HDM Breaking News,

The final definition of the “meaningful use” of electronic health records that will be used to determine eligibility for incentive payments under the economic stimulus program will not be available until the middle or end of spring 2010. That’s the prediction of David Blumenthal, M.D., national coordinator for health information technology, who held a press conference Aug. 20.

The preliminary definition of meaningful use requirements will be issued by the end of this year, followed by a 60 day comment period, Blumenthal said.

Under the American Recovery and Reinvestment Act, hospitals and physicians can receive Medicare and Medicaid incentive payments for making meaningful use of certified electronic health records systems.

A certification workgroup of the federal HIT Policy Committee recently recommended that multiple EHR certification bodies be created. Blumenthal, however, stressed that it’s premature to conclude that the final federal EHR certification rules will, in fact, include multiple certification entities.

Above article published on

http://www.healthdatamanagement.com/news/ARRA-38842-1.html

By: Howard Anderson, HDM Breaking News

Although the federal economic stimulus package will spur an increase in spending on clinical applications in the months ahead, many hospitals and clinics are now taking their time studying their options, two researchers say.

“The steady drumbeat of inevitability is changing the debate from not ‘if’ we’ll get an electronic health record but ‘when’,” says Eric Brown, research director at Forrester Research Inc., Cambridge, Mass. “There’s a tipping point at which we’ll see big growth, but we’re not there yet.”

Because of the conservative nature of health care organizations, the growth in demand will be “a slow, steady progression” rather than a spike, Brown contends. “Health care rarely meets pundits’ expectations for growth.”

Under the American Recovery and Reinvestment Act, hospitals and physician group practices can qualify for billions of dollars in extra payments from Medicare and Medicaid if they make meaningful use of qualifying electronic health records systems. But to achieve maximum payments, they must hit certain deadlines. For example, physician groups must have a qualifying EHR system in place by 2012.

“What we’re seeing now is a lot of intense research going on” at hospitals and clinics, says Chris O’Neal, director of corporate reporting at KLAS Enterprises, an Orem, Utah-based research firm that rates provider satisfaction with software. “The spike in demand is coming.”

A KLAS survey in May of 155 health care CIOs and other executives regarding the stimulus incentives found that 43% had no plans for immediate changes but were watching the market, while 30% said the stimulus likely would speed up their I.T. investments.

Providers are doing careful research on EHR vendors, O’Neal believes, because “they cannot afford a misstep” which might cause them to miss a critical deadline for qualifying for a stimulus payment.

Among hospitals, O’Neal expects strong demand for computerized physician order entry systems, which most organizations lack, as well as clinical documentation for nurses. The stimulus program likely will require both of these components for hospitals to qualify for EHR incentive payments, he notes.

Brown says many hospitals will face a difficult challenge when persuading physicians to actually use CPOE. “Will they pay physicians a percentage of the money they get from the stimulus if they use CPOE?” Brown asks. “I’m not sure.”

O’Neal says many smaller clinics will consider using remotely-hosted EHRs accessible over the Internet. Brown says this model could prove attractive to risk-averse small practices with limited budgets that want to get a piece of the stimulus action.

Above article published on

http://www.healthdatamanagement.com/news/stimulus-38773-1.html

Today, the Health IT Policy Committee approved a work group’s revised recommendations for defining “meaningful use” of electronic health records, Health Data Management reports.

The federal economic stimulus package requires hospitals and physicians to demonstrate meaningful use of EHRs to qualify for Medicare and Medicaid incentive payments.

The work group released its initial draft recommendations last month.

Revised Benchmarks

For the new recommendations, the work group revised objectives for EHRs to meet by certain deadlines. The revised 2011 criteria call for qualified health care providers to:

• Allow patients to access their health records in a timely manner;
• Develop capabilities to exchange health information where possible;
• Implement at least one clinical decision support rule for a specialty or clinical priority;
• Provide patients with electronic copies of discharge instructions and procedures;
• Submit insurance claims electronically; and
• Verify insurance eligibility electronically when possible.

The group also called for health care providers to allow all patients to access personal health records by 2013, two years earlier than under the initial recommendations.

In addition, the revised recommendations include an objective for all providers to participate in a national health data exchange by 2015.

Sliding Scale

For the new recommendations, the work group suggested that health care providers could meet the EHR adoption benchmarks on a shifted timeline.

For example, if a health care provider first started implementing health IT processes in 2012, the 2011 criteria would apply to the provider’s first adoption year. The 2013 criteria then would apply to the provider’s third adoption year.

CPOE

The work group also clarified criteria related to computerized physician order entry systems.

The new recommendations call for health care providers to use CPOE systems for 10% of all orders of any type.

However, the work group did not offer guidance on whether the 10% requirement would apply to each individual order type or all orders in total.

HIPAA

In addition, the new recommendations clarify how violations of the HIPAA medical privacy rule could affect incentive payments.

The work group recommended that CMS withhold incentive payments from health care providers until HIPAA violation charges are resolved.

Next Steps

The revised meaningful use recommendations now go to the Office of the National Coordinator for Health IT and other HHS units.

HHS will use the recommendations to help shape regulations regarding the federal incentive programs.

The federal government is expected to release a proposed rule by the end of 2009 (Goedert, Health Data Management, 7/16).

Blumenthal Notes Progress on Health IT

In related news, National Coordinator for Health IT David Blumenthal on Wednesday said HHS is moving forward on efforts to promote health IT adoption among medical providers nationwide.

Speaking during an event at the Center for American Progress, Blumenthal said ONC is prioritizing efforts to define meaningful use of EHRs.

Blumenthal said his office will publish a notice of proposed rulemaking on meaningful use within several months. Stakeholders then will have an opportunity to submit public comment before officials finalize the definition in early 2010, he added.

Coming Up

Next week, the Health IT Standards Committee will meet to discuss criteria for relating meaningful use to equipment and manufacturing decisions. HHS aims to release certification criteria by the end of the year, Blumenthal said.

Blumenthal added that ONC will unveil its plans for a health IT infrastructure this summer. He said the office also will release a blueprint for developing a health data exchange (Noyes, CongressDaily, 7/15).

Above article published on

http://www.ihealthbeat.org/Articles/2009/7/16/Health-IT-Policy-
Panel-Approves-Revisions-on-Meaningful-Use.aspx

Below are some commonly asked questions regarding the economic stimulus funding and what physicians need to do to qualify for the funding:

Who or what kinds of organizations will benefit from the healthcare IT incentives?

The incentives primarily benefit hospitals and office-based physicians. They are designed to reduce healthcare costs by accelerating the use of IT to improve quality, safety and efficiency. Ultimately, patients and caregivers also will benefit from the automation and connectivity enabled by EHRs.

What is the potential financial benefit of the healthcare IT incentives to physicians?

Each office-based physician who meaningfully uses a certified EHR could receive up to $44,000 (Medicare) or $64,000 (Medicaid) in government funding. Office-based physicians practicing in rural or underserved areas would be eligible for up to $48,400 in Medicare incentives. It’s important to note that these figures represent the maximum allowable incentives under the Medicare and Medicaid programs, and that physicians may only qualify for either the Medicare or the Medicaid funding, but cannot qualify for both.

When will the payments be made?

Funds become available for office-based physicians on January 1, 2011 (and are eligible to apply through January 1, 2012 and still receive full benefits). Providers should begin planning as soon as possible to allow time to achieve meaningful use of certified solutions during this time period.

Are there additional incentives for office-based physicians to adopt in the early years of the program?

Office-based physicians’ maximum allowable Medicare incentive for the first year of meaningful use is increased by $3,000, from $15,000 to $18,000, for meaningful EHR use in 2011 or 2012. This “early adopter” incentive raises the total amount physicians can qualify for from $41,000 to $44,000. A benefit for office-based physician early adoption does not exist under the Medicaid incentive program.

What is meant by “meaningful use” of healthcare IT?

Funding and incentives are tied to “meaningful” use. While no one yet knows the full definition of meaningful use, preliminary descriptions include the following:

An eligible professional shall be treated as a meaningful EHR user for a reporting period for a payment year if the following requirements are met:

• Meaningful use of certified EHR technology. The eligible professional demonstrates to the satisfaction of the HHS Secretary, that during such period the physician is using certified EHR technology in a meaningful manner. The certified EHR shall include the use of electronic prescribing as determined to be appropriate by the HHS Secretary.
• Information exchange. The eligible professional demonstrates to the satisfaction of the HHS Secretary that during such period such certified EHR technology is connected in a manner that provides, in accordance with law and standards applicable to the exchange of information, for the electronic exchange of health information to improve the quality of health care, such as promoting care coordination.
• Reporting of measures using EHR. Using such certified EHR technology, the eligible professional submits information for such period, in a form and manner specified by the HHS Secretary, on such clinical quality measures and such other measures as selected by the HHS Secretary. The HHS Secretary shall seek to improve the use of EHRs and healthcare quality over time by requiring more stringent measures of meaningful use selected under this paragraph.

Will the incentives be applied to systems already in use, or will they be applied to the purchase of new systems only?

The incentives are available to meaningful users of certified IT systems described in the legislation regardless of when they were implemented. The qualifier is the date at which the eligible provider can demonstrate meaningful use of the certified technology

Above article published on

http://emrresource.com/2009/04/09/economic-stimulus-physician-faq/

By Tod Newcombe, Editor

I live in Massachusetts, where 97 percent of citizens have health-care coverage thanks to a 2006 law that mandates every resident have insurance through a unique public-private initiative. The first part of the law was to get as many people covered as fast as possible, and everybody agrees the results have been wildly successful.

That was the easy part. Now Massachusetts is working to rein in health-care costs. A key part of the state’s plan calls for increased use of electronic health records (EHRs). In fact, the state passed a law last year requiring hospitals and health-care clinics to use EHRs and created a fund to help physicians put IT into their practices.

Massachusetts also began building an interoperable statewide EHR network that will let doctors, hospitals and insurance providers share information electronically. The investment will save money and lives by reducing medical errors.

States are sometimes called “laboratories of democracy,” and in this case, Massachusetts is the test tube everybody is watching because no state has gone this far to insure so much of its population and require such a massive shift to EHRs.

Fortunately the rest of the public sector isn’t waiting to see what happens in New England. Several key federal agencies that provide insurance to their workers and clients are adopting EHRs, as have some publicly financed health-care facilities. The economic stimulus package is about to pour $20 billion into programs similar to Massachusetts’. The infusion of funds will thrust the public sector into a much more active health-IT role.

Not surprisingly, public CIOs have a role to play even if health IT isn’t part of their existing responsibilities. Public policies on IT interoperability, standards and infrastructure will expand as billions of technology funds start flowing through our country’s public and private health-care system. CIOs must have a seat at the table as this happens.

To help readers get a sense of what some CIOs are already doing, writer David Raths investigated. His findings are an intriguing, first-draft look at what happens when health IT intersects with the public CIO’s role.

While some public CIOs may think they have enough on their plate without the addition of health IT, one former CIO wishes he still had a plate to hold. Former Missouri CIO Dan Ross was the unfortunate victim of state politics when his boss, then-Gov. Matt Blunt, didn’t seek re-election, forcing Ross to vacate his office and state government.

As Missouri CIO, he managed the state’s IT programs, which he streamlined and consolidated with the help of some brilliant deputies, such as Bill Bott, while also keeping up with emerging IT trends. Ross worked with a legislature that thought cell phones were a frivolous luxury in state government, yet he recruited and hired IT workers through the virtual world Second Life.

Ross’ ability to balance the somewhat conservative views of state politicians with the trendiness of technology made him unique among public CIOs. Though he wishes he could remain a public servant, Ross has launched a consulting company that advises governments and IT firms on how to work together. He’s written an essay on his being a public-IT servant, with advice for current and future public CIOs. It’s well worth the read.

These are just two of the many articles in an issue rich in knowledge and advice. I hope you agree. Let me know what you think.

Above article published on

http://www.govtech.com/gt/articles/698261

By Rosemarie Nelson

The economic stimulus bill (the American Recovery and Reinvestment Act of 2009, or ARRA) provides incentive payments up to a maximum of $44,000 per physician over five years for “meaningfully using health information technology.”

Although we don’t yet have definition of “meaningful use,” we can be pretty sure doctors will need to be e-prescribing, exchanging information electronically, and reporting clinical quality measures.

Rather than wait for that definition, start your EMR selection and implementation project now. And start it with an educational demo.

An educational demo is an opportunity for a vendor to help you understand what his EMR can do for your practice, so that as you evaluate products and services, you’ll have a better understanding of how to get a good fit.

The demo serves as an introduction to the possibilities that an EMR brings to a practice for improved operational workflow. That workflow includes both the patient flow when the patient visits the practice and the paper flow that occurs in anticipation of a visit or as the result of a visit (follow-up test results, telephone calls, correspondence, etc.).

Technology changes what is feasible and the demo will help open up ideas that you might not be able to anticipate without some background about the potential.

Pay attention to all the “set-up” and “follow-up” work the EMR can help with “around” the patient visit. In other words, do not get too hung up on the use of the EMR inside the exam room.

The chart is handled and touched and prepped and moved about three times as much outside the exam room as it is inside the exam room. This is especially important for the physicians viewing the demo to remember, because there will be a tendency to think about how it effects the doctor in the room with the patient.

You need to look at the breadth of the interaction with that chart around its entire use.

Look at two aspects of how the prescription function works. One being the first time you prescribe a medication and the second being how the reissue of a prescription will work, including the “messaging” between the nurse on the phone and the provider approving the reissue.

Also look at the messaging and communication systems in general — how will the ability to report and communicate in-office lab test results improve the workflow?

Get comfortable with the “home” page or your “desktop” (all vendors call it something different) where you will “run” your day. Look at the incoming messages and how they are highlighted or categorized.

Look at your schedule for the day with patient information, and how that is integrated/passed from the practice management system.

Get a sense of how you can navigate from a message to the patient’s last office visit documentation and then how you can generate an order (in house or outside the practice).

Know where you’ll find information about the patient’s insurer so you know which ancillary services can be provided by which testing centers, etc.

Try to learn, too, about how external documents will flow through the system — where is the point of entry in the practice and then how does the document get into the patient’s record and to the correct person for review?

Keep the 80-20 rule in mind. In other words, you will have instances that pop into mind about that one-off or atypical encounter and you’ll get caught up in the demo about how to accommodate that. Stop and ask yourself, how often is that an issue? Chances are it’s not worth spending time in the EMR demo on such problems. No EMR can accommodate every situation.

These may seem like a lot of things to consider in a 90-minute demo, but they can all be covered.

And be sure to ask questions, especially if things are not obvious or demonstrated for you.

But above all, get started! There’s economic stimulus money to be had.

Above article published on

http://www.medpagetoday.com/Columns/14250