The American Recovery and Reinvestment Act establishes an incentive program that provides incentive payments to eligible physicians (EP) and eligible hospitals for meaningfully using electronic health records (EHR). While many specialists are learning the conditions under which they can capitalize on these incentive payments, anesthesiologists will learn that they do not qualify as EPs, thus not able to receive incentive payments for their meaningful use of EHRs.

One requirement that a physician satisfy is that s/he is a non-hospital-based physician. “Hospital-based” physicians are defined to include those that provide 90% of their Medicare-covered services within a Place of Service (POS) of 21, 22, or 23–either an inpatient hospital, outpatient hospital, or emergency room hospital, respectively. Furthermore, the statute explicitly states that anesthesiologists–who furnish substantially all of their Medicare-covered services in a hospital setting, using the hospital’s facilities and equipment, and qualified EHRs–are not eligible to receive the incentive payments because they are not bringing their own equipment to the hospital in furtherance of the medical services they perform. If a hospital demonstrates is meaningful use of an EHR, it can qualify for incentive payments.

Above article publish on http://www.attorney-dwi.info/health/incentive-payments-for-meaningful-use-of-ehr-technology-does-not-apply-to-anesthesiologists/

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

Article by Ryan

The HITECH Stimulus Act is legislation designed to promote the adoption of Electronic Health Records (EHRs) among physicians. Passed near the beginning of 2009, the HITECH Act will reimburse qualified physicians who purchase and implement a certified EHR system. If a physician’s practice includes 30% Medicaid patients or more, they could qualify for up to $64,000. Medicare incentives could total up to $44,000, depending upon allowable charges.

“Meaningful Use” is a core concept of the HITECH Stimulus Act. Physicians must do more than simply seeing a certain amount of Medicaid or Medicare patients. “Meaningful Use” outlines a set of EHR features that physicians must use in their practice. On December 30th, 2009, The Centers for Medicare and Medicaid Services (CMS) along with the Office of the National Coordinator for Health Information Technology (ONC) published a final recommendation for the meaningful use definition.

Meaningful use is broken up into several stages. In Stage 1, physicians will have to use features like Computerized Physician Order Entry (CPOE), implement drug-to-drug, drug-to-allergy, and drug-to-forumlary checks, and maintain an updated problem list with ICD-9 or SNOMED, along with a whole host of other requirements. For the most part, the final recommendations look much the same as the initial recommendations from the ONC committee earlier in 2009. The final recommendations will take effect in approximately thirty days; the public is encouraged to comment for the next sixty days. CMS could decide to change the recommendations before final adoption, but most think any changes will be minor.

Deliberations over the meaningful use definitions created a great deal of uncertainty in the EHR market. Most physicians put their buying plans on hold, rather than taking the chance of purchasing an EHR that may not meet the requirements. While caution is understandable, physicians who wait too long may have trouble implementing an EHR in time to qualify for the 2011 reimbursements.

Purchasing an EHR is not like buying off-the-shelf software. With all the vendors, systems, and options, it normally takes several months to make a purchase decision. Once they sign papers, physicians may need to wait up to six months for installation to begin because of vendor backlogs. After installation, physicians and their staff still have to train, which can take weeks for more complicated systems.

Fortunately, the wait is over. CMS and ONC have published their final recommendations. EHR vendors are busy making sure their systems meet the meaningful use requirements. Likewise, physicians need to get busy with their EHR search. Physicians need to make a decision as soon as possible to qualify for 2011 and avoid increasing vendor backlogs. If you are interested in participating in the HITECH Stimulus, ask an EHR vendor to perform a needs analysis for your practice.

Above article publish on http://www.ehrscope.com/blog/meaningful-use-%E2%80%93-interim-final-rule-published/

Dom Nicastro and Janice Simmons, for HealthLeaders Media,

With the release yesterday of its “meaningful use” definition and standards, government agencies have laid the foundation for an “evolutionary process in achieving and maintaining the meaningful use of certified EHR technology,” says Frank Ruelas, director of compliance and risk management at Maryvale Hospital and principal, HIPAA Boot Camp, in Casa Grande, AZ.

CMS and the Office of the National Coordinator for Health Improvement Technology (ONC) on Wednesday, December 30, released two anxiously-awaited regulations providing both the definition of “meaningful use” of electronic health records (EHRs) and the standards to improve the efficiency of health information technology used nationwide by hospitals and physicians.

“Both regulations are important in their own right, but they should be seen as part of a larger effort—a more comprehensive effort—to improve the health of the American people and the efficiency of its health system by equipping physicians, hospitals, and other health professionals with the best, most accurate, and most up-to-date information that they need and can use to help their patients, ” said David Blumenthal, MD, national coordinator for health information technology, at a briefing late Wednesday.

Ruelas cites the identification of three stages, each with its own set of objectives that support the meaningful use of an EHR. Providers can be eligible for thousands of dollars if they meet the criteria included in the three stages.

The initial set of criteria will focus on collecting data electronically, sharing this data with other healthcare providers and patients, and finally reporting the measures to the government. The second stage of criteria would be proposed by the end of 2011. This will focus on structured information exchange and continuous quality improvement. Stage 3, which will focus on decision support for “national high priority conditions” and population health, would come out in 2013.

For example, physicians must use computerized provider order entries (CPOEs) for 80% of their orders; hospitals 10%, according to CMS’ proposed rule.

“This was a very novel approach, in my opinion, because as is stressed in this document, the adoption of certified EHR technology and its meaningful use is more of a process to be developed and adopted over time versus an on/off proposition,” Ruelas says. “Oftentimes, people will use the phrase that some processes are more like running a marathon than a sprint. This interim rule certainly gives the impression that we going to be in a marathon mode.”

The ONC interim final rule begins to define standard formats for clinical summaries and prescriptions; standard terms to describe clinical problems, procedures, laboratory tests, medications and allergies; and standards for the secure transportation of this information using the Internet.

The American Recovery and Reinvestment Act of 2009 required HHS to adopt an initial set of standards for EHR technology by December 31, 2009. This regulation will go into effect 30 days after publication in the Federal Register, with an opportunity for public comment over the next 60 days. A final rule will be issued in 2010.

above article publish on : http://www.healthleadersmedia.com/content/TEC-244313/Marathon-of-Meaningful-Use-EHR-Standards-Just-Beginning

After federal officials publish an interim rule on the “meaningful use” of electronic health records, the Health IT Standards Committee will use public comments to shape a final version of the rule, according to John Halamka, vice chair of the committee, Government Health IT reports.

Halamka spoke last week during the panel’s final meeting of the year.

The Office of the National Coordinator for Health IT is scheduled to release interim certification standards on meaningful use by the end of the month. In addition, CMS is expected to publish guidance on the federal incentive payment programs.

During the standards panel meeting, Halamka said the committee strove to recommend meaningful use standards that would be amenable to health care organizations of different sizes and types.

The committee also pushed for data protection standards that align with the HIPAA privacy and security rule. The recommendations call for electronic health systems to authenticate identities, create an audit trail, encrypt and decrypt information and restrict access to authorized users.

When the committee returns to work in 2010, the group will continue its efforts to develop data standards, facilitate EHR adoption and reduce barriers to health IT, Halamka said (Mosquera, Government Health IT, 12/22).

Above article publish on http://www.ihealthbeat.org/articles/2009/12/23/public-comments-will-help-shape-meaningful-use-rule.aspx

By Nicolel

Just this week, HHS Secretary Kathleen Sebelius and Dr. David Blumenthal announced plans to establish nationwide Health IT “Beacon Communities.” $235 million dollars have been allocated to fund the program through the American Recovery and Reinvestment Act (ARRA).

The program’s mission is to accelerate the adoption of HIT, and prove its effectiveness in transforming the quality, efficiency, and financial viability of local healthcare systems. The initiative will distribute $220 million in grants among 15 selected U.S. communities. For the 36-month program, the communities will use these funds to build and strengthen HIT infrastructure and capacity for health information exchange. The federal government is communicating that extreme caution should be taken in building an infrastructure with strong privacy and security measures for data exchange. The 15 communities will receive an additional $15 million for technical assistance and program evaluation.

“Health information technology will make our health care system more efficient and improve care for every American,” Secretary Sebelius said. “The Beacon Community Program is a critical step forward as we work to expand the use of health information technology in hospitals and doctor’s offices across the country.”

One of the major goals of this program is to obtain evaluation measures that show vast improvements in health care quality, safety, efficiency, and population health. It is hoped that this data will be useful in informing more expansive efforts to adopt ‘meaningful use’ of EHRs throughout the United States.

A Beacon Community may represent a collective group of stakeholders and health care providers; however, the lead applicant must be a U.S.-based, non-profit organization or a government entity falling into one of the following five categories:

1. State, local, tribal, or territorial government entity with a public health focus
2. Integrated delivery network or health system with broad community partnerships
3. Independent physician association or consortium of medical groups
4. Public/Private partnership aimed at health system improvement and/or community health improvement
5. ONC-funded regional extension center with the capacity to expand its services

To qualify for the Beacon Community Program, applicants are expected to:

• Build off of existing health IT infrastructure and exchange to demonstrate care and cost savings;
• Have rates of EHR adoption that are significantly higher than published national estimates; and,
• Coordinate with the Office of the National Coordinator for Health Information Technology (ONC) programs for Regional Extension Centers and State Health Information Exchange to develop and disseminate best practices for adoption and meaningful use of EHRs to support national goals for widespread use of health IT.

“The Beacon Community Program will help provide more hard evidence that health IT exchange can make a significant and positive difference in the delivery and value of care,” stated Dr. Blumenthal.

Applications are due on February 1, 2010, and awards for the Beacon Communities are expected to be announced by March 2010. For more information, please refer to the HHS Beacon Community Program webpage: http://healthit.hhs.gov/portal/server.pt?open=512&objID=1422&parentname=CommunityPage&parentid=102&mode=2&in_hi_userid=11113&cached=true

Above article published on: http://www.ehrscope.com/blog/even-more-federal-dollars-allocated-for-health-it

In February 2009, President Obama and the Congress launched a vast, ambitious program to improve the health of Americans, and the performance of their health system, by building a nationwide, interoperable, private and secure, electronic health information system. This vision – of health care empowered by a modern information system, serving each and every American according to their needs and preferences – reflects decades of study and thinking by health care experts, health professionals, and average citizens. Typical of the consensus underlying the nation’s new health information technology (HIT) program is this recommendation by the Institute of Medicine from its seminal 2001 report, Crossing the Quality Chasm:

“Congress, the executive branch, leaders of health care organizations, public and private purchasers…should make a renewed national commitment to building an information infrastructure to support health care delivery, consumer health, quality measurement and improvement, public accountability, clinical and health services research, and clinical education. This commitment should lead to the elimination of most handwritten clinical data by the end of the decade.”

Similar recommendations have come from many other non-partisan, independent authoritative sources such as the Commonwealth Fund, the Markle Foundation, and the Robert Wood Johnson Foundation. These recommendations reflect not only academic studies showing the benefits of HIT, but also experience and common sense. We live in a digital age. We have seen technology improve virtually every facet of our lives. But medicine still relies on cumbersome paper charts. We manage information the same way Hippocrates did 2400 years ago. It’s time to move medicine into the 21st century.

Many health care organizations, big and small, public and private, have installed electronic health record systems and are reaping their benefits daily. Examples include not only national systems like the Veterans Administration and Kaiser Permanente, but regional groups like Geisinger Health System, and individual hospitals like the Beth Israel Deaconess Hospital in Boston, and Lakeland Hospital, a 77-bed facility outside of Omaha Nebraska. These organizations show that the vision is feasible – health care can be made higher in quality and lower in cost through the best existing HIT.

From a common sense perspective, it is impossible to imagine a 21st century American health system deprived of the electronic methods of collecting, managing, and moving data that have revolutionized virtually every other area of human endeavor. Information is the lifeblood of medicine. HIT is its circulatory system. A health care system without an electronic health information system simply cannot achieve its potential, anymore than an Olympic athlete could compete with a failing heart. This is the vision that President Obama and the Congress embraced in February 2009.

Nevertheless, any bold new goal has to be reduced to practice, and skeptics are now asking appropriately whether the HIT program can succeed. A few recent studies have raised questions about whether health care organizations that have installed electronic health records are actually realizing the expected benefits. Perhaps existing examples of success are atypical, and can’t be reproduced in the rest of our health system? Perhaps we are moving too fast? Perhaps the risks are too great?

As a scientist myself, I take the academic literature very seriously. I believe that policy should be based on the best available information, carefully analyzed and considered. However, recent studies raising questions about the benefits of EHRs are informative, but limited in their applicability to our HIT program. To the extent that they accurately capture past experience with EHRs, these studies illustrate something that the Congress and the President understand and have allowed for: namely, that having an EHR alone is not sufficient. Doctors and hospitals have to use this technology effectively, have to employ its extraordinary power to improve clinical decisions, in order to achieve its potential benefits. The federal government’s new programs of incentives and penalties are totally focused on encouraging the meaningful use of EHRs. The resources set aside by the Congress to encourage the adoption of EHRs will go only to physicians, hospitals, and other providers who meet carefully designed new requirements for the use of EHRs that will translate into health improvements and cost reductions for the American people. And the plan passed by Congress includes new resources and support that will help make it possible for providers and hospitals to meet these requirements. We have already announced the availability of grants that will help providers adopt and use EHRs, and we will be making additional announcements in the weeks and months ahead.

Sometimes bold steps are required to improve the human condition. Among the most successful health and social programs in American history are Social Security, Medicare, Medicaid, the Community Health Center Program, and the State Children’s Health Insurance Program. It would have been a tragic mistake, costing untold thousands of lives and enormous suffering, if we had foregone or delayed these programs. I believe the HIT initiative will rank with these huge successes in the value it will bring to the American people over the years to come.

Above article published on http://www.healthcareitnews.com/blog/evidence-hit

By Rebecca Vesely / HITS staff writer

Proposed rules on the meaningful use of electronic health records will be made public by the end of the year or perhaps sooner, said David Blumenthal, national coordinator for health information technology at HHS.

In a speech before the American Medical Informatics Association’s annual symposium in San Francisco, Blumenthal stressed that health IT must be focused on the goal of making the healthcare system work better for patients and providers.

It’s not the technology that’s important, but its effect,” Blumenthal said. “That’s the purpose of the stimulus bill.”

The American Recovery and Reinvestment Act of 2009 included Medicare and Medicaid incentives to eligible providers such as physicians and hospitals to boost adoption of EHRs. To receive the incentive payments, providers must demonstrate “meaningful use” of a certified EHR. The CMS, in conjunction with Blumenthal’s office, is developing the proposed rule that provides greater detail on the incentive program and a definition of meaningful use. The stimulus law, enacted in February, appropriated $2 billion to Blumenthal’s office to create the infrastructure for meaningful use.

After a comment period, the final rule on meaningful use will be released in the spring, Blumenthal said.

While Blumenthal declined to give a specific definition of meaningful use, he offered some hints. People working in health IT should think about EHRs “not as a technology project, but as a change-management project,” he said. Components of meaningful use include sociology, psychology, behavior change and the “mobilization of levers to change complex systems and improve their performance,” he added.

Through the stimulus law, Congress mandated that meaningful use become more focused over time, with yearly benchmarks. There has been a “lively discussion” in the Obama administration of that timetable in the proposed rulemaking of meaningful use, Blumenthal said.

“We will be looking for your feedback,” Blumenthal told the assembled association of nearly 2,000 members who attended the conference held at the Hilton San Francisco Union Square this week. “Rulemaking is not the end of the conversation.”

Privacy and security are absolutely critical to the widespread adoption of health IT, Bluementhal said, adding that this is also on top of his agenda. “Without the trust of the public, we will not be successful in getting everything out of the potential of health informatics.”

In the next few months, his office will convene a working group on privacy and security to look at what else is necessary to ensure the public’s trust beyond what is instructed by Congress in the stimulus law, he said.

“We need to be extremely vigilant and aggressive in terms of developing standards around privacy and security,” Blumenthal said.

And his office is moving forward with its first grant programs under the stimulus law. Last summer, Blumenthal announced two grant programs mandated by the stimulus law. The first is $700 million in grants to establish up to 70 health IT regional extension centers nationwide, which will offer technical assistance, guidance and information on best practices to support and accelerate providers’ efforts to become meaningful users of EHRs. The second program offers $560 million in grants to states to develop health information exchange capacities among providers.

The first round of grant recipients will be announced soon, Blumenthal said. HHS received about 90 applications for the first 20 slots in the health IT regional extension center program, he said, adding that he was encouraged by the volume and quality of the grant applications.

“The grants to states, we believe, are another good bet,” he said.

Blumenthal also gave some hints on his office’s plans to develop and announce programs to increase the supply of trained health IT workers.

“The skills needed are not necessarily what our teenage children have,” Blumenthal said, which brought laughter from the crowd.

Specifically, the nation needs professionals who understand meaningful use and improved processes of care, the ability to redesign workplaces to integrate the new technology and to help providers use the technology to its full potential, he said.

“The training needed is well beyond the installation of information technology,” he said.

Blumenthal expressed great confidence that health IT can be a foundation for fundamental change in the healthcare system.

“I believe it will be a short time before EHRs are as common in medicine as the stethoscope, the cardiogram, the MRI and other core tools,” he said. “I think we’re already moving in that direction.”

Above article published on http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20091117/REG/311179986/1134

By Brian Robinson,

The Centers for Medicare and Medicaid Services is still on target to publish by the end of the year a proposed rule on the meaningful use of electronic health records, despite growing fears from industry about the possible impact of the regulation.

Tony Trenkle, director of the Office of e-Health Standards and Services at CMS, said he had been spending a lot of time with health industry folks who have expressed “concerns and fears” about what will be in the regulation.

Those include how high the bar will be set for meeting meaningful use targets during the first year of implementation, and whether the industry will be able to meet them, he told a meeting today of National Committee on Vital and Health Statistics (NCVHS).

Other concerns include whether hospitals outpatient clinics would be eligible to receive separate payments, whether quality measures will disadvantage specialty health providers, and worries particularly by the states about whether CMS would be able to harmonize Medicare and Medicaid requirements.

Under the HITECH Act, a part of the American Recovery and Reinvestment Act, health care providers can receive payments from both the Medicare and Medicaid programs if they can demonstrate meaningful use of certified EHRs. Payments are due to begin in 2011.

One of the major outcomes of the Nov. 19-20 NCVHS meeting is expected be a letter setting out recommendations to the Secretary of the Health and Human Services for measures that can be applied to decide on just what meaningful use is.

They include commissioning a “fast track” study from the Institute of Medicine on a national strategy for quality measurement development, to begin a process to identify essential data elements, to require EHR vendors to use defined quality data elements, and to require that any certified EHR be able to add data elements that may be defined in the future.

The NCVHS expects to release the final version of the letter at the Nov. 20 conclusion of its meeting.

Above article published on http://www.govhealthit.com/newsitem.aspx?nid=72449

By Mary Mosquera

The National Institutes of Health awarded Kaiser Permanente $54 million in grants for projects that will tap clinical information from the provider’s mammoth electronic health record database to study links between genes and conditions such as heart disease, obesity, diabetes and aging.

The NIH funding originated with the HITECH Act, which allocated $400 million to NIH to support comparative effectiveness research.

The largest of the 22 awards provides $24.8 million to study the influence of genes and the environment on health, disease and longevity over time and across diverse groups of people. The grants will fund genotyping of 100,000 Kaiser members in Northern California. The University of California in San Francisco is also a partner in the research.

The analysis will link genetic information with historical clinical data taken from health surveys and Kaiser’s electronic health record database, according to Raymond Baxter, senior vice president for Kaiser. Researchers will add to the study environmental information, such as air and water quality and proximity to parks and healthy foods.

Dr. Richard Hodes, NIA director of the National Institute on Aging, said genetic information generated by the project may help researchers discover genetic factors that explain differences between people in response to medications.

“This would help doctors provide patients with the best medicines for them individually,” he said.

The grant package included $7.2 million in funding to develop a cardiovascular surveillance system for a collaborative of 14 different health plans across the U.S.

A $3.3 million grant will create a National Research Database to organize Kaiser Permanente’s electronic health records.

A $1,005,372 portion of the funding will be used to integrate the Kaiser Permanente electronic medical record to measure rehabilitation outcomes for stroke patients. Another $99,971 was allocated to study the use of natural language processing to extract data from the electronic medical record.

Above article published on

http://www.govhealthit.com/newsitem.aspx?tid=10&nid=72202