Category — electronic health records

CHICAGO – The American Board of Medical Specialties (ABMS) is creating a new measurement tool to incorporate meaningful use into its Maintenance of Certification (MOC) program, which requires physician specialists to conduct an ongoing measurement of six core competencies.

ABMS officials said the not-for-profit organization will work with the three ABMS primary care Member Boards: the American Board of Family Medicine (ABFM), the American Board of Internal Medicine (ABIM) and the American Board of Pediatrics (ABP) to develop initial products.

ABMS officials say that incorporating meaningful use into MOC certification may include:

• Developing two new knowledge self-assessment modules to evaluate:

1. A physician’s knowledge of health IT for incorporating evidence-based medicine into their practice, decision support and data acquisition, and analysis and reporting related to correct use of the health IT.
2. A physician’s knowledge of the uses of health IT to promote patient safety such as computerized physician order entry, medication reconciliation, e-prescribing and coordination of care.

• Augmenting the knowledge self-assessment modules described above with the addition of simulation, creating patient scenarios that demonstrate EHR functionality, including the development and use of a registry for quality improvement that will provide “hands-on” experience for physicians in gaining the skills they need to apply health IT effectively in quality improvement efforts.
• Developing data interchange utilities to enable physician submission of Physician Reporting Quality Initiative (PQRI) and health IT meaningful use measures to the Boards in the same format used by the Centers for Medicare & Medicaid Services (CMS). This will enable certified physicians to satisfy both PQRI and MOC requirements, and qualify for the PQRI bonus and potentially meaningful use bonus without redundant data submissions.
• Expanding and enhancing practice improvement modules (PIMs), which are Web-based self-evaluation tools that guide physicians through collecting data from their own practice using medical chart reviews, patient surveys and a practice system survey to create a comprehensive assessment of current practice performance in a specific clinical area. Select PIMs will be enhanced to enable physicians to use EHRs to track their practice data and improve care.

According to ABMS, the meaningful use measures physicians will receive federal incentives for meeting overlap with core competencies that are continually measured through ABMS MOC: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communications skills, professionalism, and systems-based practice.

“More than 750,000 U.S. physicians are certified by an ABMS Member Board, so it’s readily apparent that building meaningful use of health IT into MOC will benefit patients,” said Kevin B. Weiss, MD, ABMS president and CEO. “Aligning MOC and meaningful use of HIT will help to facilitate physicians’ knowledge, skill and use of health IT, and in turn can improve physician performance and patient outcomes.”

Source   :   http://www.healthcareitnews.com/news/american-board-medical-specialties-include-mu-certification-program

WASHINGTON – An alliance that claims more than 2,300 community-based hospitals as members is pressing Congress for a legislative fix to the final rule on meaningful use to ensure that every hospital receives its fair share of incentive payments under the HITECH Act.

After having tried in vain to have the issue addressed before the federal rule was final, the Premier healthcare alliance submitted its statement Tuesday to the House Committee on Ways and Means Subcommittee on Health at a hearing on meaningful use EHR. The panel chairman is Pete Stark (D-Calif.).

At issue: health systems with multiple inpatient facilities operating under one provider number.

The final meaningful use rule would allow only one Medicare incentive base payment per year for multiple inpatient facilities operating under the same Medicare provider number. By contrast, an identical health system whose inpatient facilities each operate under its own Medicare provider number would receive a base payment for each facility, Premier noted.

“This is a crucial issue for Premier alliance hospitals and could financially handicap co-located and multi-campus hospitals’ ability to implement EHRs in a timely manner,” the alliance wrote in its statement. “More than 50 Premier alliance hospital systems representing more than 100 inpatient facilities are affected by this methodological error by CMS, which will cost them millions of dollars in EHR incentive payments.”

“Despite receiving hundreds of comments on this specific issue in response to its proposed rule published on Jan.13, the Centers for Medicare & Medicaid Services (CMS) chose not to make any changes to its methodology for calculating a qualifying hospital’s Medicare and Medicaid EHR incentive payment,” Premier said. “By not modifying its methodology, CMS creates an arbitrary and inequitable distinction between identical hospital systems based solely on whether a system has multiple inpatient facilities operating under a single Medicare provider number.”

The government released the final rule on meaningful use on July 13. Initial industry reaction was mostly positive, with kudos given to CMS and the Office of the National Coordinator for Health Information Technology for having dropped an all-or-nothing approach and provided greater flexibility in the rule.

Source  :  http://www.healthcareitnews.com/news/alliance-calls-legislative-fix-meaningful-use

WASHINGTON – Federal officials released the long-awaited final rule on meaningful use Tuesday, with Wednesday morning showing most major organizations still wading through the more than 800 pages of regulations for an in-depth reaction. Initial response seemed to be cautiously optimistic, but the American Hospital Association expressed concerns.

Leaders of the American Hospital Association said on Tuesday they are still conducting an in-depth review of the regulation. They are initally pleased with the added flexibility and removal of some of the “unnecessary administrative burdens” in the final rule, they said.

But that’s where the positive reaction ends. Overall, AHA leaders said they remain concerned that the requirements may be out of reach for many hospitals. “Unfortunately, CMS continues to place some barriers in the way of achieving widespread IT adoption,” AHA said in its statement.

AHA concerns include:

• Individual hospitals in multi-campus settings are unfairly excluded from incentive payments. Hospitals within a healthcare system should each be eligible for incentives;
• The rule may adversely impact rural hospitals and exacerbate the digital divide in healthcare;
• The rule requires hospitals to immediately use Computerized Provider Order Entry (CPOE), “which can be complicated, costly to implement and takes time to do right;”
• The rule, in combination with the certification process, “penalizes early adopters” by requiring them to upgrade or replace already functional systems;
• The rule limits how quickly hospitals can adopt a certified EHR that can benefit patient care.

“Given limited vendor capacity and workforce shortages, many hospitals will not have timely access to certified products, since no certified EHR systems are available today,” AHA said.

Others more optimistic

William F. Jessee, president and CEO of the Medical Group Management Association said MGMA is pleased the federal government acknowledged many of MGMA’s serious concerns regarding the proposed rule.

“While challenges remain, the final rule provides a better approach to the ‘real-world’ issues faced by practices as they move toward ‘meaningful use’ of EHRs,” he said.

“Improvements sought by MGMA contained in the final rule include a reduction in the originally unrealistic thresholds related to e-prescribing, administrative transactions and computerized physician order entry, among others,” Jessee said.

Jessee said MGMA will “work closely” with the Centers for Medicare and Medicaid Services to incorporate additional changes.

The Healthcare Information and Management Systems Society (HIMSS) is expected to have an initial reaction ready by sometime Wednesday, with an in-depth analysis forthcoming, HIMSS leaders said.

H. Stephen Lieber, HIMSS president and CEO said HIMSS members “appreciate and understand the cultural and technical challenges that healthcare providers face in meeting the requirements for meaningful use,”and “HIMSS will be a leader in the transformation.”

Leaders of the College of Healthcare Information Management Executives (CHIME) said on Tuesday they are “actively reviewing” the final rule.

“It’s definitely time to begin a coordinated effort to implement electronic health records by providers nationwide,” said CHIME President and CEO Richard Correll. “We have been supportive of the federal government’s actions to encourage widespread implementation of EHRs, and we are increasing our educational programming in support of our members’ efforts to succeed in this new era of IT adoption”

The Markle Foundation, the Center for American Progress, and the Engelberg Center for Health Care Reform at Brookings issued a joint statement backing health IT adoption incentives.

“The requirements must be ambitious enough to make the investments worthwhile, but not so onerous that they discourage large numbers of doctors and hospitals from participating,” leaders of the organizations said.

Carol Diamond, MD, managing director of the Markle Foundation said the final rule has added flexibility to encourage provider participation.

The organizations are still reviewing the regulation in detail, they said.

Source  :  http://www.healthcareitnews.com/news/stakeholders-still-assessing-final-meaningful-use-rule

Tuesday at 10 am, CMS and ONC released the final rules that will guide electronic health record rollouts for the next 5 years.

Here’s my analysis of the key changes in the Final Rule:

1. HHS has adopted the HIT Policy Committee recommendation to frame Meaningful Use as core requirements and discretionary requirements. In so doing, they have reduced the total number of requirements and introduced choice.

In the NPRM there were 25 requirements for Eligible Professionals and 23 for hospitals.

In the Final Rule there are 15 core requirements for Eligible Professionals and 14 for hospitals.

There are 10 discretionary requirements from which 5 must be chosen.

2. Thresholds have been reduced in many cases. For example, CPOE had a threshold of 80% of orders for Eligible Professionals and 10% of orders for hospitals. The language in the final rule focuses on order entry of medications and requires that 30% of patients with medication orders to have at least 1 medication order entered electronically. This requirement applies to both Eligible Professionals and Hospitals.

3. Administrative Simplification has been postponed to Stage 2.

4. Decision Support rules changed from 5 to 1

5. Required Clinical quality measures have been reduced to 6 for professionals and 15 for hospitals. For professionals, there are 3 core measures required, 3 alternative core measures, and a choice of 3 from a pool of discretionary measures. Reporting by attestation is required in 2011, electronic reporting is required in 2012. Clinical quality measurements for specialists have been eliminated for stage 1. There has been great effort to align meaningful use with PQRI measures.

6. The NPRM did not include the recording of advanced directives or a provision for providing patients with educational materials. The final rule includes these as discretionary meaningful use requirements.

Overall this final rule maintains a balance between the policy objectives sought and the technology changes possible that are achievable now. There will still be 3 stages of meaningful use and later stages will be more demanding. All the original stage 1 requirements will still be part of meaningful use by stage 2.

In January of 2011, the clinicians may begin the 90 day process of using a certified record per meaningful use requirements. Attestation of this use begins in April 2011. CMS payments will begin May 2011.

ONC also released the final rule on Standards and Certification today. They have done a remarkable job adding detailed implementation guidance specificity for patient care summaries, public health laboratory reporting, syndromic surveillance, and immunizations. It’s a tricky balance to ensure there is enough specificity to test and certify EHRs and modules for interoperability while at the same time encouraging innovation. The final rule issued today achieves that balance perfectly, ensuring that only mature implementation guides are specified, leaving room for innovation in such as areas as how to transport data from point to point via NHIN Direct and other demonstration projects.

Overall, a very good day for ONC, HHS and stakeholders. The final rule means Meaningful Use will be achievable by many. The Standards and the process to certify their use are sufficiently specific. I’m impressed.

Source :- http://www.healthcareitnews.com/blog/meaningful-use-and-standards-are-finalized

WASHINGTON – Federal officials released the final rule on meaningful use Tuesday, which will allow physicians and hospitals to qualify for thousands of dollars in stimulus funding incentives for the adoption of electronic health records.

The 864-page final rule, several weeks late from its anticipated delivery before June 21, outlines the specific qualifications providers must meet to achieve the meaningful use of electronic health records.

At a news conference Tuesday morning, federal healthcare officials praised the advance of electronic health records, while acknowledging the difficulties providers face at the onset of adoption.

According to David Blumenthal, MD, national coordinator for health information technology, the final rule differs from the proposed rule issued last January: It allows providers more flexibility in choosing which measures to use for qualifications.

According to Blumenthal, the proposed rule required doctors to comply with 23 measures, and hospitals 25 measures. The government received more than 2,000 comments on the rule, many of them asking for more flexibility in allowing clinicians to qualify.

Blumenthal said the final rule took those comments into account. The final rule requires doctors to comply with a set of 15 core objectives during the first year - or Stage 1- of adoption. Hospitals are required to comply with 14 core objectives. In addition to the core objectives, both hospitals and doctors will have to choose five more objectives from a “menu” of 10, he said. The remaining objectives will be deferred to Stage 2 of adoption.

The final rule also reduced the number of electronic prescriptions a doctor is required to make from 75 percent to 40 percent, Blumenthal said.

Kathleen Sebelius, Department of Health and Human Services Secretary, said the Federation of American Hospitals is an “enthusiastic supporter” of the new rule. The federal government hopes other groups will join them, she said.

Blumenthal, a physician, said he is confident the use of electronic health records will become a core professional competency among physicians, who will eventually lead the way in adoption. Until then, the government will encourage healthcare IT adoption through financial incentives, such as these set up under the meaningful use rule. The government will also supply “shoulder-to-shoulder” support for providers through the regional extension centers.

Key changes in the final CMS rule include:

• Greater flexibility with respect to eligible professionals and hospitals in meeting and reporting certain objectives for demonstrating meaningful use. The final rule divides the objectives into a “core” group of required objectives and a “menu set” of procedures from which providers may choose any five to defer in 2011-2012.  This gives providers latitude to pick their own path toward full EHR implementation and meaningful use.
• An objective of providing condition-specific patient education resources for both EPs (eligible providers) and eligible hospitals and the objective of recording advance directives for eligible hospitals, in line with recommendations from the Health Information Technology Policy Committee.
• A definition of a hospital-based EP as one who performs substantially all of his or her services in an inpatient hospital setting or emergency room only, which  conforms to the Continuing Extension Act of 2010
• CAHs (critical access hospitals) within the definition of acute care hospital for the purpose of incentive program eligibility under Medicaid.

A CMS/ONC fact sheet on the rules is available on the CMS Web site.

Source :  http://www.healthcareitnews.com/news/flexibility-built-final-rule-meaningful-use

More than 80 community colleges and universities this fall will begin training nearly 50,000 health IT workers as part of an HHS grant program that aims to help physicians and hospitals adopt electronic health records, ComputerWorld reports (Mearian, ComputerWorld, 7/16).

Source of Funding

HHS in April announced $144 million in grants to target health IT research and work force development.

Funding was disbursed through the 2009 federal economic stimulus package (iHealthBeat, 4/5).

Breakdown of Plans

For the training, HHS has designed a curriculum to educate individuals with a health care or IT background for 12 specific roles.

The programs fall into two groups:

• A six-month program; and
• A one- to three-year training program for more advanced administrative and technical roles, such as senior clinician leaders and privacy and security specialists.

Graduates will receive a certificate in their specialties, and each school will receive approximately $1 million to implement the curriculum.

Regional Extension Centers

A large focus of the effort will be dedicated to training staff to work at 60 regional extension centers, which will help rural institutions and small physician practices install EHR systems.

The centers are expected to employ up to 30 trained workers, who will:

• Assist health care providers with reimbursement procedures;
• Assess a facility’s health IT infrastructure;
• Suggest compatible EHR systems;
• Oversee system installation;
• Analyze workflow; and
• Determine if EHR deployment meets federal “meaningful use” standards (ComputerWorld, 7/16).

Source: http://www.ihealthbeat.org/articles/2010/7/16/groups-preparing-ways-to-use-hhs-grants-for-it-training-programs.aspx

On Tuesday, federal officials announced the release of the final rule defining how hospitals and health care providers can demonstrate “meaningful use” of electronic health records to qualify for federal incentive payments, Reuters reports (Lentz, Reuters, 7/13).

Officials also released the final rule describing the required standards and certification criteria for EHR technology. The new regulation updates the interim final rule on EHR certification that ONC released in January (Mosquera, Government Health IT, 7/13).

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.

HHS Secretary Kathleen Sebelius, new CMS Administrator Donald Berwick, National Coordinator for Health IT David Blumenthal and Surgeon General Regina Benjamin announced the rules during a news conference (Health Imaging & IT, 7/13).

Core Meaningful Use Objectives

Blumenthal said the final meaningful use rule offers health care providers more flexibility than the proposed regulations released in January.

The final rule requires physicians to meet a set of 15 core objectives during the first stage of the incentive program. Hospitals are required to meet 14 core objectives for Stage 1. In addition, all health care providers will need to comply with five objectives out of a “menu” of 10 options (Manos, Healthcare IT News, 7/13).

The earlier proposed rule included 25 objectives for physicians and 23 objectives for hospitals.

One of the core objectives requires health care providers to transmit 40% of prescriptions electronically. The requirement was relaxed from the earlier proposed regulations, which called for a 75% electronic prescribing rate.

Health care providers also will need to enact a single measure to meet the clinical decision support requirement, down from five measures in the previous proposal.

In addition, CMS reduced the number of quality measures that health care providers must report on, deferring some measures to Stage 2 meaningful use requirements (Versel, FierceEMR, 7/13).

Another core objective requires hospitals and physicians to use computerized physician order entry systems to capture at least 30% of medication orders. Under the earlier regulations, hospitals would need to use CPOE systems for 10% of medication, laboratory and diagnostic orders, while doctors would need to use the systems for 80% of such orders (Robeznieks, Modern Healthcare, 7/13).

‘Menu’ of Additional Options

In addition to the core objectives, the final rule requires doctors and hospitals to comply with five objectives out of the menu of 10 options. Health care providers will need to comply with the remaining objectives as part of Stage 2 meaningful use requirements (Healthcare IT News, 7/13).

One of the new objectives in the menu calls for health care providers to offer patients condition-specific educational resources.

Clarifications on Eligibility

The final meaningful use rule defines a hospital-based eligible professional as someone who performs nearly all services in an inpatient hospital setting or emergency department.

The rule also expands the definition of acute-care hospital to include designated Critical Access Hospitals for the Medicaid incentive program (Health Imaging & IT, 7/13).

Additional Information in NEJM Piece

Blumenthal and Marilyn Tavenner, principal deputy administrator of CMS, offered additional explanations of the final meaningful use rule in a New England Journal of Medicine perspective piece.

In the perspective piece, Blumenthal and Tavenner explain that HHS weighed 2,000 outside comments before deciding on “significant changes” to the earlier meaningful use regulations.

The piece also includes a full list of the core objectives and the menu of options for the new final rule (Hobson, “Health Blog,” Wall Street Journal, 7/13).

In addition, Benjamin authored a companion piece that also appeared in the journal (FierceEMR, 7/13).

Next Steps

In January 2011, eligible health care providers and hospitals can begin registering for the EHR incentive program. CMS will manage the registration for both the Medicaid and Medicare incentive programs from one virtual location.

Federal officials expect to release additional information on the Stage 2 and Stage 3 meaningful use requirements over the next few years (Mearian, ComputerWorld, 7/13).

Source:http://www.ihealthbeat.org/articles/2010/7/13/final-rules-on-meaningful-use-ehr-standards-released-today.aspx

By Jennifer Lubell

West Virginia has received $6 million in federal stimulus funds to establish a regional health information technology extension center.

The center has been designated as the statewide organization to provide education, training and support services to help the state’s primary-care providers implement and meaningfully use health information technology for the purpose of improving patient outcomes.

“It should be active this summer,” said an aide to West Virginia Gov. Joe Manchin, who along with other local and state officials announced on June 8 the effort to help primary-care doctors adopt electronic health.

The American Recovery and Reinvestment Act of 2009, also known as the stimulus law, mandates that providers meaningfully use an electronic health-record system to qualify for up to an estimated $27.3 billion in federal reimbursements.

To help physicians become eligible for these incentive payments, the center will, among other initiatives, provide assistance in the selection and purchasing of electronic health-record systems, project management and implementation services, and guidance on privacy and security matters.

“West Virginia remains a national leader in the adoption of health information technology, and this statewide health information-technology extension center will be another key component of our ongoing efforts to use technology to improve the health of our citizens,” Manchin said in a written statement. “This project is the latest example of how West Virginia is working to modernize its healthcare delivery system in order to improve overall healthcare, enhance efficiencies and facilitate greater information-sharing between physicians and patients,” he said.

Source:http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20100609/NEWS/100609949

In a comment letter sent Friday, the College of Healthcare Information Management Executives stressed the importance of ensuring that the electronic health record certification process can adequately handle the demand to certify EHR systems, Healthcare IT News reports (Merrill, Healthcare IT News, 4/30).

CHIME also said EHR systems that receive certification under the temporary certification program being established this year should be able to have that certification carry over to the permanent program that will be established in 2012 (Goedert, Health Data Management, 4/30).

The comments are in response to the Office of the National Coordinator for Health IT’s Notice of Proposed Rulemaking on EHR certification.

CHIME also recommended that ONC:

• Ensure that the certification program has the capacity to handle demand;
• Focus on EHR certification before expanding to other technologies (Healthcare IT News, 4/30);
• Provide details on how it will coordinate the EHR testing and certification process with the National Institute of Standards and Technology;
• Explain what constitutes a self-developed EHR;
• Require vendors to disclose what functions their products are certified to perform and any known compatibility issues; and
• Give vendors adequate time to recertify their products if a certifying body loses its authority to certify products (Health Data Management, 4/30).

Above article publish on http://www.ihealthbeat.org/articles/2010/5/3/chime-offers-input-on-electronic-health-record-certification-plans.aspx

One of the keys to achieving meaningful use and thus being able to qualify for federal incentive payments for the implementation of EMRs is the use of Computerized Physician Order Entry. What exactly is CPOE and how can it be implemented successfully?

CPOE is a program that physicians use to place orders for medications, lab tests, radiology exams, admissions, referrals and other tasks. A CPOE replaces written orders, phone calls and faxes, because it is linked to every other department in the hospital.

The Agency for Health Research and Quality (AHRQ), a unit of the federal Department of Health and Human Services (HHS) awarded ten grants to various health care providers to implement CPOE, and studied what happened. Their results show that there are certain things that providers can do to help improve the chances of a successful implementation.

The ten contracts were spread across both urban and rural hospitals in various parts of the country, and were intended for use in implementing inpatient programs. Some CPOE systems were implemented with EMRs, or in addition to existing EMRs, and all of them were put in place in conjunction with a decision support system.

Interviews with the grant recipients revealed that certain factors were critical to the success of a CPOE implementation. Here is a brief summary:

• Training – Frequent training and retraining is critical to a successful implementation.
• Staffing – Staff who understand both IT and clinical science are important. If you don’t have them, hire them or train existing personnel.
• Workflow – CPOE is by nature disruptive, so plan to redesign your workflow to accommodate these changes.
• Resources – Be sure to allocate enough resources (money, time and people) for planning, training, implementation and maintenance.
• Work With Vendors – Have good relations with vendors, but don’t allow them to delay your implementation program. Write penalties into contracts.
• Committees – Create and use Clinical Steering Committees early and often.
• Order Sets – Involve as many clinicians as possible in the creation of order sets, but strike a balance between filled-in fields and default values.
• Interoperability – Good luck with this one. Most of the grantees faced challenges integrating CPOE with other programs. Vendors did not want to cooperate in connecting to other company’s products.
• Support – Support should be available 24/7, especially at the beginning of the implementation. Address problems quickly and completely. Make support easy to access.
• Alert Fatigue – Expect a lot of alerts when you go live, and expect clinicians to find it annoying. Grantees had to develop new techniques to eliminate unnecessary alerts.

The conclusions reached here show that implementing the CPOE component of an EMR will pose challenges that will require creativity and tenacity while you design workarounds, but a successful implementation is possible. It seems to be true that what works for CPOE will work for other components of an EMR implementation.

Above article publish on http://blog.pchealthstop.com/?p=926