Category — Electronic Medical Records

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

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

By Neil Versel

If nothing else, it should at least be easy to register to receive federal incentive payments for meaningful use of EMRs.

CMS has awarded a $1.6 million contract to CGI Federal, a Fairfax, Va.-based unit of Montreal-based technology consulting firm CGI Group, to revise the existing Provider Enrollment Chain Ownership System (PECOS) so physicians and hospitals can attest to meeting the requirements for meaningful use that will qualify them for Medicare bonuses. PECOS currently manages and verifies enrollment of Medicare providers and vendors.

Build-out of the online system to accommodate EMR incentive enrollment should take about 10 months, CMS says. Hospitals, however, could be eligible for the bonuses as soon as the end of December, since the rules for meaningful use, as currently proposed, only requires providers to meet the standards for 90 consecutive days in 2011. Medicare Part A, which applies to inpatient care, follows the federal fiscal year, which begins Oct.1.

For more information:
- see this Government Health IT story
- read this CMS notice about the contract award

Above article publish on http://www.fierceemr.com/story/providers-will-attest-meaningful-use-cms-registration-system/2010-04-22

By, Bernie Monegain

SAN JOSE, CA – The market for electronic medical record systems in North America will exceed $5.4 billion by 2015, according to a new report from Global Industry Analysts.

The same report, “Electronic Medical Record Systems: A North American and European Market Report,” pegs the European market at $1.4 billion by 2015.

Global Industry Analysts, Inc., (GIA) is a publisher of off-the-shelf market research. The company employs more than 800 people worldwide and publishes more than 1,100 full-scale research reports each year.

The main factors contributing to the adoption of EMR systems include effective management of the medication process, substantial clinical improvement, minimization of staff, and extraction of detailed data, according to GIA. The report does not mention recent government incentives tied to the meaningful use of healthcare information technology.

Though cost is the major constraint for healthcare centers in adopting EMRs, the ultimate reduction in costs is likely to drive the demand for EMR systems in the future, the report states.

The market growth will be driven primarily by the increasing recognition by healthcare providers that digital records help in effective communication between the clinical staff, and thereby increase operational efficiency, the GIA report notes. As clinicians and physicians spend less time on searching and filing data, there is an increased level of patient satisfaction.

“Healthcare information technology gained attention in recent years for its ability to lower medical errors, provide transparent modes for reimbursement procedures, decrease costs, and transform the healthcare delivery system,” the report states. “There are prolific opportunities in less-penetrated markets as physician practices and inpatient centers continue to adopt electronic medical records and digitize relevant areas. Though the operating costs are high and continue to increase, providers are sizing up their portfolio for better positioning in the future.”

North America and Europe dominate the global electronic medical record (EMR) systems market, according to GIA. However, it adds, the market has excellent potential in healthcare systems worldwide.

Above article publish on http://www.healthcareitnews.com/news/ehr-market-forecast-54b-2015

The Healthcare Information Technology Standards Panel has extended its contract with HHS through April 30, 2010, the panel announced Tuesday, Healthcare IT News reports.

The panel and HHS have collaborated to expand the adoption and interoperability of electronic health records since HITSP’s creation in 2005, according to Fran Schrotter, HITSP’s project director and senior vice president and chief operating officer of the American National Standards Institute, which administers HITSP.

During the extension period, Schrotter said HITSP will:

• Collaborate with CMS on a project on quality demonstration;
• Conduct monthly informational update calls; and
• Take part in the Healthcare Information and Management Systems Society’s annual conference and exhibition.

The contract extension ensures that HITSP volunteers remain engaged until the next phase of standards harmonization, which will be funded by the Office of the National Coordinator, is announced, Schrotter added (Manos, Healthcare IT News, 2/16

Above Article Publish On http://www.ihealthbeat.org/articles/2010/2/16/hhs-extends-hitsp-contract-pushes-ahead-with-ehr-adoption.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

The state of Kentucky will receive a $2.6 million in federal matching funds from the Centers for Medicare and Medicaid Services (CMS) to help fund the development of the state’s electronic health records incentive program.

The American Recovery and Reinvestment Act of 2009 provided a 90 percent federal match for state planning activities related to the creation of an incentive program that encourages Medicaid providers to establish electronic medical records systems, according to a CMS news release.

Electronic medical records give health care providers instant access to patients’ medical information over a secure network. When complete, the Kentucky system is expected to help health care providers coordinate patient care.

Kentucky will use the funding to analyze the progress state’s health information technology initiative, according to the release.

Officials will explore topics such as barriers to developing the records system, provider eligibility for participating in the electronic health records network and the creation of a state Medicaid health information technology plan, according to the release.

Above article publish on http://health-information.advanceweb.com/Web-Extras/EHR-Today/KY-to-Receive-Federal-Funds-for-EHR.aspx

By Rebecca Vesely / HITS staff writer

Proposed rules on the meaningful use of electronic health records will be made public by the end of the year or perhaps sooner, said David Blumenthal, national coordinator for health information technology at HHS.

In a speech before the American Medical Informatics Association’s annual symposium in San Francisco, 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.”

The American Recovery and Reinvestment Act of 2009 included Medicare and Medicaid incentives to eligible providers such as physicians and hospitals to boost adoption of EHRs. To receive the incentive payments, providers must demonstrate “meaningful use” of a certified EHR. The CMS, in conjunction with Blumenthal’s office, is developing the proposed rule that provides greater detail on the incentive program and a definition of meaningful use. The stimulus law, enacted in February, appropriated $2 billion to Blumenthal’s office to create the infrastructure for meaningful use.

After a comment period, the final rule on meaningful use will be released in the spring, Blumenthal said.

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.

“We will be looking for your feedback,” Blumenthal told the assembled association of nearly 2,000 members who attended the conference held at the Hilton San Francisco Union Square this week. “Rulemaking is not the end of the conversation.”

Privacy and security are absolutely critical to the widespread adoption of health IT, Bluementhal said, adding that this is also on top of his agenda. “Without the trust of the public, we will not be successful in getting everything out of the potential of health informatics.”

In the next few months, his office will convene a working group on privacy and security to look at what else is necessary to ensure the public’s trust beyond what is instructed by Congress in the stimulus law, he said.

“We need to be extremely vigilant and aggressive in terms of developing standards around privacy and security,” Blumenthal said.

And his office is moving forward with its first grant programs under the stimulus law. Last summer, Blumenthal announced two grant programs mandated by the stimulus law. The first is $700 million in grants to establish up to 70 health IT regional extension centers nationwide, which will offer technical assistance, guidance and information on best practices to support and accelerate providers’ efforts to become meaningful users of EHRs. The second program offers $560 million in grants to states to develop health information exchange capacities among providers.

The first round of grant recipients will be announced soon, Blumenthal said. HHS received about 90 applications for the first 20 slots in the health IT regional extension center program, he said, adding that he was encouraged by the volume and quality of the grant applications.

“The grants to states, we believe, are another good bet,” he said.

Blumenthal also gave some hints on his office’s plans to develop and announce 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.modernhealthcare.com/apps/pbcs.dll/article?AID=/20091117/REG/311179986/1134