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

In a comment letter sent Friday, the College of Healthcare Information Management Executives stressed the importance of ensuring that the electronic health record certification process can adequately handle the demand to certify EHR systems, Healthcare IT News reports (Merrill, Healthcare IT News, 4/30).

CHIME also said EHR systems that receive certification under the temporary certification program being established this year should be able to have that certification carry over to the permanent program that will be established in 2012 (Goedert, Health Data Management, 4/30).

The comments are in response to the Office of the National Coordinator for Health IT’s Notice of Proposed Rulemaking on EHR certification.

CHIME also recommended that ONC:

• Ensure that the certification program has the capacity to handle demand;
• Focus on EHR certification before expanding to other technologies (Healthcare IT News, 4/30);
• Provide details on how it will coordinate the EHR testing and certification process with the National Institute of Standards and Technology;
• Explain what constitutes a self-developed EHR;
• Require vendors to disclose what functions their products are certified to perform and any known compatibility issues; and
• Give vendors adequate time to recertify their products if a certifying body loses its authority to certify products (Health Data Management, 4/30).

Above article publish on http://www.ihealthbeat.org/articles/2010/5/3/chime-offers-input-on-electronic-health-record-certification-plans.aspx

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

Yesterday, Reps. Patrick Kennedy (D-R.I.) and Tim Murphy (R-Pa.) introduced a bill (HR 5025) that would allow behavioral, mental health and substance abuse treatment providers to qualify for incentive payments for the “meaningful use” of electronic health records, Healthcare IT News reports.

Under the 2009 federal economic stimulus package, hospitals and physicians who demonstrate meaningful use of EHRs can qualify for incentive payments through Medicaid and Medicare.

The new Health Information Technology Extension for Behavioral Health Services Act of 2010 would extend eligibility for the incentive payments to:

• Behavioral and mental health professionals and clinics;
• Substance abuse professionals and treatment facilities;
• Psychiatric hospitals; and
• Licensed psychologists and clinical social workers (Merrill, Healthcare IT News, 4/16).

Above article publish on http://www.ihealthbeat.org/articles/2010/4/16/bill-would-expand-eligibility-for-meaningful-use-incentives.aspx

By Mike Miliard

CLEVELAND – Case Western Reserve University (CWRU) School of Medicine has received nearly $8 million in federal stimulus money from the Ohio Health Information Partnership (OHIP), the state designated entity for health information exchange development. That funding will position the school as a regional extension center (REC), allowing it to help 1,765 healthcare providers in Lorain, Cuyahoga, Lake, Geauga and Ashtabula counties advance the use of health IT in their practices.

The CWRU School of Medicine is one of seven RECs in Ohio established by OHIP and made possible by funding from the American Recovery and Reinvestment Act (ARRA). An eighth REC was awarded directly by the federal government to HealthBridge, a not-for-profit health information exchange serving Greater Cincinnati and surrounding areas.

The federal and state initiative is providing smaller primary care practices with an incentive to early adoption of health information technology.

“Electronic health records tend to be financially out of reach for private practitioners and small practices,” said Julie Rehm, senior associate dean of the CWRU School of Medicine and associate vice president of strategic initiatives for CWRU. “If healthcare providers adopt early they are eligible for additional reimbursement from the Centers of Medicare and Medicaid Services until 2011. After that, the reimbursement declines and penalties kick in starting in 2015.”

The REC endeavor, as directed by the federal government, is targeted towards primary care providers, specifically, physicians—MDs or DOs who are family physicians, general internal, pediatric or OB/GYN, and other primary care providers such as nurse practitioners, nurse midwives, or physician assistants with prescriptive privileges and practicing in one of the previously mentioned areas.

The CWRU School of Medicine will provide administration and management to multiple contractors whose roles will vary by expertise but overall will help providers select products and provide training on how to use the technology to its fullest potential in order to improve patient care. This includes providing workforce support, implementation and project management, practice and workflow design, vendor selection, privacy and security best practices, progress towards meaningful use, functional interoperability and health information exchange.

The CWRU REC has a number of stakeholders, including University Hospitals, the Cleveland Clinic and Massachusetts eHealth Collaborative. In addition, the entities likely to participate in the CWRU REC include Kaiser Permanente, Medical Mutual of Ohio and CareSource.

“The School of Medicine is committed to improving the health of our community,” said Pamela B. Davis, MD, dean of the School of Medicine and vice president for medical affairs, CWRU. “We believe that HIT is a key tool in healthcare reform and we look forward to partnering with independent healthcare providers to encourage quick adoption of HIT. Once enabled, HIT provides a two-fold benefit: 1) improving patient care, for example, through electronic alerts that notify healthcare providers of a patient’s need for annual testing e.g., mammograms, and 2) by lowering healthcare costs by reducing redundant testing.”

The Case Western Reserve REC is expected to begin work sometime this month.

“Success for the CWRU REC will be measured in three ways,” said Rehm. “First, we must meet the milestones and metrics that are being asked of us by the federal government. Second, we must enable the earliest adoption possible which will allow primary care providers to pull in the maximum amount of federal dollars from reimbursements. And third, we must improve the quality of care through the utilization of this technology which will ultimately improve the health of Clevelanders.”

Above article publish on http://www.healthcareitnews.com/news/case-western-reserve-help-providers-adopt-ehrs-ohio

According to recommendations from a large collaboration of organizations, the success of the new federal incentives program for health information technology (“HIT”) largely depends on a specific set of health improvement goals, a prioritized set of metrics, and the widespread participation of health care providers and patients.

Health care leaders from 56 different organizations filed a joint public comment on the program, which is part of the economic stimulus in the American Recovery and Reinvestment Act (“ARRA”). The Markle Foundation, the Center for American Progress, and the Engelberg Center for Health Care Reform at Brookings coordinated the collaborative comments on the Centers for Medicare & Medicaid Services’ Notice of Proposed Rulemaking for the Electronic Health Record Incentive Program.

The joint public comment recommends priorities to the U.S. Department of Health and Human Services (“HHS”), which will manage the new Medicare and Medicaid subsidies to doctors and hospitals for “meaningful use” of HIT starting in 2011.

The comment requests that HHS make clear a set of health improvement goals such as improving medication management and reducing readmissions to hospitals, so that everyone can contribute to these priorities.

Peter Basch, MD, senior fellow at the Center for American Progress, said: “As a practicing physician who has gone through the process of implementing health IT, I can say that it’s critical to set a bar that is ambitious but also achievable for the many diverse practices and hospitals that might participate in this program. We point out areas in which HHS can lower burdens on physicians without losing focus on the important goals of using health IT in ways that improve the patient’s experience and outcomes.”

Among other things, the collaborative letter stressed that the HIT program should encourage broad participation of providers by prioritizing the requirements necessary to receive payments and should enhance the ability of patients to obtain electronic copies of their health information.

Above article publish on http://pvwlaw.wordpress.com/2010/03/21/56-organizations-agree-on-priorities-for-%E2%80%9Cmeaningful-use%E2%80%9D-program/

By Andrea Kraynak

Hospitals with electronic health records (EHR) may be eligible for meaningful use incentives as early as October 2010, and physicians follow soon after. What if a provider is hoping to take advantage of the incentives, but is still fully paper-based? Waiting for the release of final rules on the incentive program and EHR certification before moving forward may not be wise.

Providers should begin by looking into the reasons their facility doesn’t have many of the components that make up an EHR, or lacks an electronic system altogether. For example, if providers haven’t begun to invest in a system because of high up-front costs, they may be able to obtain funding that can help.

“Right now, there is a significant amount of money that is being funneled through the states for health IT,” says Chris Apgar, CISSP, president of Apgar & Associates, LLC, in Portland, OR. Depending on their location, healthcare providers may be able to take advantage of it.

“Go to the medical association in your state that you’re a member of, and put a little pressure on them,” he says.

If your state has grant or loan funding available, remind your association that there is money available and encourage them to lobby and partner with others to push your state to start allocating EHR funding, whether it happens to be low- or no-interest loans or outright grants.

If your state is not offering funding, there may be other programs you can find that offer no- and low-cost loans and other programs to provide support and consultative assistance, especially for small hospitals and physicians, says Margret Amatayakul, RHIA, CHPS, CPHIT, CPEHR, FHIMSS, president of Margret\A Consulting in Schaumburg, IL.

Smaller providers may also want to look into independent physicians associations (IPA), some of which are purchasing EHRs and making them available through a subscription fee. With this option, you have your own Web-based version, and you pay the IPA a certain amount annually to host the EHR, explains Apgar.

“This can be affordable because you don’t have to go out and buy a brand-new system and implement it and have someone administer it and all that,” he says. “You’re paying a subscription fee to use it, in essence, so you don’t have the cost of ownership.”

Remember, however, that subscription-based EHRs may end up costing more in the end, even though they are becoming more common, Apgar says.

If you are still searching for an EHR vendor, don’t forget about the big picture. With additional requirements coming soon, whether additional meaningful use measures or other capabilities your EHR will need to be ICD-10 compliant, look for a product and vendor that will be able to keep up.

“If you are in the position of buying a product today, you want to be buying a product that is going to take you through those stages,” Amatayakul says. “My sense is that you approach this by trying to address the long haul. Otherwise, you’re going to be faced with pieces of things that don’t work together real well.”

And avoid vendors who don’t have a sense of the upcoming changes and how they plan to address them.

“If there is little to no understanding on the part of the vendor as to what this means, or the vendor can’t describe for you what they plan to do, I would avoid that vendor,” Amatayakul says. “That means they’re not going to be able to keep up.”

Above Article Publish on http://www.healthleadersmedia.com/page-1/TEC-247509/Get-Moving-to-Catch-Early-EHR-Meaningful-Use-Incentives