More than 80 community colleges and universities this fall will begin training nearly 50,000 health IT workers as part of an HHS grant program that aims to help physicians and hospitals adopt electronic health records, ComputerWorld reports (Mearian, ComputerWorld, 7/16).

Source of Funding

HHS in April announced $144 million in grants to target health IT research and work force development.

Funding was disbursed through the 2009 federal economic stimulus package (iHealthBeat, 4/5).

Breakdown of Plans

For the training, HHS has designed a curriculum to educate individuals with a health care or IT background for 12 specific roles.

The programs fall into two groups:

• A six-month program; and
• A one- to three-year training program for more advanced administrative and technical roles, such as senior clinician leaders and privacy and security specialists.

Graduates will receive a certificate in their specialties, and each school will receive approximately $1 million to implement the curriculum.

Regional Extension Centers

A large focus of the effort will be dedicated to training staff to work at 60 regional extension centers, which will help rural institutions and small physician practices install EHR systems.

The centers are expected to employ up to 30 trained workers, who will:

• Assist health care providers with reimbursement procedures;
• Assess a facility’s health IT infrastructure;
• Suggest compatible EHR systems;
• Oversee system installation;
• Analyze workflow; and
• Determine if EHR deployment meets federal “meaningful use” standards (ComputerWorld, 7/16).

Source: http://www.ihealthbeat.org/articles/2010/7/16/groups-preparing-ways-to-use-hhs-grants-for-it-training-programs.aspx

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 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

http://www.govhealthit.com/newsitem.aspx?nid=72050

Market research firm INPUT has just released a report, forecasting an increase in health information technology use among state governments from FY2009 through FY2014. The expected growth rate for the state and local market will be around 4.6 percent, increasing the health IT market value from $7.6 billion to $9.6 billion.

According to INPUT’s “Health IT Transformation: FY2009-FY2014 State and Local Market Forecast,” electronic health records (EHRs) at public hospitals and health organizations will be the primary driver for growth opportunity. Spending on EHR systems is projected to expand from $850 million this year to $1.85 billion in 2014. But EHRs are not the only health IT tools state and local agencies are interested. INPUT found there are at least fourteen different types of health IT products and services, including software and systems for clinical data, labs and pharmacies, patient tracking, decision support, telehealth, health information exchange, and disease outbreak management.

The American Recovery and Reinvestment Act will also push the health IT vertical market and EHR adoption, INPUT found, increasing agencies’ use from 2009 to 2013 with a 17 percent compound growth rate over the period. Other forces shaping the market include the states’ budget crunch, President Obama’s healthcare reform and other national health initiatives, EHR standards and certification rulings, as well as Health IT interoperability standards.

INPUT’s report also painted a complex picture for the market’s funding. There are at least three federal sources of funding, including the Recovery Act, Medicaid supplemental payments and annual budgets. And to complicate matters further, there are eleven or more different open hands asking for those funds at the state and local level, including hospitals, clinics, regional health organizations, mental health facilities, Medicaid, children’s health programs, prisons and IT departments.

Above article published on

http://civsourceonline.com/2009/08/28/state-and-local-health-it-market-to-reach-9-6b-in-2014/

By Steven Kraus, DC, DIBCN, CCSP, FASA

This spring, I traveled extensively to Washington, D.C., for a variety of reasons, mainly to advocate on behalf of chiropractic physicians as our government initiates massive health care reform efforts.

I attended the HL-7 Conference, which is an invitation-only gathering of health care officials dedicated to setting the programming standards for health information exchanges (HIEs) and standards for required data for electronic health records (EHRs).

The conference, sponsored by the Agency for Healthcare Research and Quality, has historically been limited to hospital and allopathic audiences. This year’s group was expanded for the first time to include other health care experts, and I was the designee from the chiropractic profession. My goal and commitment to the profession remains clear: I want to ensure that the interests of chiropractic physicians are considered in any and all discussions related to policy-making for health care information technology. And in the case of HL-7, chiropractic participation is critical so the concerns of our profession with regard to the development of HIEs will be heard.

The catalyst for broadening this conference audience was presumably the economic stimulus package, formally known as the American Recovery and Reinvestment Act (ARRA) of 2009, which includes more than $19 billion to fund the introduction of electronic health records in every physician office in America. The section of the ARRA that deals specifically with this appropriation is the HITECH Act, which outlines the requirements for funding eligibility. To be qualified for incentive payments offered through the legislation, doctors must adopt qualified EHRs that have the functionality to communicate with HIEs, making the standards by which HIEs are governed extremely important and elevating the prominence of interfacing capabilities with other systems.

I’ll discuss more about the requirements for incentive payments later in this article, but the main reason I share my involvement with the creation of health care information technology standards is to demonstrate how the general health care industry is finally opening its arms to the chiropractic profession. We’ve been dancing on the periphery for years, but finally, we are gaining recognition as an essential component of health care delivery and actively participating in these important discussions regarding policy, standards and reform.

Reform = Collaboration + Technology

Speaking of reform, during that same visit to D.C., I also met with Sen. Tom Harkin’s staffers as well as government relations personnel from the American Chiropractic Association to discuss the evolving model of reform for our health care system. As I shared in a previous column, elements of several models are under consideration including the Medical Home Model, which relies heavily on collaboration among health care professionals in order to improve the quality of patient care. Harkin and several of his colleagues are outlining a comprehensive national health care reform plan we can expect to be introduced later this year.

The cornerstone of that plan will be collaboration, and the framework to support collaboration will be driven by technology. While many uncertainties still remain, these two elements are certain. And with collaboration at the forefront, Harkin and others understand that chiropractic physicians and other nonmedical providers are an integral element of national reform. The reform movement is committed to supporting true wellness, something doctors of chiropractic have been preaching for years.

Now it’s time for us to rise to the occasion and continue walking our talk, while we have people watching us and listening. The first step in walking the talk is adopting EHRs. Why? Because technology will create the path to collaboration by assisting case management through registries, database queries, instant access to information, alerts and reminders, and all the related tools the digital age provides us. We need technology to form the health care teams that will improve patient care for every American.

With the anticipated health care reform model so heavily reliant on technology, those who do not adopt an EHR will be left out of the health care framework. In fact, the government is emphasizing the critical role an EHR will play in successful reform so heavily that it is funding the digital transition in its entirety. In order to adapt to the new model of health care, we must adopt an EHR. Since the government will pay for our EHR (up to $44,000 for each physician), we’re simply being asked to fund the energy and effort to implement it. Seems like more than a fair deal to me.

How to Access Your $44,000 Incentive

As I mentioned earlier, the process to fund your EHR is structured through incentive payments to physicians who adopt such systems. Not all health care professionals will be eligible for incentive payments, but doctors of chiropractic are an approved group, as they are covered by the Social Security code defining physicians, which the ARRA is using as its definition.

Two major areas will be evaluated by our government when determining payment approvals. First, the EHR system must be qualified, and second, the system must be used meaningfully by the chiropractic physician. A qualified EHR system must have the capacity to handle patient demographics and clinical health information, and also must have clinic management capabilities, as outlined by the entity that certifies qualified EHR. Only a certified EHR system will be eligible. The certifying body has not yet been announced, but the industry anticipates that the Certification Commission for Healthcare Information Technology (CCHIT) will be the likely choice since it was approved in 2006 by the government’s Office of the National Coordinator of Health Care Information Technology and Medicare to manage such efforts.

The second requirement, “meaningful use,” is determined by three important measures: (1) connectivity to health information exchanges and other EHR systems so they can share information when authorized by the patient; (2) regular reporting of quality measures to the Centers for Medicare & Medicaid Services (CMS), including capturing outcome assessments and performance of pain assessments; and (3) e-prescribing capability. Because we don’t have prescribing privileges, it is unknown at this time whether this will remain a requirement for doctors of chiropractic. With regard to reporting requirements, the general structure of the plan suggests that reporting of quality measures will likely be managed by the PQRI (Physicians’ Quality Reporting Initiative), a standardized mechanism that already exists.

As much as $44,000 can be paid as an incentive to a doctor for investing in a qualified EHR system. And in clinics with multiple physicians, each physician can qualify for the incentives, as long as the aforementioned terms are met. And while we know that CMS will be involved, its specific role is still being evaluated with regard to reporting and eligibility requirements for doctors participating in the incentive program. For example, minimum billing thresholds such as an annual $25,000 in covered services to CMS are being considered in order to be eligible for the incentive payments. However, there is some discussion on consideration for proportionate payments if the threshold is not met. So, if you average 16 Medicare patient visits a week, you would likely qualify. I will follow-up on this issue in a future article once the policies and standards relating to the Department of Health and Human Services and Medicare have been formally released.

To access the full $44,000, which is paid through Medicare in stages (four annual installments starting in 2011), the EHR system has to be qualified and used in a meaningful way starting in 2010. To clarify the timing, it is necessary to explain PQRI’s influence on the process. PQRI, which is expected to oversee reporting requirements, currently requires reporting on at least 80 percent of patients. To accommodate this requirement, the EHR system would need to be in use for the majority of the year prior to the first incentive payment, assuming adherence to PQRI standards will be required. Hence, EHR implementation in 2010 is necessary in order to receive an $18,000 first payment in 2011 and maximize the incentives available.

For new users, implementation of an EHR system typically requires 90 days to six months. Given the expectation that meaningful use will be necessary for the better part of 2010 in order to get a 2011 incentive payment, the implementation process for chiropractic physicians should begin promptly in 2009. Those who had the vision to implement a qualified EHR and can demonstrate meaningful use are already eligible for the full incentive payments.

Penalties for Not Transitioning to EHR

The Evolving Health Care Landscape: Technology Front and Center Those who choose not to transition to an EHR system will be penalized beginning 2015 and continuing through 2018. These penalties will be assessed through a reduction in your Medicare claims reimbursement on services billed. To further motivate adoption, some states have already passed laws that mandate EHR use after 2014 in order to attain a license to practice or to renew a license, concurrent with the stimulus plan. With financial and legal ramifications in play, the incentives to adopt an EHR now are enormous.

The Reform Cube

Given the benefits the government is providing chiropractic physicians, it is a wonder that any of us are still waiting to implement EHR. If the financial incentives are not enough motivation, doctors of chiropractic must consider what role they will play in the health care reform cube. Our health care landscape will soon shift to a different model; consider a cube in which quality, cost, and delivery of care through collaboration and access exist at each point, while technology sits squarely in the middle. Technology improves quality by offering reminders, alerts and other assistive techniques; technology lowers costs by reducing duplication of services; and technology improves collaboration and access by providing a mechanism to share patient health information across all providers. All of this allows for a robust clinic management system.

As chiropractic physicians, we strive to improve quality, we seek to reduce costs, and we crave the opportunity to collaborate on the health care team, so the cube is the ideal home for us. When we adopt the proper technology, we gain not only substantial financial support, but also membership in the cube. And isn’t membership what we’ve been asking for from the health care community all these years? This membership is not for the sake of privilege, but for the sake of having other providers refer patients to receive the benefit of chiropractic care, achieve wellness, and experience cost-effective and efficacious care naturally. Accept the invitation now - it won’t be offered again.

Above article published on

http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=53922