Category — EMR

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

By, Diana Manos

CHICAGO – Officials of HIMSS Analytics, the not-for-profit subsidiary of the Healthcare Information and management System Society (HIMSS), announced Wednesday they would be adding new questions to their annual study on meaningful use to gauge hospitals’ readiness.

With hospitals expected to complete the first phase of deadlines for meaningful use by 2011 to qualify for bonuses under the American Recovery and Reinvestment Act of 2009, HIMSS Analytics will ask hospitals about their inclusion of structured document standards to convert narrative data to a structured format importable to an electronic medical record (EMR).

HIMSS Analytics tracks the EMR implementation status of more than 5,000 U.S., non-governmental hospitals through its annual study with hospital CIOs. The data gathered provides a detailed look at the clinical and financial application environments in U. S. hospitals.

HIMSS Analytics also developed the Electronic Medical Record Adoption ModelSM - or EMRAM - to score hospitals in the HIMSS Analytics Database on their .progress in completing the eight stages to creating a paperless patient record environment.

“In our evaluation of EMR Adoption Model scores over 2008-2009, we found that hospitals are continuing to advance the care delivery capabilities of their EMR environment,” said John Hoyt, vice president of HIMSS Healthcare Organizational Services.

“ARRA funding incentives are driving EMR implementation,” Hoyt said. “With this expanded arsenal of data, HIMSS Analytics can help healthcare providers better understand and follow the Meaningful Use requirements while moving higher on the EMRAM scale.”

According to Liora Alschuler executive committee representative of the Health Story Project, which helped write the new questions for HIMSS Analytics, much of the information in a patient’s medical record may be entered by the physician or nurse in chart form, such as notes taken during a clinic visit, lab reports or other information that contributes to the completeness of individual health history.

Health Story produces data standards for the flow of information between common types of healthcare documents and electronic medical records, Alschuler said.

Alschuler, principal, at Alschuler Associates, LLC, said the Health Story standards are based on HL7 Clinical Document Architecture reusing templates from the Continuity of Care Document. The Health Story Project, founded a little over two years ago, is a nonprofit collaborative of healthcare vendors, providers and associations.

“The members of Health Story believe that all of the clinical information required for good patient care, administration, reporting and research should be readily available electronically, including information from narrative documents,” Alschuler said. “With the data gathered from the HIMSS Analytics Study, we will know how hospitals are using document standards to enrich the flow of information to their EMRs.”

Officials at HIMSS Analytics said they expect to begin reporting on hospital readiness for meaningful use in September 2010.

Source: http://www.healthcareitnews.com/news/himss-analytics-gauge-hospital-readiness-meaningful-use

Last week, National Coordinator for Health IT David Blumenthal published an open letter touting the Nationwide Health Information Network as a model to help health care providers meet the “meaningful use” requirements of the 2009 federal economic stimulus package, Modern Healthcare reports.

Under the stimulus package, health care providers who demonstrate meaningful use of electronic health records will qualify for Medicare and Medicaid incentive payments (Conn, Modern Healthcare, 5/17).

Blumenthal wrote that NHIN is “not a network per se, but rather a set of standards, services, and policies that enable the Internet to be used for the secure exchange of health information to improve health and health care.”

NHIN Direct

He also acknowledged that some health care providers “may have simpler needs for information exchange, or perhaps less technically sophisticated capabilities.” He said such health care providers could benefit from NHIN Direct, which still is under development (Blumenthal letter, 5/14).

NHIN Direct is a basic version of NHIN that offers health care providers open-source software to develop a network for the electronic transmission of health information (Modern Healthcare, 5/17).

Blumenthal wrote that NHIN Direct “is meant to enhance, not replace, the capabilities offered by other means of exchange.” He added that the model could “complement existing NHIN exchange capabilities and strengthen our efforts toward comprehensive interoperability across the nation” (Blumenthal letter, 5/14).

In addition, Blumenthal wrote that ONC is “on an aggressive timeline” to develop standards for NHIN Direct so health care providers can use the framework to qualify for incentive payments.

He also called for greater public participation in the NHIN Direct project through blogs and a community wiki, which are available on the project’s website (Modern Healthcare, 5/17).

Above article publish on http://www.ihealthbeat.org/articles/2010/5/17/blumenthal-nhin-nhin-direct-offer-paths-to-meaningful-use.aspx

By Joseph Conn

The CMS has announced the awarding of a total of just over $9 million in matching funds to be used by four states to plan for their Medicaid programs to subsidize provider purchases and the use of electronic health-record systems under the American Recovery and Reinvestment Act of 2009, also known as the stimulus law.

The states and their grant amounts are: New Jersey, $4.93 million; Louisiana, $1.85 million; Maryland, $1.37 million; and Minnesota, $1.04 million.

Since November 2009, 39 states, Puerto Rico and the U.S. Virgin Islands have shared nearly $67.6 million in planning grants, according to news release information on the CMS website.

The stimulus law provides a 90% federal match to cover the cost of state planning efforts for the Medicaid EHR subsidy programs. According to federal estimates, the government estimates it could spend as much as $27.3 billion on the EHR subsidies under Medicaid, Medicare and Medicare Advantage programs.

Above article publish on http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20100511/NEWS/100519988

By Liv Osby

Stimulus money to the tune of $5.6 million was awarded to Health Sciences South Carolina with a goal of getting 1,000 primary care doctors in the state to adopt the new electronic medical records system.

The funds will be used to set up a regional program called the Center for Information Technology Implementation Assistance. HSSC worked with the state Department of Health and Human Services to develop a statewide strategy for forging ahead with EMR.

“CITIA-SC will play a key role in supporting medical professionals throughout the state as they adopt and expand health information technologies in their practices,” said DHHS Director Emma Forkner.

DHHS spokesman Jeff Stensland said the University of South Carolina estimates about 60 percent of physician practices and 42 percent of hospitals have fully-integrated EMRs.

DHHS recently got a $9 million grant for its statewide health information exchange, which gives hospitals, doctors, clinics and other health care providers access to medical records.

HSSC is a partnership between universities and hospitals in the state to foster economic growth and improve health.

Above article publish on http://www.greenvilleonline.com/article/20100426/NEWS/304260003/1004/NEWS01/Medical-records-system-benefits–from-stimulus-funds-

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

The Health IT Standards Committee’s implementation work group is considering the development of an online collection of resources to help health care providers and vendors meet proposed “meaningful use” criteria for electronic health records, Government Health IT reports.

Earlier this year, CMS published a notice of proposed rulemaking describing how health care providers can demonstrate meaningful use of certified EHRs to qualify for incentive payments under the 2009 federal economic stimulus package.

At a recent work group meeting, health care providers asked for more guidance on how to comply with the meaningful use rules.

Aneesh Chopra — chair of the panel and U.S. Chief Technology Officer — said the work group could generate a digital library that would enable health care providers to access details about requirements for each meaningful use provision.

He said the panel’s blog could serve as an initial source of information. He added that the work group also could pass along user feedback to the Office of the National Coordinator for Health IT.

The work group is scheduled to offer recommendations to the full Standards Committee on April 28. The panel might propose a formal resource Web site as part of its recommendations (Mosquera, Government Health IT, 3/31).

Above article publish http://www.ihealthbeat.org/articles/2010/4/1/panel-mulls-creation-of-resource-web-site-for-meaningful-use-rules.aspx

On Thursday, CMS awarded federal stimulus funding to six state Medicaid programs for planning activities related to the implementation of an electronic health record incentive program, AHA News reports.

Under the American Recovery and Reinvestment Act of 2009, states can receive a 90% federal match for planning activities to:

• Administer EHR incentive payments to Medicaid providers;
• Ensure proper payments through audits; and
• Promote interoperability and “meaningful use” of EHRs (AHA News, 3/25).

According to CMS’ announcement of the awards:

• Colorado will receive $798,000;
• Mississippi will receive $1.47 million;
• Nevada will receive $1.05 million;
• North Carolina will receive $2.29 million;
• Utah will receive $396,000; and
• Wyoming will receive $596,000 (Monegain, Healthcare IT News, 3/25).

Since November, CMS has awarded matching funds to 32 states and territories (AHA News, 3/25).

Above article publish on http://www.ihealthbeat.org/articles/2010/3/26/six-states-get-federal-matching-funds-for-ehr-incentive-programs.aspx

By, Rich Silverman

Massachusetts, long a leader in the delivery of quality medical care to its citizens, has just received more than $24 million from the federal government to speed the adoption of electronic medical records (EMRs) throughout the Commonwealth.

According to a report in govmonitor .com, the Office of the National Coordinator (ONC) has authorized the release of the $24 million, the maximum that Massachusetts is entitled to under the American Recovery and Reinvestment Act (ARRA) of 2009. According to the report, $13.4 million will go to support the adoption of EMRs throughout the Commonwealth, and another $1.6 million will go toward creating a statewide high-speed communications system for medical data and records.

According to Massachusetts Governor Deval Patrick, “This federal funding will help reduce health care costs and improve patient care using proven technologies, many of which are developed right here in Massachusetts.” Lieutenant Governor Timothy Murray added that in addition to streamlining health care, the money would help create jobs.

The grants, given in furtherance of the adoption of EMRs, will be administered by the Massachusetts e-Health Institute, the state agency created for that purpose. One if its key goals, according to an article in MassHighTech.com, will be to ensure the privacy of all medical records in the state.

Couple the release of this funding with recent news that meaningful use has finally been defined and that ONC is taking definitive steps to develop a certification, and it looks like providers in Massachusetts are finally getting the tools they need to fully implement EMRs.

Above article publish on http://blog.pchealthstop.com/?p=849