Category — Electronic Medical Records

CMS soon will release modifications for certain provisions in the final rule for Stage 1 of the meaningful use ehr incentive program, Government Health IT reports.

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

Tony Trenkle — director of the Office of e-Health Standards and Services at CMS — said the adjustments to the meaningful use criteria currently are undergoing a federal clearance process, which is the final step before publication. Trenkle spoke on Wednesday during a Health IT Policy Committee meeting.

Trenkle added that CMS also will release guidance for health care providers on how to meet quality measures in the incentive program.

Discussion of Stages 2, 3

During the meeting, the Policy Committee also considered what incentive requirements to include in the next stages of the meaningful use program.

Committee members discussed whether Stage 2 meaningful use requirements — which are expected to go into effect in 2013 — should be incrementally built on requirements from Stage 1, or if there should be a set of larger steps framed around measuring and improving patient outcomes.

Paul Tang — chair of the meaningful use work group and chief medical information officer at the Palo Alto Medical Foundation — said the committee would prefer to establish the Stage 3 goals for 2015 first and then backtrack to form Stage 2 requirements.

Committee member Latanya Sweeney — director of the data privacy lab at Carnegie Mellon University — said future meaningful use criteria should incorporate privacy regulations (Mosquera, Government Health IT, 10/20).

National Coordinator for Health IT David Blumenthal said that the rollout of Stage 1 of the meaningful use criteria “was very rushed” (Conn, Modern Healthcare, 10/21). He added that the next stages should focus on infrastructure and interoperability.

Time Frame

Tang said that the meaningful use work group aims to have draft requirements for Stages 2 and 3 by Nov. 19, adding that it will revise the draft after taking comments from the full Policy Committee.

He said final recommendations could be submitted to the Office of the National Coordinator for Health IT by the third quarter of 2011, while CMS could release a notice of proposed rulemaking on the next stages by the fourth quarter of next year (Manos, Healthcare IT News, 10/21).

Source  :  http://www.ihealthbeat.org/articles/2010/10/21/officials-preparing-adjustments-to-meaningful-use-final-rule.aspx

It was inevitable, given the short timeline and the apparent seat-of-the-pants nature of the rulemaking process, but CMS is preparing a guidance document intended to clarify several details and fix some inconsistencies in the final Stage 1 rule for meaningful use of EMR.

At last week’s meeting of the Health IT Policy Committee’s workgroup on meaningful use, Tony Trenkle, director of the CMS Office of e-Health Standards and Services, said the guidance will provide more detail on the objectives and measures in the rule and “should help clarify issues and help the [committee] plan for recommendations for future stages,” Government Health IT reports. The clarifications should be out “shortly,” Trenkle promised.

Meanwhile, the workgroup is looking ahead to Stage 2 of meaningful use, 2013-14, which will have higher thresholds of compliance than Stage 1, while trying not to deter hospitals and physicians from adopting EMRs. “We want to pay particular attention to smaller practices and hospitals,” workgroup chair Dr. Paul Tang said, according to Government Health IT. “We want to raise the tides but not sink the boats.”

For the next stage, the workgroup likely will attempt to find a happy medium between the initial standards for 2011-12 and the more rigorous requirements for Stage 3, which is set to begin in 2015. For example, Stage 1 requires physicians to write 30 percent of their prescriptions electronically and federal officials ultimately would like to see a 90 percent e-prescribing rate, so expect the Stage 2 standard to be 60 percent.

The Health IT Policy Committee would like to take some of the reporting burden off of providers, so Stage 2 probably will call for EMRs to have more standard and coded data for easier extraction. “”We hope that they are capturing the information as part of patient care and not a separate activity,” Tang said.

Expect the workgroup to have Stage 2 recommendations ready for public consumption by October, and to seek comments on its preliminary plan in December.

Source       :         http://www.fiercehealthit.com/story/cms-developing-meaningful-use-guidance-remove-contradictions/2010-09-27?utm_medium=nl&utm_source=internal

BOSTON – The Physicians Foundation, a national organization that supports the interests of physicians and their patients, announced Tuesday it awarded 15 individual grants in 13 states totaling nearly $2 million for numerous health IT projects that support high quality patient care.

Foundation officials said the grants are particularly relevant given the national push toward digital health records, and that they hope to “shape how those changes are implemented in the months and years ahead.”

“Our country’s healthcare workforce is already overworked, and as the government encourages a large scale move to digital records, that transition is going to have a significant impact on practicing physicians,” said Foundation Board Member Ripley Hollister.  “The Foundation has made HIT a specific focus, because it wants to ensure that the move to digital records and the use of other technologies is made in a constructive, positive fashion – specifically, one that preserves and supports the doctor-patient relationship.”

Projects receiving Foundation support in this round of grants include:

•    “Meaningful Use Achievement Toolkit,” a program to develop and disseminate tools that assist physicians with achieving meaningful use of certified electronic record systems.
•    “HIT in Practice,” a program to develop a series of supports and resources for implementation of electronic health records (EHR) in small practices.
•    Grants for assisting physicians in various states with implementing digital health records.

The health IT grants are part of a larger effort this year by the Physicians Foundation, totaling more than $4.2 million.

“Our fundamental goal in making these grants was simple,” said Lou Goodman the foundation’s president. “We want to help improve the practice environment for physicians so that they can more easily do what matters most to them: spend time taking care of patients.”

Source      :       http://www.healthcareitnews.com/news/physicians-foundation-awards-15-organizations-2m-it-projects

CMS has provided $6.9 million in federal matching funds to Medicaid programs in four states to support their efforts to manage the “meaningful use” incentive payment program, Government Health IT reports.

Background

Under the 2009 economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health records can qualify for incentive payments (Mosquera, Government Health IT, 9/14).

Through the HITECH Act, which contains the health IT provisions of the stimulus package, eligible Medicaid providers can receive as much as 85% of $75,000 — or $63,750 — in incentive payments across six years for meaningful use of ehr systems (McKinney, Modern Healthcare, 9/14).

CMS Funding

The four states that were given funding are:

• Hawaii, which received $836,000;
• Massachusetts, which received $3.56 million;
• North Dakota, which received $226,000; and
• Ohio, which received $2.29 million (Goedert, Health Data Management, 9/14).

In total, CMS has provided $81.44 million in matching funds to:

• 49 states;
• The District of Columbia;
• The U.S. Virgin Islands; and
• Puerto Rico (Modern Healthcare, 9/14).

Territories and states had to submit plans to CMS for approval before receiving matching funds. The four states are the last to receive federal matching funds for Medicaid health IT efforts (Health Data Management, 9/14).

Using the Funds

States will use the funds to take inventory of their existing health IT status, which includes:

• Examining roadblocks to the use of EHRs;
• Determining health care provider eligibility for the incentive payments (Government Health IT, 9/14); and
• Creating a long-term plan for health IT use within the Medicaid program (Health Data Management, 9/14).

Source    :     http://www.ihealthbeat.org/articles/2010/9/15/cms-awards-69m-to-medicaid-programs-for-meaningful-use.aspx

CMS and the Office of the National Coordinator for Health IT are working to ensure that health care providers know how to participate in the soon-to-be launched incentive program for the meaningful use of ehr (electronic health records), InformationWeek reports (Guerra, InformationWeek, 7/26).

Last week, CMS and ONC began hosting a series of training sessions to provide clarification on the newly released final rule on meaningful use and the accompanying final rule on EHR certification.

First Session

For the first session, each agency provided an overview of the EHR incentive program, which was established under the 2009 federal economic stimulus package (CMIO, 7/26). The session focused on:

• Eligibility issues;
• The relationship between the stimulus package and other government incentive programs; and
• How the federal government and states will coordinate the Medicare and Medicaid portions of the incentive program.

Eligible Providers at Multiple Locations

Jessica Kahn, technical director for health IT at CMS, also addressed concerns related to eligible health care providers who practice at multiple locations. She said clinicians who work at several locations but do not have access to certified EHRs at each facility must:

• Have at least 50% of their total patient encounters take place at locations with certified EHR technology; and
• Base all of their meaningful use objectives only on patient encounters that take place at locations with certified EHRs (InformationWeek, 7/26).

Source  :   http://www.ihealthbeat.org/articles/2010/7/27/onc-cms-offer-meaningful-use-and-ehr-certification-guidance.aspx

In a recent survey, 90% of health care leaders said achieving “meaningful use” of Electronic Health Records to qualify for incentive payments made available by the 2009 economic stimulus package was one of their organization’s top two priorities, InformationWeek reports.

CSC, an IT services and consulting firm, surveyed 60 health care executives in June and July about critical concerns and goals. Roughly 50% of respondents were CIOs or IT leaders, while 50% were operational executives including CEOs, CFOs and COOs.

Meaningful Use Results

The survey found that compliance with meaningful use provisions was the top priority for:

• 84% of CIOs and other health IT leaders;
• 67% of all respondents; and
• 48% of non-IT executives.

In addition, 42% of all respondents said helping their networks of owned or affiliated physicians comply with meaningful use rules for ambulatory care EHR systems was their second highest priority.

Other Findings

One-tenth of respondents cited conversion to ICD-10 diagnosis coding by 2013 as their top priority (Kolbasuk McGee, InformationWeek, 7/22).

Two-thirds of respondents plan to participate in a health information exchange. Currently, 11% of respondents said their facilities take part in a statewide exchange (Manos, Healthcare IT News, 7/22).

Source     :     http://www.ihealthbeat.org/articles/2010/7/26/meeting-standards-for-meaningful-use-tops-goals-of-health-leaders.aspx

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 – 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