Category — EMR

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

CMS must pay special attention to ensure that the final version of the proposed “meaningful use” rule for electronic health records fits with other rules for standards and certification, as well at the interim final rule for the certification of EHRs, 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.

The Office of the National Coordinator for Health IT also published an interim final rule describing required certification standards for EHR technology.

Tony Trenkle, CMS director of e-health and standards, recently stressed how the interplay between different regulations will be important in determining what health care providers will need to demonstrate to qualify for the incentive payments.

ONC policy analyst Steve Posnack said that CMS and ONC are coordinating their regulations to ensure that the standards set for determining meaningful use are in step with rules governing certification of EHRs (Mosquera, Government Health IT, 3/18).

Above article publish on http://www.ihealthbeat.org/articles/2010/3/19/cms-aims-to-coordinate-meaningful-use-rules-with-other-regulations.aspx

Final awards of state health information exchange cooperative agreement program work to build health information exchange infrastructure throughout the states

U.S. Department of Health and Human Services Secretary Kathleen Sebelius today announced awards to help states facilitate health information exchange and advance health information technology (health IT).  Funded by the American Recovery and Reinvestment Act of 2009, today’s  awards are part of the $2 billion effort to achieve widespread meaningful use of health IT and provide use of an electronic health record by every citizen by the year 2014.  Every state and eligible territory has now been awarded funds under this program.

“These critical investments will help unleash the power of health information technology to cut costs, eliminate paperwork, and help doctors deliver high-quality, coordinated care to patients,” said Secretary Sebelius. “States are important partners in improving and expanding our electronic health records system.  By improving the secure exchange of electronic health records between providers and hospitals within and across states, these awards mark a significant step in bringing our health system into the 21^st century.”

The health information exchange HIE awards announced today provide approximately $162 million to 16 states and qualified state designated entities (SDEs) to facilitate non-proprietary health information exchange that adheres to national standards.  Health information exchange is critical to enabling care coordination and improving the quality and efficiency of health care.

“Today’s announcement of awards to 16 states and SDEs marks a significant milestone with all states now empowered to start their journey towards identifying innovative ways to break down theses barriers that prevent the seamless exchange of information, so that we can give patients the access to care they deserve and expect,” stated Dr. David Blumenthal, national coordinator for health information technology.  “States play a critical leadership role in advancing the development of the exchange capacity of healthcare providers and hospitals within their states and across the nation. Health information exchange will enable eligible healthcare providers to be deemed meaningful users of health IT and receive incentive payments under the Medicare and Medicaid electronic health record (EHR) incentive program.”

These cooperative agreements were awarded under the authority of Title XIII of ARRA, the Health Information Technology for Economic and Clinical Health (HITECH) Act which amends Title XXX of the Public Health Service Act by adding Section 3013, State Grants to Promote Health Information Technology. Section 3013 provides for the awarding of competitive grants to promote health information technology.  On February 12, 2010, HHS awarded $385 million to 40 states and SDEs.  The awards announced today complete the awarding of cooperative agreements funded by this program.

A listing of the state HIE competitive agreements announced today follow:

Additional information about the state HIE program may be found at http://healthit.hhs.gov/portal/server.pt?open=512&objID=1488&parentname=CommunityPage&parentid=2&mode=2&in_hi_userid=10741&cached=true

And http://www.whitehouse.gov/the-press-office/sebelius-solis-announce-nearly-1-billion-recovery-act-investment-advancing-use-heal

Above article publish on http://www.hhs.gov/news/press/2010pres/03/20100315a.html

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

On December 30, 2009, the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) at the Department of Health and Human Services issued proposed regulations on the definition of “meaningful use” and the initial set of standards, implementation specifications, and certification criteria for EHR technology.

This announcement was made in conjunction with the publishing of two separate documents and a request for public comments:

Health Information Technology Initial Set of Standards, Implementation

Medicare and Medicaid Programs; Electronic Health Record Incentive Program

Beginning on page 32 of the “Medicare and Medicaid Programs: Electronic Health Record Incentive Program” document, a definition of “meaningful use” is provided along with associated discussions such as definition background and definition considerations.

Both documents discuss the proposed stages of “meaningful use”:

Stage 1 (beginning in 2011): The proposed Stage 1 meaningful use criteria “focuses on electronically capturing health information in a coded format; using that information to track key clinical conditions and communicating that information for care coordination purposes (whether that information is structured or unstructured, but in structured format whenever feasible); consistent with other provisions of Medicare and Medicaid law, implementing clinical decision support tools to facilitate disease and medication management; and reporting clinical quality measures and public health information.”

Stage 2 (beginning in 2013): CMS has proposed that its goals for the Stage 2 meaningful use criteria, “consistent with other provisions of Medicare and Medicaid law, expand upon the Stage 1 criteria to encourage the use of health IT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible, such as the electronic transmission of orders entered using computerized provider order entry (CPOE) and the electronic transmission of diagnostic test results (such as blood tests, microbiology, urinalysis, pathology tests, radiology, cardiac imaging, nuclear medicine tests, pulmonary function tests and other such data needed to diagnose and treat disease). Additionally we may consider applying the criteria more broadly to both the inpatient and outpatient hospital settings.”

Stage 3 (beginning in 2015): CMS has proposed that its goals for the Stage 3 meaningful use criteria are, “consistent with other provisions of Medicare and Medicaid law, to focus on promoting improvements in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to self management tools, access to comprehensive patient data and improving population health.”

Pages 51 through 61 of the “Health Information Technology Initial Set of Standards, Implementation” document provide Stage 1 “meaningful use” objectives in a table alongside corresponding certification criteria to support the achievement of “meaningful use” Stage 1 by eligible professionals and eligible hospitals. In reading this table, keep in mind the provided definition of “EHR module”:

EHR Module: any service, component, or combination thereof that can meet the requirements of at least one certification criterion adopted by the Secretary

The following note is provided alongside examples of EHR modules:

While the use of EHR Modules may enable an eligible professional or eligible hospital to create a combination of products and services that, taken together, meets the definition of Certified EHR Technology, this approach carries with it a responsibility on the part of the eligible professional or eligible hospital to perform additional diligence to ensure that the certified EHR Modules selected are capable of working together to support the achievement of meaningful use. In other words, two certified EHR Modules may provide the additional capabilities necessary to meet the definition of Certified EHR Technology, but may not integrate well with each other or with the other EHR technology they were added to. As a result, eligible professionals and eligible hospitals that elect to adopt and implement certified EHR Modules should take care to ensure that the certified EHR Modules they select are interoperable and can properly perform in their expected operational environment.

Pages 79 through 81of the “Health Information Technology Initial Set of Standards, Implementation” document elaborate on this interoperability requirement for patient summary records, drug formulary checks, electronic prescribing, administrative transactions, quality reporting, submission of lab results to public health agencies, submission to public health agencies for surveillance or reporting, and submission to immunization registries. Page 85 outlines adopted privacy and security standards for Certified EHR Technology, and the document distinguishes these standards from those associated with HIPAA.

With a combined total of nearly-700 pages, the two documents discussed here necessitate a thorough review that will take some time to digest. This post simply provides an initial level of awareness that these documents have been published.

Above article publish on http://nvisia.com/techs/?p=364

Last week, CMS released proposed regulations defining the “meaningful use” of electronic health records, Reuters reports (Wutkowski/Heavey, Reuters, 12/31/09).

In addition, the Office of the National Coordinator for Health IT released an interim final rule describing the required certification standards for EHR technology (Simmons, HealthLeaders Media, 12/31/09).

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

Officials will offer a 60-day public comment period after both regulations are published in the Federal Register on Jan. 13. The interim final rule on EHR certification is scheduled to take effect 30 days after publication (Goedert, Health Data Management, 12/30/09).

Phased Approach to Meaningful Use

CMS’ plan proposes phasing in meaningful use requirements over three stages between now and 2013.

The first stage of the meaningful use criteria emphasizes:

• Collecting electronic health data in coded formats;
• Implementing clinical decision support tools;
• Reporting clinical quality measures and public health data; and
• Using EHR data to track conditions and coordinate care (Monegain, Healthcare IT News, 12/30/09).

The criteria call for physicians to submit at least 80% of their orders electronically and for hospitals to submit at least 10% of orders electronically. The proposed rules also call for health care providers to use EHRs to check for potential drug interactions (Perrone, AP/San Francisco Chronicle, 12/30/09).

In addition, the rule requires health care providers to provide patients with electronic copies of their medical records within 48 hours of a request (Hensley, “Shots,” NPR, 12/31/09).

A list of Stage 1 criteria for physicians and a list of Stage 1 criteria for hospitals are available from Healthcare IT News (Healthcare IT News, 12/30/09).

The Stage 2 criteria are expected to focus on structured data exchange and continuous quality improvement. CMS is scheduled to release the second phase criteria by the end of 2011.

The Stage 3 criteria are expected to center on advanced decision support and population health. CMS is scheduled to publish the third phase criteria by the end of 2013.

Certification Criteria for EHRs

ONC’s interim final rule outlines the technical standards and features that EHR systems must include to receive certification for meaningful use.

The rule includes:

• Standard formats for clinical summaries and prescriptions;
• Standard terms to describe clinical problems, laboratory tests, medications and procedures; and
• Standards for secure transmission of online data.

The rule focuses solely on standards for certified EHRs. Later in 2010, ONC is scheduled to release additional guidance on the process for EHR certification.

Reduced Budget for Incentive Payments

When federal officials released the two new regulations, they also announced that the government might distribute less money than anticipated for the incentive payment program.

Initially, the Congressional Budget Office estimated that total federal incentive payouts could reach $34 billion (Mosquera, Government Health IT, 12/30/09).

However, officials last week said the outlays are likely to range from $14.1 billion to $27.3 billion.

They added that the government might pursue further budget revisions after evaluating the popularity of the incentive payment program (Schulte/Schwartz, Huffington Post Investigative Fund, 12/30/09).

Above article publish on http://www.ihealthbeat.org/articles/2010/1/4/officials-announce-meaningful-use-ehr-certification-criteria.aspx