Category — Electronic Medical Records

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

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

By Neil Versel

Dr. David Blumenthal has been national coordinator for health information technology for a little more than six months now, and for all the health IT meetings I go to, teleconferences I listen in on and webinars I participate in, Wednesday was the first time I’d had the opportunity to hear him speak.

In delivering the opening keynote to the College of Healthcare Information Management Executives (CHIME) Fall CIO Forum in Indian Wells, Calif., Blumenthal didn’t break a whole lot of new ground, but he did bring the national EMR strategy into sharper focus, give an update on some progress within the federal government, demonstrate his deep passion for healthcare quality improvement, and even put the vendor community on notice. (See the story in this week’s issue for more on his vendor-related comments.)

“You all are the very core of our success,” Blumenthal told this gathering of CIOs in the California desert. It was nothing they didn’t already know. He did say, however, that even without the healthcare reform being debated in Washington right now, the HITECH Act–the health IT portion of the American Recovery and Reinvestment Act–still is “unprecedented” in the scope of change it will effect.

Blumenthal highlighted four things that flow from HITECH: “meaningful use” of EMRs–something we all know about; the Health IT Policy Committee and Health IT Standards Committee to advise HHS; privacy and security of health data, symbolized by the tightening of HIPAA; and, of course, the federal subsidy program. Blumenthal believes that the last point probably gets more attention than it deserves. “There’s the money, which is important, but it isn’t the whole thing,” he said.

“What Congress has basically asked us to do with this legislation is to change the practice of medicine,” Blumenthal said. “It’s really a matter of change management rather than technology.”

Blumenthal is prohibited by federal ethics standards from discussing deliberations on the forthcoming parameters for meaningful use, but he reiterated that a proposed rule will be out by the end of the year, and that HHS is still on target to finalize the definition next spring, following a 60-day public comment period on the proposal. He also said that his office is talking with other federal agencies with experience encrypting and securing sensitive electronic data, something that will be hugely important in healthcare as more patient information is computerized.

Blumenthal added that the health IT extension centers will be modeled after the long-established USDA Agricultural Extension Service. “This is all about technology transfer from government to industry,” he said. He also called on the hundreds of healthcare CIOs in attendance to provide leadership and educate hospital CEOs about the importance of

Above article published on http://www.fierceemr.com/story/blumenthal-doesnt-tip-hand-meaningful-use-highlights-non-financial-aspects-arra/2009-10-29#ixzz0WdXFxKVB

The Social Security Administration has set aside $24 million to expand a program under which it contracts with hospitals and health information exchanges willing to electronically share electronic health data on patients seeking disability benefits.

Each year, SSA makes more than 15 million patient-authorized requests for medical information from treating providers, but most of this exchange is paper based and as such is very inefficient, SSA officials say. They’re hoping the use of health IT will greatly improve the process.

SSA is looking for a provider willing to link to the agency via local HIEs and the Nationwide Health Information Network. Contracts for the project, proposals for which are due Sept. 18, will be funded through the stimulus law.

Using the NHIN, providers will get a standardized electronic request for medical records along with a patient’s authorization. Providers will then be able to automatically respond to SSA requests with a standardized Continuity of Care Document.

To be eligible for the project, providers must use a certified electronic health record app and be able to demonstrate the technical ability to create a sample Continuity of Care Document with de-identified EMR information.

Above article published on http://www.fiercehealthit.com/story/social-security-budgets-24m-exchange-health-data-hospitals-and-hies/2009-08-10

Health and Human Services Secretary Kathleen Sebelius released a report Thursday on how information technology can improve healthcare for Americans living in rural communities.

The report examines how the Columbia Basin Health Association in Othello, Wash., uses IT to improve healthcare quality and patient safety as well as promote care coordination and continuity.

“The Columbia Basin Health Association is just one place in America where health information technology and electronic health records have helped ensure patients get better care,” said Sebelius. “Health information technology can reduce paperwork, make care more efficient and let doctors spend more time practicing medicine and less time filling out forms.”

The CBHA provides 25,000 patients with access to a variety of medical, dental, prescription and other services at four sites and was one of the first health centers in the United States to fully transition from paper-based charts to an electronic health record system.

In response to the growing prevalence of diabetes in rural communities, the CBHA used its EHR system to track 1,302 diabetic patients, monitoring whether they received recommended exams and providing feedback to healthcare providers on their performance.

In January 2008, 31 percent of patients at the CBHA had received a foot exam and 37 percent had received an eye exam during the previous year. By June 2008, 86 percent of patients had received a foot exam and 63 percent had received an eye exam over the previous year.

According to the report, since the CBHA’s implementation of EHRs, the community health center has consistently ranked above the 95th percentile nationally in total medical and dental team productivity.

Approximately 65 million Americans live in communities with shortages of primary care providers and nearly 50 million live in rural areas. Sebelius said health information technology, and specifically EHRs, can improve care for patients and assist in clinical decision-making and the use of evidence-based guidelines. EHRs can also decrease administrative hassle, increasing workplace satisfaction and productivity.

The American Recovery and Reinvestment Act encourages greater use of health information technology through significant new investments, Sebelius said. Through incentive payments to providers and hospitals, she said, the ARRA will accelerate the adoption of health information technology and creation of an interoperable, nationwide network, and health insurance reform will build on this investment by simplifying and streamlining administrative procedures, investing in telehealth and improving the quality of healthcare.

Above article published on

http://www.healthcareitnews.com/news/hhs-secretary-speaks-power-healthcare-it-rural-communities

Diana Manos, Senior Editor

The HIT Policy Committee is holding a hearing today in Washington, D.C. to discuss the privacy aspects of healthcare IT found in the American Recovery and Reinvestment Act (ARRA).

Jodi Daniel, director of the Office of Policy and Research at the Office of the National Coordinator for Health IT (ONC), who opened the meeting this morning, said privacy and security are fundamental building blocks for meaningful use of healthcare IT.

“The success of health information technology and exchange rests on consumer and provider confidence in privacy and security protections,” she said.

Daniel outlined the key privacy aspects found in ARRA. The HIT Policy Committee is responsible for advising the federal government on:

• Technologies that protect the privacy of health information and promote security in an electronic health record;
• Segmentation and protection from disclosure of specific and sensitive individually identifiable health information with the goal of minimizing the reluctance of patients to seek care;
• Use and disclosure of limited data sets;
• Infrastructure that allows for accurate exchange;
• Technologies for an accounting of TPO (treatment, payment and health operations) disclosures;
• Technologies that allow IIHI to be rendered unusable, unreadable or indecipherable to unauthorized individuals; and
• Methods to facilitate secure access to personal health information by an individual or person assisting in care.

ONC officials proposed a breach notification rule in April, with a final rule out in August. The rule will be effective Sept. 23 with a comment period closing Oct. 23, Daniel said.

Deborah Peel, a national expert on patient healthcare IT privacy, was the first to testify today on patient privacy. “Millions of Americans are concerned about the control of their personal data,” she said. She said ensuring data privacy and security is the only way that healthcare IT can move forward successfully.

Peel said privacy should have been established before policy on healthcare IT.

Above article published on

http://www.healthcareitnews.com/news/hit-policy-committee-holds-privacy-hearing-today

By Sue Hildreth

Consistent Processes, Performance Metrics and Quantifiable Patient Benefits are Long-Term Goals

Many in healthcare and government want to see the wide gap in IT capabilities closed and more providers moved to adopt electronic health records (EHR) systems in order to improve the healthcare industry’s ability to transmit, share and access critical patient data when and where it is needed.

EHR applications range from simple electronic patient charts with demographic data, problem lists and medication lists, to integrated intra-hospital networks with access to diagnostic images, e-prescribing, physician notes, and decision support tools to alert physicians and nurses to potential errors or omissions, and to advise them on the best practices.

Proponents claim EHR not only improves patient safety but can save hospitals – and potentially the U.S. healthcare system – millions of dollars.

Skeptics claim EHR benefits are overrated, and point to the high cost of EHRs, which typically run in the millions of dollars, and to past implementation failures – such as LA’s Cedars-Sinai Medical Center and its failed attempt to get its physicians to adopt a computerized physician order entry system in 2003 – as proof that EHRs may not be right for all healthcare providers.

To be sure, EHR isn’t a cure-all for the healthcare industry’s ills, and the up-front costs of adoption are significant. Neither is the risk of failure miniscule. But that can be said of all major enterprise software projects. The adoption of electronic healthcare records does have the potential to significantly reduce paperwork and administrative overhead, reduce the cost of housing massive paper archives, and improve the speed and accuracy of medical care.

Table 1: Examples of EHR’s ROI by Annual Cost Reduction

Why Healthcare Needs the American Recovery and Reinvestment Act and EHR

The American Hospital Association reported in November that hospitals responding to a DATABANK survey were, on average, $831.5 million in the red in the third quarter of 2008. Cost cutting measures they were making included reducing administrative costs, laying off staff, and reducing services.

EHRs can help improve efficiency of operations and capture more of the patient services that doctors and nurses provide, thus enabling more complete billing (or overcharging, depending on who is arguing the issue).

Government has been looking at ways to encourage the adoption of e-prescribing and other electronic systems by healthcare providers for several years already. The Obama administration’s signing of the American Recovery and Reinvestment Act (ARRA), with its $19 billion in stimulus funds for healthcare IT, is the most expansive effort to date. It includes a menu of grants to states, Medicare and Medicaid incentives for hospitals and physician practices, and a timetable for imposing penalties for non-adopters of EHR after 2015.

Barriers and Obstacles to Adoption

The cost of software and implementation services is by far the biggest obstacle to adoption for both hospitals and physicians’ clinics. A small hospital might pay $3 million for an EHR system, while physicians’ electronic records software costs, on average, $35,000 to $50,000 per physician. So a ten-physician clinic is looking at a half million dollar investment. That is a significant investment at a time when providers are feeling squeezed financially at both ends – by the insurance payers, both private and Medicare/Medicaid, and by rising operating costs such as malpractice insurance and billing and administrative costs.

Physician reluctance to adopt IT – both in their own practices and in hospitals – is another major factor. Doctors who do take the plunge may wind up frustrated by poorly designed user interfaces or applications that lack the features they most need. Both hospitals and physicians are often handicapped by a lack of knowledge of EHR and may not know how to evaluate products or adequately map out all of the factors in the implementation.

Access to financing, as well as an investment in outside consulting help in selecting an EHR and mapping out the migration, increase the odds of a successful outcome.

Moving From EHR to HIE

Because healthcare providers rarely have the same EHR system, integration between providers in a state or region is being addressed by healthcare information exchanges (HIEs). At the end of 2008, there were 42 operational healthcare information exchanges and another 36 in the process of implementation. If most of those 36 became operational this year, there are now over 75 exchanges in the U.S., with dozens more in the planning. A few have also closed up shop, typically due to lack of financial support and interest on the part of participating hospitals.

Patient safety is one motivation for regional hospitals to collaborate on an exchange, and gaining efficiencies in their operations is another. Given that the typical patient today may see a dozen different providers of healthcare services – laboratories, diagnostic centers, nursing centers, mental health clinics, specialists, and physical therapy clinics, to name a few – integration across such a diverse group would be prohibitively costly and time consuming if done with point-to-point integration. An exchange that provides one or more standard methods for integrating with it means that a provider needs to integrate just once, to the exchange, rather than dozens of times.

Physician clinics and hospitals which obtain test results via an exchange save themselves the time and administrative costs of waiting for a fax or courier, and routing the documents to the appropriate department or physician. With electronic delivery of results and patient data from outside providers, caregivers can more quickly, effectively and efficiently care for patients.

For hospitals, exchanges also help ease integration between them and their affiliated physicians. Some hospitals have offered free EHRs to their doctors, in an attempt to improve information flow. Not all doctors opt to use the hospital’s system, however, and an HIE alleviates the need to construct point-to-point integrations between hospital EHRs, physicians’ electronic records applications.

Our Assessment

A basic EHR application that meets federal certification requirements will be a necessary investment for all hospitals. However, hospitals should resist the rush to purchase and implement EHR in order to meet federal deadlines and take the time needed to carefully evaluate, test and implement the best application for the needs of the medical staff. Even with the clock ticking on the Medicare incentives, a precipitous purchase of the wrong EHR would wind up being a much more costly move then missing a year of incentives.

At the same time, the government has made it clear that all but the most cash-strapped rural hospitals and clinics will be expected to be using EHR within the next few years or face real financial penalties – up to a 3% reduction in Medicare payments. While these penalties may wind up being delayed, there is no good reason for most healthcare providers not to be evaluating EHR products with an eye to adoption in 2010 or 2011 at the latest.

While the Medicare and Medicaid incentive payments won’t provide for the initial cost of an EHR implementation, AARA does include monies for state loan programs, and other federal and state grants and loans are available for healthcare IT adoption. Also, more EHR vendors are likely to be willing to provide low-interest loans or payment plans for healthcare providers, so that their customers can use the ARRA incentives to pay them back in the future. Healthcare providers which already have an EHR system will qualify for incentives, but only if those systems meet the government’s requirements. So this is the time to begin evaluating upgrade possibilities to ensure the system is compliant.

Above article published on

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By Gautham Nagesh

The Centers for Medicare and Medicaid Services will reimburse states that issue incentive payments to health care providers to encourage adoption of electronic medical records, according to guidance released on Sept. 1.

A letter from CMS Director Cindy Mann to state Medicaid directors details a program under the 2009 American Recovery and Reinvestment Act that offers financial incentives for eligible Medicare and Medicaid providers to adopt interoperable electronic health records. Approximately $20 billion will be distributed to providers by 2014, mostly in the form of grants.

The payments will help defray the costs of deploying electronic health record systems and can be used to pay for hardware, software, support services and training. But the grants will not necessarily cover the entire cost of installing such systems.

“The incentive payments are not direct reimbursement for such activities. Rather they are intended to serve as an incentive for eligible providers to adopt and meaningfully use certified EHR technology,” Mann said in her letter.

The funds can be used only for electronic health records technology that is certified and interoperable with state or federal administrative management systems.

“Therefore, states risk making unallowable incentive payments prior to receiving guidance on how to make these systems compatible,” Mann wrote.

States are immediately eligible to request 90 percent reimbursement for administrative costs associated with planning and issuing the payments. But that money comes with significant conditions attached. For administrative reimbursement, states must obtain prior approval from CMS for any planning activities or expenditures. They also must provide documentation demonstrating adequate oversight of their incentive programs.

Under the Recovery Act payments would be limited, based on average costs of setting up electronic health record systems, which have yet to be determined. Mann said the secretary of Health and Human Services will establish guidance on those limits.

CMS plans to issue a proposed rule by the end of the year that will contain more detailed information, and will work with states to determine when they are ready to begin issuing payments.

Above article published on

http://www.nextgov.com/nextgov/ng_20090904_7905.php?oref=topnews