The American Recovery and Reinvestment Act establishes an incentive program that provides incentive payments to eligible physicians (EP) and eligible hospitals for meaningfully using electronic health records (EHR). While many specialists are learning the conditions under which they can capitalize on these incentive payments, anesthesiologists will learn that they do not qualify as EPs, thus not able to receive incentive payments for their meaningful use of EHRs.

One requirement that a physician satisfy is that s/he is a non-hospital-based physician. “Hospital-based” physicians are defined to include those that provide 90% of their Medicare-covered services within a Place of Service (POS) of 21, 22, or 23–either an inpatient hospital, outpatient hospital, or emergency room hospital, respectively. Furthermore, the statute explicitly states that anesthesiologists–who furnish substantially all of their Medicare-covered services in a hospital setting, using the hospital’s facilities and equipment, and qualified EHRs–are not eligible to receive the incentive payments because they are not bringing their own equipment to the hospital in furtherance of the medical services they perform. If a hospital demonstrates is meaningful use of an EHR, it can qualify for incentive payments.

Above article publish on http://www.attorney-dwi.info/health/incentive-payments-for-meaningful-use-of-ehr-technology-does-not-apply-to-anesthesiologists/

By, Bernie Monegain

BETHESDA, MD – Investments in community health centers that provide care for about 15 million people who are poor, underserved and uninsured have helped expand the services, according to new research. The funds sometimes also give technology a boost.

The authors of the new study, published in the February 2010 edition of the journal Health Affairs estimate that a $500,000 increase in grant support for all centers would provide treatment for an additional 500,000 uninsured patients. The study does not mention the use of healthcare information technology in expanding services. But several community centers have either built their own in-house electronic health record or installed one that is commercially available.

Two of the 2009 Davies Award winners given by the Healthcare Information and Management Systems Society - Urban Health Plan and Heart of Texas - are community health centers that have employed EHRs to improve care delivery.

Urban Health Plan operates 13 sites in the South Bronx and Queens boroughs in New York. It rolled out its health record in 2006, and CEO Paloma Hernandez says the EHR has helped transform healthcare delivery and helped eliminate healthcare disparities in the communities the centers serve.

The authors of the new study say that their findings bode well for effective use of the more than $2 billion in funds provided to community health centers under the American Recovery and Reinvestment Act (ARRA).

The stimulus funding was the largest one-time investment in the centers in their history - and this study shows that in previous years, the centers used such investments to increase the care provided to low-income or underserved patients.

“Community health centers play a vital role in providing primary care and other services to those who cannot afford it or cannot access care,” says lead author Anthony Lo Sasso, a researcher at the University of Illinois at Chicago School of Public Health. “They are an investment that pays off for patients and the nation as a whole.”

Researchers examined investments and their effects on care in 1996-2006 from federal, state and local or private sources in so-called federally qualified community health centers. These are “safety net” providers such as community health centers, public housing centers, outpatient health programs funded by the Indian Health Service, and programs serving migrants and the homeless that meet federal criteria for receiving funding. Federal grants to federally qualified community health centers, for example, have grown from roughly $550 million in 1990 to nearly $2 billion in 2007.

The study authors found that these and other public dollars helped increase all services, especially mental health and substance abuse treatment and counseling.

The authors predict that an additional $500,000 in federal grants to federally qualified health clinics would help provide $135,000 worth of free or discounted care and could translate into 540 more uninsured patients who receive treatment. If federally qualified health centers leveraged their federal grant support to gain additional state, local, and private grant dollars, this could lead to higher levels of service and more care for the uninsured, the researchers conclude.

The health policy journal Health Affairs is published by Project HOPE.

Above article publish on http://www.healthcareitnews.com/news/stimulus-could-boost-technology-care-safety-net-centers

On December 30, 2009, the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) at the Department of Health and Human Services issued proposed regulations on the definition of “meaningful use” and the initial set of standards, implementation specifications, and certification criteria for EHR technology.

This announcement was made in conjunction with the publishing of two separate documents and a request for public comments:

Health Information Technology Initial Set of Standards, Implementation

Medicare and Medicaid Programs; Electronic Health Record Incentive Program

Beginning on page 32 of the “Medicare and Medicaid Programs: Electronic Health Record Incentive Program” document, a definition of “meaningful use” is provided along with associated discussions such as definition background and definition considerations.

Both documents discuss the proposed stages of “meaningful use”:

Stage 1 (beginning in 2011): The proposed Stage 1 meaningful use criteria “focuses on electronically capturing health information in a coded format; using that information to track key clinical conditions and communicating that information for care coordination purposes (whether that information is structured or unstructured, but in structured format whenever feasible); consistent with other provisions of Medicare and Medicaid law, implementing clinical decision support tools to facilitate disease and medication management; and reporting clinical quality measures and public health information.”

Stage 2 (beginning in 2013): CMS has proposed that its goals for the Stage 2 meaningful use criteria, “consistent with other provisions of Medicare and Medicaid law, expand upon the Stage 1 criteria to encourage the use of health IT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible, such as the electronic transmission of orders entered using computerized provider order entry (CPOE) and the electronic transmission of diagnostic test results (such as blood tests, microbiology, urinalysis, pathology tests, radiology, cardiac imaging, nuclear medicine tests, pulmonary function tests and other such data needed to diagnose and treat disease). Additionally we may consider applying the criteria more broadly to both the inpatient and outpatient hospital settings.”

Stage 3 (beginning in 2015): CMS has proposed that its goals for the Stage 3 meaningful use criteria are, “consistent with other provisions of Medicare and Medicaid law, to focus on promoting improvements in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to self management tools, access to comprehensive patient data and improving population health.”

Pages 51 through 61 of the “Health Information Technology Initial Set of Standards, Implementation” document provide Stage 1 “meaningful use” objectives in a table alongside corresponding certification criteria to support the achievement of “meaningful use” Stage 1 by eligible professionals and eligible hospitals. In reading this table, keep in mind the provided definition of “EHR module”:

EHR Module: any service, component, or combination thereof that can meet the requirements of at least one certification criterion adopted by the Secretary

The following note is provided alongside examples of EHR modules:

While the use of EHR Modules may enable an eligible professional or eligible hospital to create a combination of products and services that, taken together, meets the definition of Certified EHR Technology, this approach carries with it a responsibility on the part of the eligible professional or eligible hospital to perform additional diligence to ensure that the certified EHR Modules selected are capable of working together to support the achievement of meaningful use. In other words, two certified EHR Modules may provide the additional capabilities necessary to meet the definition of Certified EHR Technology, but may not integrate well with each other or with the other EHR technology they were added to. As a result, eligible professionals and eligible hospitals that elect to adopt and implement certified EHR Modules should take care to ensure that the certified EHR Modules they select are interoperable and can properly perform in their expected operational environment.

Pages 79 through 81of the “Health Information Technology Initial Set of Standards, Implementation” document elaborate on this interoperability requirement for patient summary records, drug formulary checks, electronic prescribing, administrative transactions, quality reporting, submission of lab results to public health agencies, submission to public health agencies for surveillance or reporting, and submission to immunization registries. Page 85 outlines adopted privacy and security standards for Certified EHR Technology, and the document distinguishes these standards from those associated with HIPAA.

With a combined total of nearly-700 pages, the two documents discussed here necessitate a thorough review that will take some time to digest. This post simply provides an initial level of awareness that these documents have been published.

Above article publish on http://nvisia.com/techs/?p=364

HHS is gearing up to award $50 million in task orders to establish a national Health IT Research Center, Federal Computer Week reports.

Joshua Seidman — acting director of the “meaningful use” division at the Office of the National Coordinator for Health IT — discussed HHS’ plans for the research center this week during a conference sponsored by the eHealth Initiative.

He said the Health IT Research Center will provide a virtual learning community through an online portal. The center also will help users develop communities around research subjects that support the meaningful use of electronic health records.

Support for Regional Extension Centers

Seidman said the research center will serve as a resource for about 60 regional health IT extension centers.

HHS is awarding nearly $600 million in stimulus funding to establish the extension centers in communities across the country. Officials are expected to select about half of the extension centers within the next few weeks, Seidman said.

The regional extension centers aim to offer health care providers guidance on:

• Best practices in health IT privacy and security;
• EHR vendor selection and group purchasing;
• Health data exchange and interoperability;
• Health IT project implementation and management;
• Workflow redesign and work force support (Lipowicz, Federal Computer Week, 1/26).

Above article publish on http://www.ihealthbeat.org/articles/2010/1/27/hhs-to-award-50m-to-set-up-national-center-for-health-it-research.aspx

Practices that have been waiting for CMS to define the term “meaningful use” are finally in luck. But as is always the case when the feds are involved, don’t look for a quick one-sentence definition.

The American Recovery and Reinvestment Bill of 2009 (ARRA) offers annual bonuses to practices that show “meaningful use” of electronic health records, and in 2015, practices that aren’t showing meaningful use will face penalties.

On Dec. 29, CMS and the Office of the National Coordinator for Health Information Technology announced that the definition was finally available for public comment. “CMS’s proposed regulation would define and specify how to demonstrate ‘meaningful use’ of EHR technology, which is a prerequisite for receiving the Medicare incentive payments,” said Charlene Frizzera, CMS’s acting administrator, in a Dec. 30 statement.

25 measures: Stage 1 of the meaningful use criteria (which begins in 2011) includes 25 objectives/measures for eligible professionals (most Part B practices fall under this category) and 23 objectives/measures for eligible hospitals. To be considered a meaningful EHR user, you must meet all of the criteria set forth.

For example: The following includes just a sampling of what you’ll find in the list of 25 meaningful use criteria for stage one of the incentive program. To read the complete list, check out the proposal in the Federal Register.

• Use a computer physician order entry (CPOE)
• Implement drug-drug, drugallergy, drug-formulary checks
• Maintain an up-to-date problem list of current and active diagnoses based on ICD-9 or SNOMED CT
• Generate and transmit permissible prescriptions electronically
• Maintain an active medication list
• Maintain an active medication allergy list
• Record demographics (preferring language, insurance type, gender, race, ethnicity, and date of birth)
• Record and chart changes in vital signs
• Record smoking status for patients age 13 and older
• Incorporate clinical lab test results into EHR as structured data
• Generate lists of patients by specific conditions
• Report ambulatory quality measures to CMS
• Send reminders to patients for preventive follow-up care (per patient preference)
• Implement five clinical decision support rules relevant to specialty or high clinical priority
• Check insurance eligibility electronically from payers
• Submit claims electronically.

Keep in mind: You can not only qualify for a financial bonus if you use EHRs — but you could also boost your practice’s efficiency, CMS says. “Widespread adoption of electronic health records holds great promise for improving health care quality, efficiency, and patient safety,” said David Blumenthal, MD, national coordinator for health information technology, in a Dec. 30 statement.

CMS will accept public comments on the rule for 60 days, either electronically or by mail (CMS, Department of Health and Human Services, Attention: CMS-0033-P, P.O. Box 8013, Baltimore, MD 21244-8013). If you do submit comments, refer to ID CMS-0033-P.

Article publish on http://hitnews.inhealthcare.com/fact-finder/hitech-physicians-must-meet-25-criteria-to-achieve-meaningful-use/?dynamic_id=2086766482

By Mary Mosquera

The clock starts ticking today on a two-month window in which the public can comment on the Health & Human Service Department’s “meaningful use” proposal, a set of rules outlining how providers can qualify for incentives for using electronic health records.

The Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health IT officially published their rules in the Federal Register Jan. 13.

The package comes in two parts: an ONC interim final rule (IFR) covering standards and certification of EHRs and a notice of proposed rulemaking (NPRM) from the Centers for Medicare and Medicaid Services defining the “meaningful use” of health IT.

According to CMS’s meaningful use NPRM, the public has 60 days, or until March 15, in which to comment on the regulation after it is published in the Federal Register. Subsequent revisions will be made, with the final rule expected in spring of 2010.

The ONC interim final rule will become effective 30 days after it is published in the Federal Register, or Feb. 12. However, the public may comment on its possible refinement over the next 60 days, after which ONC will issue the final rule.

The rules describe how physicians and hospitals can qualify for tens of thousands of dollars in financial incentives for meeting three stages of progressively more demanding sets of measures when using health IT in their practices.

The initial set of criteria would concentrate on collecting data electronically, sharing information with other providers and patients, and reporting quality measures to the government.

The standards rule focuses only on standards that comprise a certified EHR. The actual process by which those systems will be certified will be the subject of an additional notice of proposed rulemaking ONC will announce later in 2010.

Since the announcement of the rules Dec. 30, health IT experts have offered a range of opinions about them. Writing in his blog this week, Dr. John Halamka, co-chairman of the Health IT Standards Panel, which advises ONC, said he had received hundreds of emails about the rules. Many find CMS’s proposed rule “intimidating,” he wrote Jan. 11

“Taking a typical community hospital from their current state to the degree of functionality required in the NPRM [proposed rule] is a challenge,” said Halamka, who is also chief information officer of Boston’s Beth Israel Deaconess Medical Center.

In summarizing the comments he received, Halamka said providers need specific guidance to meet the aggressive interoperability timelines in the rules. “This leaves a choice – either the standards need more detail, especially in the transmission area, or the NPRM goals need to be reduced in scope/extended in time,” Halamka said in his blog.

Above article publish on http://www.govhealthit.com/newsitem.aspx?tid=10&nid=72929

The Centers for Medicare & Medicare Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) encourage public comment on two regulations issued today that lay a foundation for improving quality, efficiency and safety through meaningful use of certified electronic health record (EHR) technology. The regulations will help implement the EHR incentive programs enacted under the American Recovery and Reinvestment Act of 2009 (Recovery Act).

A proposed rule issued by CMS outlines proposed provisions governing the EHR incentive programs, including defining the central concept of “meaningful use” of EHR technology. An interim final regulation (IFR) issued by ONC sets initial standards, implementation specifications, and certification criteria for EHR technology. Both regulations are open to public comment.

“Widespread adoption of electronic health records holds great promise for improving health care quality, efficiency, and patient safety,” said, National Coordinator for Health Information Technology David Blumenthal, M.D., M.P.P. “The Recovery Act’s financial incentives demonstrate Congress’ and the Administration’s commitment to help providers adopt and make meaningful use of EHR technology so they can give better care and their patients’ experience of care will improve. Over time, we believe the EHR incentive program under Medicare and Medicaid will accelerate and facilitate health information technology adoption by more individual providers and organizations throughout the health care system.”

“These regulations are closely linked,” said Charlene Frizzera, CMS acting administrator. “CMS’s proposed regulation would define and specify how to demonstrate ‘meaningful use’ of EHR technology, which is a prerequisite for receiving the Medicare incentive payments. Our rule also outlines the proposed payment methodologies for the Medicare and Medicaid EHR incentive programs. ONC’s regulation sets forth the standards and specifications that will enhance the interoperability, functionality, utility and security of health information technology.”

CMS and ONC worked closely to develop the two rules and received input from hundreds of technical subject matters experts, health care providers, and other key stakeholders. Numerous public meetings to solicit public comment were held by three Federal advisory committees: the National Committee on Vital and Health Statistics (NCVHS), the Health IT Policy Committee (HITPC), and the Health IT Standards Committee (HITSC). HITSC presented its final recommendations to the National Coordinator in August 2009. These recommendations, along with all other input were considered to help inform the development of the regulations announced today.

The IFR issued by ONC describes the standards that must be met by certified EHR technology to exchange healthcare information among providers and between providers and patients. This initial set of standards begins to define a common language to ensure accurate and secure health information exchange across different EHR systems. The IFR describes standard formats for clinical summaries and prescriptions; standard terms to describe clinical problems, procedures, laboratory tests, medications and allergies; and standards for the secure transportation of this information using the Internet.

CMS provides a 60-day comment period on the proposed rule. “The definition and requirements for demonstrating meaningful use of EHR technology are proposals. CMS welcomes and will give serious consideration to comments that improve our proposal while achieving the goals Congress established for the EHR incentive programs,” Frizzera said.

The CMS proposed rule and fact sheets, may be viewed at http://www.cms.hhs.gov/Recovery/11_HealthIT.asp

ONC’s interim final rule may be viewed at http://healthit.hhs.gov/standardsandcertification. In early 2010 ONC intends to issue a notice of proposed rulemaking related to the certification of health information technology.

Above article publish on http://www.hhs.gov/news/press/2009pres/12/20091230a.html

Last week, CMS released proposed regulations defining the “meaningful use” of electronic health records, Reuters reports (Wutkowski/Heavey, Reuters, 12/31/09).

In addition, the Office of the National Coordinator for Health IT released an interim final rule describing the required certification standards for EHR technology (Simmons, HealthLeaders Media, 12/31/09).

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHRs will qualify for incentive payments through Medicaid and Medicare.

Officials will offer a 60-day public comment period after both regulations are published in the Federal Register on Jan. 13. The interim final rule on EHR certification is scheduled to take effect 30 days after publication (Goedert, Health Data Management, 12/30/09).

Phased Approach to Meaningful Use

CMS’ plan proposes phasing in meaningful use requirements over three stages between now and 2013.

The first stage of the meaningful use criteria emphasizes:

• Collecting electronic health data in coded formats;
• Implementing clinical decision support tools;
• Reporting clinical quality measures and public health data; and
• Using EHR data to track conditions and coordinate care (Monegain, Healthcare IT News, 12/30/09).

The criteria call for physicians to submit at least 80% of their orders electronically and for hospitals to submit at least 10% of orders electronically. The proposed rules also call for health care providers to use EHRs to check for potential drug interactions (Perrone, AP/San Francisco Chronicle, 12/30/09).

In addition, the rule requires health care providers to provide patients with electronic copies of their medical records within 48 hours of a request (Hensley, “Shots,” NPR, 12/31/09).

A list of Stage 1 criteria for physicians and a list of Stage 1 criteria for hospitals are available from Healthcare IT News (Healthcare IT News, 12/30/09).

The Stage 2 criteria are expected to focus on structured data exchange and continuous quality improvement. CMS is scheduled to release the second phase criteria by the end of 2011.

The Stage 3 criteria are expected to center on advanced decision support and population health. CMS is scheduled to publish the third phase criteria by the end of 2013.

Certification Criteria for EHRs

ONC’s interim final rule outlines the technical standards and features that EHR systems must include to receive certification for meaningful use.

The rule includes:

• Standard formats for clinical summaries and prescriptions;
• Standard terms to describe clinical problems, laboratory tests, medications and procedures; and
• Standards for secure transmission of online data.

The rule focuses solely on standards for certified EHRs. Later in 2010, ONC is scheduled to release additional guidance on the process for EHR certification.

Reduced Budget for Incentive Payments

When federal officials released the two new regulations, they also announced that the government might distribute less money than anticipated for the incentive payment program.

Initially, the Congressional Budget Office estimated that total federal incentive payouts could reach $34 billion (Mosquera, Government Health IT, 12/30/09).

However, officials last week said the outlays are likely to range from $14.1 billion to $27.3 billion.

They added that the government might pursue further budget revisions after evaluating the popularity of the incentive payment program (Schulte/Schwartz, Huffington Post Investigative Fund, 12/30/09).

Above article publish on http://www.ihealthbeat.org/articles/2010/1/4/officials-announce-meaningful-use-ehr-certification-criteria.aspx

Article by Ryan

The HITECH Stimulus Act is legislation designed to promote the adoption of Electronic Health Records (EHRs) among physicians. Passed near the beginning of 2009, the HITECH Act will reimburse qualified physicians who purchase and implement a certified EHR system. If a physician’s practice includes 30% Medicaid patients or more, they could qualify for up to $64,000. Medicare incentives could total up to $44,000, depending upon allowable charges.

“Meaningful Use” is a core concept of the HITECH Stimulus Act. Physicians must do more than simply seeing a certain amount of Medicaid or Medicare patients. “Meaningful Use” outlines a set of EHR features that physicians must use in their practice. On December 30th, 2009, The Centers for Medicare and Medicaid Services (CMS) along with the Office of the National Coordinator for Health Information Technology (ONC) published a final recommendation for the meaningful use definition.

Meaningful use is broken up into several stages. In Stage 1, physicians will have to use features like Computerized Physician Order Entry (CPOE), implement drug-to-drug, drug-to-allergy, and drug-to-forumlary checks, and maintain an updated problem list with ICD-9 or SNOMED, along with a whole host of other requirements. For the most part, the final recommendations look much the same as the initial recommendations from the ONC committee earlier in 2009. The final recommendations will take effect in approximately thirty days; the public is encouraged to comment for the next sixty days. CMS could decide to change the recommendations before final adoption, but most think any changes will be minor.

Deliberations over the meaningful use definitions created a great deal of uncertainty in the EHR market. Most physicians put their buying plans on hold, rather than taking the chance of purchasing an EHR that may not meet the requirements. While caution is understandable, physicians who wait too long may have trouble implementing an EHR in time to qualify for the 2011 reimbursements.

Purchasing an EHR is not like buying off-the-shelf software. With all the vendors, systems, and options, it normally takes several months to make a purchase decision. Once they sign papers, physicians may need to wait up to six months for installation to begin because of vendor backlogs. After installation, physicians and their staff still have to train, which can take weeks for more complicated systems.

Fortunately, the wait is over. CMS and ONC have published their final recommendations. EHR vendors are busy making sure their systems meet the meaningful use requirements. Likewise, physicians need to get busy with their EHR search. Physicians need to make a decision as soon as possible to qualify for 2011 and avoid increasing vendor backlogs. If you are interested in participating in the HITECH Stimulus, ask an EHR vendor to perform a needs analysis for your practice.

Above article publish on http://www.ehrscope.com/blog/meaningful-use-%E2%80%93-interim-final-rule-published/

Dom Nicastro and Janice Simmons, for HealthLeaders Media,

With the release yesterday of its “meaningful use” definition and standards, government agencies have laid the foundation for an “evolutionary process in achieving and maintaining the meaningful use of certified EHR technology,” says Frank Ruelas, director of compliance and risk management at Maryvale Hospital and principal, HIPAA Boot Camp, in Casa Grande, AZ.

CMS and the Office of the National Coordinator for Health Improvement Technology (ONC) on Wednesday, December 30, released two anxiously-awaited regulations providing both the definition of “meaningful use” of electronic health records (EHRs) and the standards to improve the efficiency of health information technology used nationwide by hospitals and physicians.

“Both regulations are important in their own right, but they should be seen as part of a larger effort—a more comprehensive effort—to improve the health of the American people and the efficiency of its health system by equipping physicians, hospitals, and other health professionals with the best, most accurate, and most up-to-date information that they need and can use to help their patients, ” said David Blumenthal, MD, national coordinator for health information technology, at a briefing late Wednesday.

Ruelas cites the identification of three stages, each with its own set of objectives that support the meaningful use of an EHR. Providers can be eligible for thousands of dollars if they meet the criteria included in the three stages.

The initial set of criteria will focus on collecting data electronically, sharing this data with other healthcare providers and patients, and finally reporting the measures to the government. The second stage of criteria would be proposed by the end of 2011. This will focus on structured information exchange and continuous quality improvement. Stage 3, which will focus on decision support for “national high priority conditions” and population health, would come out in 2013.

For example, physicians must use computerized provider order entries (CPOEs) for 80% of their orders; hospitals 10%, according to CMS’ proposed rule.

“This was a very novel approach, in my opinion, because as is stressed in this document, the adoption of certified EHR technology and its meaningful use is more of a process to be developed and adopted over time versus an on/off proposition,” Ruelas says. “Oftentimes, people will use the phrase that some processes are more like running a marathon than a sprint. This interim rule certainly gives the impression that we going to be in a marathon mode.”

The ONC interim final rule begins to define standard formats for clinical summaries and prescriptions; standard terms to describe clinical problems, procedures, laboratory tests, medications and allergies; and standards for the secure transportation of this information using the Internet.

The American Recovery and Reinvestment Act of 2009 required HHS to adopt an initial set of standards for EHR technology by December 31, 2009. This regulation will go into effect 30 days after publication in the Federal Register, with an opportunity for public comment over the next 60 days. A final rule will be issued in 2010.

above article publish on : http://www.healthleadersmedia.com/content/TEC-244313/Marathon-of-Meaningful-Use-EHR-Standards-Just-Beginning