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

HHS Secretary Kathleen Sebelius today announced awards totaling $27.8 million to health center-controlled networks and large multi-site health centers to implement electronic health records (EHR) and other health information technology (HIT) innovations. The funds are part of the $2 billion allotted to HHS’ Health Resources and Services Administration (HRSA) under the American Recovery and Reinvestment Act of 2009 (ARRA) to expand health care services to low-income and uninsured individuals through its health center program.

“The increased use of health information technology is a key focus of our reform efforts because it will help to improve the safety and quality of health care generally while also cutting waste out of the system,” said Secretary Sebelius.

“These funds to expand and upgrade electronic health records systems will make a huge difference for health centers struggling to provide health care to the growing number of people in need,” said HRSA Administrator Mary Wakefield, Ph.D., R.N.

“Broad use of health information technology has the potential to improve health care quality, prevent medical errors, and increase the efficiency of care provision,” added David Blumenthal, National Coordinator for Health Information Technology. “This program supports the Department’s overall efforts to assist physicians and hospitals in adopting and becoming meaningful users of health information technology.”

Eighteen grants totaling more than $22.6 million will support EHR implementation. Grants totaling more than $2.6 million will help four grantees implement a variety of HIT innovations, including the creation of health information exchanges among different providers and the incorporation of HIT at dental delivery sites. Another five grants totaling over $2.5 million will help health centers devise plans to use existing EHRs to improve patient health outcomes.

HRSA received $2 billion through the Recovery Act to expand health care services to low-income and uninsured individuals through its health center program. To date, more than $1.3 billion of these funds have been awarded to community-based organizations across the country. HRSA-supported health centers treated 17 million patients in 2008, 40 percent of whom have no health insurance.

In addition, HRSA received $500 million in Recovery Act workforce funds—$300 million to expand the National Health Service Corps (NHSC) and another $200 million for other health care workforce programs. The NHSC funds will pay for student loan repayments for primary care medical, dental, and mental health clinicians who will practice for a minimum of two years in NHSC sites that treat underserved and uninsured people. Recently, awards totaling $33 million—part of the $200 million total—were announced to expand the training of health care professionals.

The list of grant recipients follows:

alth Resources and Services Administration (HRSA), part of the U. S. Department of Health and Human Services, is the primary Federal agency for improving access to health care services for people who are uninsured, isolated, or medically vulnerable.  For more information about HRSA and its programs, visit www.hrsa.gov.

Above article published on

http://www.hhs.gov/news/press/2009pres/09/20090929a.html

Diana Manos, Senior Editor

President Barack Obama took his health reform cause to a higher level Wednesday night in an address to a joint session of Congress.

It’s rare for a president to address a joint session of Congress, aside from the annual state of the union speech, but Obama has felt that the hotly debated healthcare reform issue merits the attention.

Obama has long supported healthcare IT as a foundation for change. Preventive treatment, best practices and fraud prevention–all part of his reform plan–rely on healthcare IT.

In his speech, he highlighted healthcare facilities such as Intermountain Healthcare in Utah and the Geisinger Health System in rural Pennsylvania – both of which, he said, offer high-quality care at costs below average. Both facilities have been committed to health IT adoption and use for decades.

Obama said healthcare reform is fundamental to saving the American economy. “Our collective failure to meet this challenge – year after year, decade after decade – has led us to the breaking point,” he said.

Four of five Congressional committees assigned to draft a health reform bill have completed their work, with the Senate Finance Committee announcing Wednesday they are nearing completion of their bill.

“Our overall efforts have been supported by an unprecedented coalition of doctors and nurses, hospitals, seniors’ groups and even drug companies – many of whom opposed reform in the past,” Obama said. “And there is agreement in this chamber on about 80 percent of what needs to be done, putting us closer to the goal of reform than we have ever been.”

The president’s speech drew praise from a number of analysts and healthcare experts.

“It was encouraging to see the president’s commitments to efficiency, effectiveness and innovation while reducing waste and fraud in our healthcare system,” said Justin T. Barnes, vice president of marketing and government affairs at Greenway Medical Technologies and chairman of the Electronic Health Record Association.

“Healthcare reform can’t even exist without a health IT foundation,” he said. “No matter what direction you go in health reform you have to go with health IT.”

Barnes, who works closely on Capitol Hill and with the administration, said Obama has consistently advocated healthcare IT. “He personally ensured the health IT adoption incentives stayed in the stimulus package because he knew that health IT is the essential framework needed to support any healthcare reform that truly could slow the growth of costs, increase access while creating better outcomes, increasing care quality and saving lives,” he said.

Thomas M. Leary, senior director of federal affairs at the Healthcare Information and Management Systems Society said, “President Obama’s speech reinforces the necessity for the adoption and meaningful use of healthcare IT solutions outlined in the American Recovery and Reinvestment and Act, and emphasizes the essential role interoperable tools will have in ensuring the quality, access, and cost effectiveness improvements the president is seeking.”

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By Mary Mosquera

The Centers for Medicare and Medicaid Services will reimburse states for 100 percent of their payments to healthcare providers participating in the federal health IT stimulus program, according to a Sept. 1 letter from CMS to state Medicaid directors.

Moreover, state Medicaid agencies can immediately apply for 90 percent in federal matching funds to cover the initial planning that will be required to launch health IT incentive payment systems in their states, according to the letter from Cindy Mann, director of CMS’s Center for Medicaid and State Operations.

The letter and a package of supporting policy documents are the first formal direction CMS has provided state Medicaid agencies on how to manage the millions of dollars in incentive payments that will flow to healthcare practices under the federal stimulus law.

But federal financial support for state planning will not come without a hefty burden on state Medicaid agencies. According to the documents, CMS plans to keep a close eye on how states develop their incentive payment systems as well as how they mesh with other state health IT projects.

In order to receive the 90 percent administrative match, state Medicaid agencies must obtain from CMS an “HIT Advance Planning Document prior to initiating planning activities and expending funds.” States must receive prior approval of any initial planning eligible for the match, according to the letter.

CMS outlined a litany of state activities that could be eligible for 90 percent matching funds, including planning “for incentive payment delivery systems and audit tracking of payments to providers,” CMS said.

Work by states to set up “metrics and measures for providers to demonstrate meaningful use of electronic health records” would also be eligible for a match. So far, CMS has issued no guidance on how it plans to measure, account for, and verify payments that will be made to providers under the health IT stimulus plan.

States will also be on the hook for making payments to providers whose certified EHR software is incompatible with state and federal administrative management systems. “States risk making unallowable incentive payments prior to receiving guidance on how to make these systems compatible,” Mann said.

Although the letter focuses on Medicaid, it notes that Medicare provider health IT incentives are also called for under the stimulus plan. CMS said it will be a “priority for these incentives to be coordinated in order to reduce confusion, improve administration, and maximize the ability to advance HIT across the health system.”

CMS will provide states with more guidance about planning and administrative expenses and will work with the states to determine when each is ready to start making payments, the letter said. CMS will detail the information in a proposed rule by the end of the year.

CMS is especially keen that state Medicaid agencies’ incentive payment management systems be linked to the states’ overarching vision for health information exchange.

According to the letter, Medicaid offices will be required to submit a “State Medicaid HIT Plan,” or SMHP, describing “how it will integrate current and planned Medicaid HIT assets and fit within the larger State HIT/HIE roadmap,” the letter said.

“We expect the State to include in the SMHP their vision for Medicaid to become part of existing or planned Federal, regional, statewide, and/or local health information exchanges (HIE),” CMS said, “with projected dates for achieving objectives of the vision where appropriate.

“State plans should build off of existing efforts to advance regional and State level HIE, facilitate and expand the secure, electronic movement and use of health information according to nationally recognized standards, and move towards nationwide interoperability.”

The 90 percent matching funds are in addition to matching funds rates that states now receive under current law for using state Medicaid claims processing and automated retrieval systems, referred to as the Medicaid Management Information System (MMIS).

CMS expects that states to closely link their SMHP with these systems, as well as their work adhering to the Medicaid IT Architecture (MITA), an ongoing technology and business plan for Medicaid IT systems.

The MMIS contains a great deal of claims data and other information. “When combined with other systems and databases, [MMIS] can be of significant value in achieving the vision of using certified electronic health record technology to promote health information exchange, enhance quality and improve outcomes,” Mann said.

But CMS cautioned that states “should not begin implementation activities” related to their SHMP’s “until CMS issues future guidance on the Recovery Act HIT requirements or states risk not receiving (federal funding) for incentive payments due to non-compliance.”

CMS and the National Coordinator for Health IT will evaluate the states Medicaid health IT plans to make sure that planning activities are coordinated. CMS will publish more guidance in the near future on the review process, Mann said.

Above article published on

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The economic stimulus bill, passed as the 2009 American Recovery and Reinvestment Act, included provisions for health industry reform. Most of this funding was included in the “Health Information Technology for Economic and Clinical Health Act” portion of stimulus bill.

There are eight key areas where funding has been allocated to stimulate the healthcare industry. In particular, there is an emphasis on providing funds for Electronic Health Record (EHR) software. Putting money into this sector of the healthcare industry will allow individual medical practices and the entire medical system to become more organized, streamlined and cost-efficient.

Money for EHR software and other medical advances was included in eight main allocations of the economic stimulus bill:

• $17.2 billion given to those who can prove “meaningful use” of proper EHR software
• $2 billion to jump start IT use, with government oversight.
• $4.7 billion allotted for the National Telecommunications and Information Administration’s “Broadband Technology Opportunities Program.”
• $2.5 billion allotted for the U.S. Department of Agriculture’s “Distance Learning, Telemedicine, and Broadband Program.”
• $1.5 billion allotted for Health Resources and Services Administration to supplement community health centers.
• $500 million for the Social Security Administration.
• $85 million for the Indian Health Service.
• $50 million for the Veterans Benefits Administration

These funds in the economic stimulus bill are accessible for implementing certified EHR software and are key to getting the healthcare industry to a cost-efficient record management system. This economic bill has many facets, but some experts are suggesting that this is the beginning of a more comprehensive and beneficial healthcare reform. Getting medical records in order is the first step to organizing the system and building a better health care infrastructure.

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EHR-Software—Stimulating-the-Health-Industry&id=2077865