet federal reporting requirements to qualify for the incentive payment and are concerned that the path to meaningful use isn't well defined.

Though about half of the 120 CIOs surveyed, all of whom belong to the College of Healthcare Information Management Executives, expect to show meaningful use and apply for stimulus dollars in 2011, many worried about their abilities to meet the tougher Stage 2 and Stage 3 requirements that will take effect for fiscal years 2013 and 2015, respectively. Though CMS hasn't specified what the later stages will encompass, the American Recovery and Reinvestment Act says meaningful use must eventually include advancing care processes via clinical decision support, the ability to populate personal health records, and outcomes improvement via data sharing.

CIOs generally believe that the existing health IT infrastructure isn't good enough to support such advanced functions, PwC reports, plus many healthcare organizations are unable to see the bigger picture right now. "Healthcare organizations are building high-performance race cars to travel back country roads," Daniel Garrett, leader of PwC's health IT practice, says in a written statement. "Furthermore, we found many healthcare providers are mired in the complexity of incentive-rule criteria and may not be working toward longer-term goals for meaningful EHR usage.

"The bottom line is improved quality of care and patient safety, delivered more efficiently. Government leaders and health organizations need to give consideration to the ultimate goal as they work to finalize and meet guidelines for meaningful use," Garrett adds.

For much more information:
- check out this Healthcare IT News story
- see this PricewaterhouseCoopers press release
- download the PwC report and accompanying charts

ONC to seek feedback on NHIN Exchange governance structure

Neil Versel — Thu, 01 Jul 2010 08:23:28 -0400

In preparation for expanding the Nationwide Health Information Network's NHIN Exchange beyond federal agencies and their contractors and grantees, the Office of the National Coordinator for Health Information Technology is developing governance rules for private-sector participation.

ONC is planning to issue a request for information in August, seeking public comments on how to shape the governance structure, Government Health IT reports. A proposed rule will follow early next year before ONC finalizes the rule in the summer of 2011, said Mary Jo Deering, senior policy advisor in the ONC Office of Policy and Planning at a Health IT Policy Committee meeting last Friday."Without governance, the NHIN can't expand and grow beyond the current specific category of participants that are limited by legal guidance," Deering explained.

While states that are building out health information exchanges have welcomed providers and technology vendors to share electronic transactions, a problem arises when those HIEs link up with the NHIN Exchange. "We need to give them a process and conditions for docking, and once you go down that route a series of legal and policy questions come up," national health IT coordinator Dr. David Blumenthal said at the same meeting, according to Government Health IT.

"The [HHS] general counsel has ruled that they can't do much unless we help them do it. They have no framework for doing that now, and they have no legal authority or mechanism to do that," Blumenthal said.

ONC's rule likely will address when when patient consent is needed, the degree of transparency required, business and legal requirements, identity verification and technical specifications. Still to be determined, Deering said, is whether compliance will be mandatory for NHIN Exchange participants.

For greater detail:
- read this Government Health IT story

Do the math: Stanford docs could earn $44M in EMR incentives, while children's hospitals chase Medicaid dollars

Neil Versel — Thu, 01 Jul 2010 07:59:33 -0400

As usual, there's a burgeoning trend in technology and people in Northern California smell the money. "The push to implement electronic healthcare records could mean hundreds of millions of dollars pouring into Silicon Valley," notes the Silicon Valley/San Jose Business Journal.

This time, though, the money won't necessarily be going to all the high-tech companies that call the Bay Area home. At least not directly, and that's where the math gets a little fuzzy. The Business Journal is referring to the federal stimulus dollars in the form of Medicare and Medicaid incentive payments for achieving "meaningful use" of EMRs, and as we've often reported, that cash may not add to a provider's top line, just help offset some of the cost for the technology.

Still, the numbers appear staggering when extrapolated across a large organization. Stanford Hospital and Clinics CMIO Dr. Pravene Nath estimates that as many as 1,000 affiliated physicians could qualify for the extra reimbursements. At up to $44,000 per doctor, meaningful use could be worth as much as $44 million to Stanford physicians. And that doesn't even include the hospital's potential bonus of several million dollars. "We don't yet know the exact amount the hospital could receive, but it's enough money that it's a huge incentive for us," Nath is quoted as saying. "We absolutely intend to get it."

We then run into yet another case of the non-healthcare media misunderstanding what's truly going on when the Business Journal reporter brings up Lucille Packard Children's Hospital, which is a Stanford facility. Pediatric providers, of course, don't do a whole lot of Medicare business. "To address this problem, the federal government added a provision that allows hospitals such as Children's Hospital to qualify if they demonstrate "meaningful use" of EHRs," the publication erroneously reports.

"At Children's Hospital, digitizing records and processes already has an impact on patient care. A system that allows physicians to make orders digitally was correlated with a 20 percent decrease in mortality rates at the hospital over an 18-month period," the story says.

Meaningful use, as FierceEMR readers are keenly aware, applies to anyone seeking American Recovery and Reinvestment Act (not "Federal Recovery and Reinvestment Act," as the Business Journal says) bonuses for EMR/EHR implementation. The difference for pediatric facilities is that their threshold for qualifying for Medicaid incentives is lower--they need 20 percent of their patients to be on Medicaid, vs. 30 percent for adult and general provider organizations. Either way, quality improvement matters.

The education process continues.

To read more--and do so at your own peril:
- see this story from the Silicon Valley/San Jose Business Journal (subscription req.)

SPOTLIGHT: Physician practices struggle with choosing, implementing EHRs, MGMA says

Neil Versel — Thu, 01 Jul 2010 03:13:37 -0400

Not surprisingly, selecting and implementing EHRs has moved into the top three daily challenges of running a physician practice, according to a newly released survey from the Medical Group Management Association, trailing only dealing with rising operating costs and managing finances during this period of uncertainty about Medicare reimbursement rates. "EHRs? Stress city. Not only must practices struggle to come up a way--amid their staggering operating costs--to fund and implement the technology, but guard against liability risks of which they may have not even considered," FiercePracticeManagement editor Debra Beaulieu writes in her weekly commentary. FiercePracticeManagement

HHS says providers, HIEs must get consent to share substance abuse records electronically

Neil Versel — Thu, 24 Jun 2010 13:29:55 -0400

Two HHS agencies have published answers to frequently asked questions in an attempt to clarify how records of patients' treatment for alcohol and drug abuse can be shared electronically. A federal law that predates HIPAA prohibits disclosure of such records without patient consent.

The Office of the National Coordinator for Health Information Technology and the Substance Abuse and Mental Health Services Administration now say that records pertaining to substance abuse can be shared on a health information exchange if treatment programs obtain patient consent to disclose their information to HIEs and their technology partners. Patients also must consent for HIEs to redistribute records to specific participating providers, and patients must be told the nature of each disclosure.

"The consent requirement is often perceived as a barrier to the electronic exchange of health information," the two agencies say. "However, as explained in other FAQs, it is possible to electronically exchange drug and alcohol treatment information while also meeting the requirements of [the confidentiality law]."

One particular sticking point has been with primary-care physicians who need complete patient histories so they can determine whether any drug they prescribe may interact with a medication given for substance abuse treatment, Government Health IT reports. Based on the guidance, primary-care physicians still will have to obtain patient consent to see records related to such treatment.

For more information:
- read this Government Health IT story
- visit the SAMHSA website on health information privacy