Category — Economic Stimulus

The American Academy of Family Physicians is calling for significant changes to “meaningful use” criteria that will be used to determine whether health care providers are eligible for federal subsidies for health IT usage, Modern Healthcare reports.

In a seven-page letter to acting CMS Administrator Charlene Frizzera, Ted Epperly, chair of AAFP’s board of directors, wrote that the group agrees with many of the criteria’s stated goals, but urged CMS to reconsider:

• Requirements to report computerized physician order entry measures that he maintains could force health workers to manually enter results from laboratories that do not have an interoperable interface;
• A requirement that a patients’ health information be shared with them within 48 hours; and
• Language that requires physicians to meet all of the proposed requirements to receive incentive payments.

In addition, Epperly asserts that the term “health information” is used throughout the proposed criteria but is never defined explicitly (Robeznieks, Modern Healthcare, 3/7).

Above Article Publish on http://www.ihealthbeat.org/articles/2010/3/8/aafp-asks-cms-for-significant-changes-to-meaningful-use-criteria.aspx

WASHINGTON - The Obama administration announced $975 million in grants to help states, doctors and hospitals move from paper to computerized record-keeping.

Studies show electronic medical records help reduce medical errors and improve the quality of patient care. The grant money comes from the economic stimulus passed by Congress last year and is part of a push to get health care providers to adopt electronic record-keeping.

The White House says the awards will help make electronic record-keeping technologies available to more than 100,000 hospitals and primary care physicians by the year 2014 while helping train thousands of people for careers in health care and information technology.

The grants come from two federal agencies.

Health and Human Services Secretary Kathleen Sebelius announced $386 million in grants to advance electronic health records at the state level. Sebelius is also granting $375 million to 32 nonprofits for regional training of health care workers on these technologies.

Labor Secretary Hilda Solis announced around $225 million to support 55 job-training programs in 30 states. The administration says around 15,000 people should get training in the health records technology field. Solis said the training will lead those people to jobs offering career-track employment and good pay and benefits.

Above article publish on http://www.startribune.com/business/84237597.html

Healthcare IT News in this article published the list of 25 meaningful use objectives that professionals and hospitals must meet in order to receive stimulus funds from the government provided through Recovery Act. This list was taken from the proposed rule: “Medicare and Medicaid Programs; Electronic Health Record Incentive Program.

[1] Objective: Use CPOE

Measure: CPOE is used for at least 80 percent of all orders

[2] Objective: Implement drug-drug, drug-allergy, drug- formulary checks

Measure: The EP has enabled this functionality

[3] Objective: Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT®

Measure: At least 80 percent of all unique patients seen by the EP have at least one entry or an indication of none recorded as structured data.

[4] Objective: Generate and transmit permissible prescriptions electronically (eRx).

Measure: At least 75 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology.

[5] Objective: Maintain active medication list.

Measure: At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient is not currently prescribed any medication) recorded as structured data.

[6] Objective: Maintain active medication allergy list.

Measure: At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient has no medication allergies) recorded as structured data.

[7] Objective: Record demographics.

Measure: At least 80 percent of all unique patients seen by the EP or admitted to the eligible hospital have demographics recorded as structured data

[8] Objective: Record and chart changes in vital signs.

Measure: For at least 80 percent of all unique patients age 2 and over seen by the EP, record blood pressure and BMI; additionally, plot growth chart for children age 2 to 20.

[9] Objective: Record smoking status for patients 13 years old or older

Measure: At least 80 percent of all unique patients 13 years old or older seen by the EP “smoking status” recorded

[10] Objective: Incorporate clinical lab-test results into EHR as structured data.

Measure: At least 50 percent of all clinical lab tests results ordered by the EP or by an authorized provider of the eligible hospital during the EHR reporting period whose results are in either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data.

[11] Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach.

Measure: Generate at least one report listing patients of the EP with a specific condition.

[12] Objective: Report ambulatory quality measures to CMS or the States.

Measure: For 2011, an EP would provide the aggregate numerator and denominator through attestation as discussed in section II.A.3 of this proposed rule. For 2012, an EP would electronically submit the measures are discussed in section II.A.3. of this proposed rule.

[13] Objective: Send reminders to patients per patient preference for preventive/ follow-up care

Measure: Reminder sent to at least 50 percent of all unique patients seen by the EP that are 50 and over

[14] Objective: Implement five clinical decision support rules relevant to specialty or high clinical priority, including for diagnostic test ordering, along with the ability to track compliance with those rules

Measure: Implement five clinical decision support rules relevant to the clinical quality metrics the EP is responsible for as described further in section II.A.3.

[15] Objective: Check insurance eligibility electronically from public and private payers

Measure: Insurance eligibility checked electronically for at least 80 percent of all unique patients seen by the EP

[16] Objective: Submit claims electronically to public and private payers.

Measure: At least 80 percent of all claims filed electronically by the EP.

[17] Objective: Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, and allergies) upon request

Measure: At least 80 percent of all patients who request an electronic copy of their health information are provided it within 48 hours.

[18] Objective: Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies)

Measure: At least 10 percent of all unique patients seen by the EP are provided timely electronic access to their health information

[19] Objective: Provide clinical summaries to patients for each office visit.

Measure: Clinical summaries provided to patients for at least 80 percent of all office visits.

[20] Objective: Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically.

Measure: Performed at least one test of certified EHR technology’s capacity to electronically exchange key clinical information.

[21] Objective: Perform medication reconciliation at relevant encounters and each transition of care.

Measure: Perform medication reconciliation for at least 80 percent of relevant encounters and transitions of care.

[22] Objective: Provide summary care record for each transition of care and referral.

Measure: Provide summary of care record for at least 80 percent of transitions of care and referrals.

[23] Objective: Capability to submit electronic data to immunization registries and actual submission where required and accepted.

Measure: Performed at least one test of certified EHR technology’s capacity to submit electronic data to immunization registries.

[24] Objective: Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice.

Measure: Performed at least one test of certified EHR technology’s capacity to provide electronic syndromic surveillance data to public health agencies (unless none of the public health agencies to which an EP or eligible hospital submits such information have the capacity to receive the information electronically).

[25] Objective: Protect electronic health information maintained using certified EHR technology through the implementation of appropriate technical capabilities.

Measure: Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308 (a)(1) and implement security updates as necessary.

Above article publish on http://www.healthcareitnews.com/news/eligible-provider-meaningful-use-criteria

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

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

By Healthcare IT News Staff

It has been an up-and-down year for healthcare informational technology. The biggest story, no doubt, was the impact that national recession had on healthcare investments – way back in January, the picture was bleak. But with the passage of the American Recovery and Reinvestment Act, the industry received a $19 billion shot in the arm from the new Obama Administration. While the money – to be used as incentives for adopting healthcare IT – doesn’t begin to flow in 2011, EHR adoption planning has already begun.

In the second half of the year, the top issue has been healthcare reform. The last sentences on that story have yet to be written, but on Dec. 24, the Senate finally passed its own bill. All that remains is reconciling the Senate and House versions and President Obama’s signature.

Below you’ll find the top issues of the last 12 months, selected by the editors of Healthcare IT News.

Privacy issues dog progess on NHIN

Privacy issues continue to keep the country’s planned nationwide health information network on the slow track, but government and community leaders say it won’t be a problem going forward. Yet things did not go exactly as the Office of the National Coordinator for Health Information Technology planned at a demonstration last month, where 19 cooperative organizations were scheduled to use real patient data to show how interoperability works. Instead, they used fictitious patient records to demonstrate greater depth in capabilities for interoperability than the initial trial run held in September.

IT pledge has market on pins and needles

President Barack Obama’s pledge to inject $50 billion into the healthcare field over the next five years to develop and support technology has many in the industry wondering how and where that money might be spent. On Jan. 22, 117 CEOs and business leaders sent a letter to House and Senate leaders supporting federal investment in healthcare information technology, broadband and energy smart grids, saying they “will provide our nation with a near-term stimulus and long-term comparative advantage.”

$19 billion to fuel healthcare IT

The $787 billion economic stimulus package signed by President Barack Obama on Feb. 17 includes $19 billion toward health information technology. While many healthcare IT industry insiders welcomed the spending as providing a needed impetus to pushing the healthcare system into the 21st Century, many also worried about getting IT done right. “I think it’s a terrible idea by the government to invest in healthcare IT – in EMR systems – without investing in standards,” said Marc Probst, CIO at Intermountain Healthcare in Salt Lake City.

HHS introduces new HIT Czar

Just as the April issue of Healthcare IT News was going to press, the Human Department of the Health and Services introduced David Blumenthal, MD, is Obama administration’s new National Coordinator for Health Information Technology. “I am humbled and honored to have the opportunity to serve President Obama and the American people in the effort to harness the power of health information technology,” Blumenthal said.

Hospitals shun life-saving IT

“Disappointing” and “disturbing” are two words Leah Binder chose to describe the results of a recent survey that revealed only 7 percent of hospitals across the country have adopted CPOE. CPOE, or computerized physician order entry, can reduce adverse events by 88 percent, according to Binder, the CEO of the healthcare watchdog organization The Leapfrog Group.

Obama budget reflects IT promise

President Barack Obama’s expanded fiscal year 2010 budget signals continued commitment to advancing healthcare IT as a way to cut healthcare costs and save lives. Obama’s $3.4 trillion federal budget, released May 8, expanded the outline he presented to Congress at the end of February.

Meaningful use draft approved

The federal health IT policy committee on July 16 approved long-awaited recommendations from its meaningful use workgroup on how providers can qualify to receive incentives through the new stimulus package. Measuring and improving outcomes is a key component.

Reform bill contains IT piece

The Senate Finance Committee health reform package, released Sept. 16, includes measures to advance healthcare IT. The committee’s reform bill has been the most controversial and the last proposal to come out of five Congressional committees that have jurisdiction over healthcare.

50,000 jobs: who will fill them?

The government’s piece of the stimulus package designed to encourage the adoption and use of healthcare information technology is expected to create 50,000 new jobs – maybe more.

Search is on for new CCHIT Chief

Key industry leaders are weighing in on the news that Mark Leavitt, MD, is retiring from his role as chairman of the Certification Commission for Health Information Technology.

Above article publish on http://www.healthcareitnews.com/news/newsmakers-year-review

Posted by Mitch Wagner,

National health IT coordinator Dr. David Blumenthal dropped a big hint about upcoming criteria for giving out e-health records grants. He advised healthcare IT managers to focus on “goals of care” rather than technology.

Blumenthal works for the U.S. Department of Health and Human Services, which is responsible for giving out grant money to reimburse healthcare providers for implementing electronic medical records. The U.S. American Recovery and Reinvestment Act of 2009 (ARRA), which set aside the money, specified that the funding will go to “meaningful use” of EMRs, but did not specify a definition for the phrase. HHS plans to release a preliminary definition of meaningful use next month. But Blumenthal dropped a hint at an address at the Medical Informatics Association’s annual symposium. He “gave attendees what they wanted to hear by reiterating his philosophy that technology simply is an enabler of quality improvement, not a panacea for healthcare,” according to FierceEMR.

“The meaningful use framework will be about the goals of care, not the technology,” Blumenthal said. While he didn’t elaborate on that statement, he did state the position of the Obama administration–one largely held by the informatics community, if not the broader healthcare industry–that the billions of dollars in federal subsidies aren’t simply meant to buy EMRs for providers. “It’s not the money that will turn out to be the most important,” Blumenthal said.

Instead, the net $19 billion investment is a way to demonstrate that EMRs should and will be accepted in the fairly near future as “symbolic of professionalism in medicine,” just as much as the stethoscope or examination table are today. “The idea that government should subsidize health IT will be as foreign an idea that the government should buy stethoscopes or exam tables for doctors,” Blumenthal explained.

“Information is really the lifeblood of medicine,” Blumenthal added. “Health information technology is its circulatory system.”

Final standards for meaningful use will be released in the spring, after a period of public comment on the first effort to be released by the end of the year, according to a ModernHealthcare.com write-up of Blumenthal’s address.

Blumenthal stressed that health IT must be focused on the goal of making the healthcare system work better for patients and providers.

“It’s not the technology that’s important, but its effect,” Blumenthal said. “That’s the purpose of the stimulus bill.”….

While Blumenthal declined to give a specific definition of meaningful use, he offered some hints. People working in health IT should think about EHRs “not as a technology project, but as a change-management project,” he said. Components of meaningful use include sociology, psychology, behavior change and the “mobilization of levers to change complex systems and improve their performance,” he added.

Through the stimulus law, Congress mandated that meaningful use become more focused over time, with yearly benchmarks. There has been a “lively discussion” in the Obama administration of that timetable in the proposed rulemaking of meaningful use, Blumenthal said.

Privacy and security will be essential, he said.

HHS plans to announce the first round of recipients of two major rounds of grants soon, Blumenthal said. The first, for $700 million, will establish up to 70 health IT regional extension centers nationwide to help healthcare providers become meaningful users of EHRs. The second program offers $560 million in grants to states to develop health information exchanges linking providers.

HHS also plans programs to increase the supply of trained health IT workers.

“The skills needed are not necessarily what our teenage children have,” Blumenthal said, which brought laughter from the crowd.

Specifically, the nation needs professionals who understand meaningful use and improved processes of care, the ability to redesign workplaces to integrate the new technology and to help providers use the technology to its full potential, he said.

“The training needed is well beyond the installation of information technology,” he said.

Blumenthal expressed great confidence that health IT can be a foundation for fundamental change in the healthcare system.

“I believe it will be a short time before EHRs are as common in medicine as the stethoscope, the cardiogram, the MRI and other core tools,” he said. “I think we’re already moving in that direction.”

Above article published on http://www.informationweek.com/blog/main/archives/2009/11/blumenthal_pati.html;jsessionid=0K5NXFIO4JNUHQE1GHOSKHWATMY32JVN

By Wendy Johnson

HHS’ definition of meaningful use will include an organization’s ability to use health IT to improve quality and “inform clinical decisions at the point of care,” David Blumenthal, national coordinator for health information technology, wrote in an Oct. 1 letter to the industry.

CMS is expected to publish its formal definition of meaningful use by the end of the year. Expect it to require providers to use HIT to “reduce the amount of time spent on duplicative paperwork” so they can spend more time with patients, Blumenthal wrote.

“The concept of meaningful use is simple and inspiring, but we recognize that it becomes significantly more complex at a policy and regulatory level,” he added. “As a result, we expect that any formal definition of ‘meaningful use’ must include specific activities healthcare providers need to undertake to qualify for incentives from the federal government.”

Above article published on http://www.fiercehealthit.com/story/blumenthal-meaningful-use-must-result-quality-improvement-more-time-bedside-less-duplication/2

Changes in Stark laws allow hospitals to offer EMR-implementation subsidies to physicians. Physicians can also tap into federal stimulus money for EMRs. How will the two funding options converge?

By Pamela Lewis Dolan, amednews staff.

Availability of government stimulus money, combined with hospitals being allowed to finance portions of physicians’ electronic medical record systems, could make EMR adoption a veritable bargain. Or the stimulus money could make hospital systems less eager to help pay for your EMR, figuring that government funds will instead.

Either way, the possibility of combining two avenues of EMR funding has added a twist to the economic picture for physicians deciding what, when and whether to buy.

Doctors can get a maximum of $44,000 in funds from the federal economic stimulus package for adopting a certified EMR system that meets the government’s “meaningful use” standards. How much physicians get in stimulus funds will be based on the percentage of their practice that is made up of Medicare or Medicaid patients. Hospitals can get their own share of stimulus funds, but the amount depends on how they’re connected with physicians.

Read More  http://www.ama-assn.org/amednews/2009/11/23/bisa1123.htm

By Brian Robinson,

The Centers for Medicare and Medicaid Services is still on target to publish by the end of the year a proposed rule on the meaningful use of electronic health records, despite growing fears from industry about the possible impact of the regulation.

Tony Trenkle, director of the Office of e-Health Standards and Services at CMS, said he had been spending a lot of time with health industry folks who have expressed “concerns and fears” about what will be in the regulation.

Those include how high the bar will be set for meeting meaningful use targets during the first year of implementation, and whether the industry will be able to meet them, he told a meeting today of National Committee on Vital and Health Statistics (NCVHS).

Other concerns include whether hospitals outpatient clinics would be eligible to receive separate payments, whether quality measures will disadvantage specialty health providers, and worries particularly by the states about whether CMS would be able to harmonize Medicare and Medicaid requirements.

Under the HITECH Act, a part of the American Recovery and Reinvestment Act, health care providers can receive payments from both the Medicare and Medicaid programs if they can demonstrate meaningful use of certified EHRs. Payments are due to begin in 2011.

One of the major outcomes of the Nov. 19-20 NCVHS meeting is expected be a letter setting out recommendations to the Secretary of the Health and Human Services for measures that can be applied to decide on just what meaningful use is.

They include commissioning a “fast track” study from the Institute of Medicine on a national strategy for quality measurement development, to begin a process to identify essential data elements, to require EHR vendors to use defined quality data elements, and to require that any certified EHR be able to add data elements that may be defined in the future.

The NCVHS expects to release the final version of the letter at the Nov. 20 conclusion of its meeting.

Above article published on http://www.govhealthit.com/newsitem.aspx?nid=72449