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

WASHINGTON – Federal officials released the final rule on meaningful use Tuesday, which will allow physicians and hospitals to qualify for thousands of dollars in stimulus funding incentives for the adoption of electronic health records.

The 864-page final rule, several weeks late from its anticipated delivery before June 21, outlines the specific qualifications providers must meet to achieve the meaningful use of electronic health records.

At a news conference Tuesday morning, federal healthcare officials praised the advance of electronic health records, while acknowledging the difficulties providers face at the onset of adoption.

According to David Blumenthal, MD, national coordinator for health information technology, the final rule differs from the proposed rule issued last January: It allows providers more flexibility in choosing which measures to use for qualifications.

According to Blumenthal, the proposed rule required doctors to comply with 23 measures, and hospitals 25 measures. The government received more than 2,000 comments on the rule, many of them asking for more flexibility in allowing clinicians to qualify.

Blumenthal said the final rule took those comments into account. The final rule requires doctors to comply with a set of 15 core objectives during the first year - or Stage 1- of adoption. Hospitals are required to comply with 14 core objectives. In addition to the core objectives, both hospitals and doctors will have to choose five more objectives from a “menu” of 10, he said. The remaining objectives will be deferred to Stage 2 of adoption.

The final rule also reduced the number of electronic prescriptions a doctor is required to make from 75 percent to 40 percent, Blumenthal said.

Kathleen Sebelius, Department of Health and Human Services Secretary, said the Federation of American Hospitals is an “enthusiastic supporter” of the new rule. The federal government hopes other groups will join them, she said.

Blumenthal, a physician, said he is confident the use of electronic health records will become a core professional competency among physicians, who will eventually lead the way in adoption. Until then, the government will encourage healthcare IT adoption through financial incentives, such as these set up under the meaningful use rule. The government will also supply “shoulder-to-shoulder” support for providers through the regional extension centers.

Key changes in the final CMS rule include:

• Greater flexibility with respect to eligible professionals and hospitals in meeting and reporting certain objectives for demonstrating meaningful use. The final rule divides the objectives into a “core” group of required objectives and a “menu set” of procedures from which providers may choose any five to defer in 2011-2012.  This gives providers latitude to pick their own path toward full EHR implementation and meaningful use.
• An objective of providing condition-specific patient education resources for both EPs (eligible providers) and eligible hospitals and the objective of recording advance directives for eligible hospitals, in line with recommendations from the Health Information Technology Policy Committee.
• A definition of a hospital-based EP as one who performs substantially all of his or her services in an inpatient hospital setting or emergency room only, which  conforms to the Continuing Extension Act of 2010
• CAHs (critical access hospitals) within the definition of acute care hospital for the purpose of incentive program eligibility under Medicaid.

A CMS/ONC fact sheet on the rules is available on the CMS Web site.

Source :  http://www.healthcareitnews.com/news/flexibility-built-final-rule-meaningful-use

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

On Tuesday, federal officials announced the release of the final rule defining how hospitals and health care providers can demonstrate “meaningful use” of electronic health records to qualify for federal incentive payments, Reuters reports (Lentz, Reuters, 7/13).

Officials also released the final rule describing the required standards and certification criteria for EHR technology. The new regulation updates the interim final rule on EHR certification that ONC released in January (Mosquera, Government Health IT, 7/13).

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHRs will qualify for incentive payments through Medicaid and Medicare.

HHS Secretary Kathleen Sebelius, new CMS Administrator Donald Berwick, National Coordinator for Health IT David Blumenthal and Surgeon General Regina Benjamin announced the rules during a news conference (Health Imaging & IT, 7/13).

Core Meaningful Use Objectives

Blumenthal said the final meaningful use rule offers health care providers more flexibility than the proposed regulations released in January.

The final rule requires physicians to meet a set of 15 core objectives during the first stage of the incentive program. Hospitals are required to meet 14 core objectives for Stage 1. In addition, all health care providers will need to comply with five objectives out of a “menu” of 10 options (Manos, Healthcare IT News, 7/13).

The earlier proposed rule included 25 objectives for physicians and 23 objectives for hospitals.

One of the core objectives requires health care providers to transmit 40% of prescriptions electronically. The requirement was relaxed from the earlier proposed regulations, which called for a 75% electronic prescribing rate.

Health care providers also will need to enact a single measure to meet the clinical decision support requirement, down from five measures in the previous proposal.

In addition, CMS reduced the number of quality measures that health care providers must report on, deferring some measures to Stage 2 meaningful use requirements (Versel, FierceEMR, 7/13).

Another core objective requires hospitals and physicians to use computerized physician order entry systems to capture at least 30% of medication orders. Under the earlier regulations, hospitals would need to use CPOE systems for 10% of medication, laboratory and diagnostic orders, while doctors would need to use the systems for 80% of such orders (Robeznieks, Modern Healthcare, 7/13).

‘Menu’ of Additional Options

In addition to the core objectives, the final rule requires doctors and hospitals to comply with five objectives out of the menu of 10 options. Health care providers will need to comply with the remaining objectives as part of Stage 2 meaningful use requirements (Healthcare IT News, 7/13).

One of the new objectives in the menu calls for health care providers to offer patients condition-specific educational resources.

Clarifications on Eligibility

The final meaningful use rule defines a hospital-based eligible professional as someone who performs nearly all services in an inpatient hospital setting or emergency department.

The rule also expands the definition of acute-care hospital to include designated Critical Access Hospitals for the Medicaid incentive program (Health Imaging & IT, 7/13).

Additional Information in NEJM Piece

Blumenthal and Marilyn Tavenner, principal deputy administrator of CMS, offered additional explanations of the final meaningful use rule in a New England Journal of Medicine perspective piece.

In the perspective piece, Blumenthal and Tavenner explain that HHS weighed 2,000 outside comments before deciding on “significant changes” to the earlier meaningful use regulations.

The piece also includes a full list of the core objectives and the menu of options for the new final rule (Hobson, “Health Blog,” Wall Street Journal, 7/13).

In addition, Benjamin authored a companion piece that also appeared in the journal (FierceEMR, 7/13).

Next Steps

In January 2011, eligible health care providers and hospitals can begin registering for the EHR incentive program. CMS will manage the registration for both the Medicaid and Medicare incentive programs from one virtual location.

Federal officials expect to release additional information on the Stage 2 and Stage 3 meaningful use requirements over the next few years (Mearian, ComputerWorld, 7/13).

Source:http://www.ihealthbeat.org/articles/2010/7/13/final-rules-on-meaningful-use-ehr-standards-released-today.aspx

By Joseph Conn

HHS has sent its final meaningful-use rules and certification criteria for electronic health-record system testing to the Office of Management and Budget—typically one of the last bureaucratic hurdles before rules are released. The criteria are called for under the EHR subsidy program established by the American Recovery and Reinvestment Act of 2009.

OMB received a copy of the final rule of the “meaningful use” criteria from the CMS Monday, according to the posting on the website of its Office of Information and Regulatory Affairs.

The White House budget authority also received a copy of the final rule on an initial set of standards, implementation specifications and certification criteria from HHS on July 2.

Under the Medicare provisions of the stimulus law, to receive an estimated $14 billion to $27 billion in federal subsidies for EHR purchases, hospitals and qualifying office-based physicians must use certified EHRs in a “meaningful manner.”

Robert Tennant, the Washington, D.C.-based senior policy adviser to the Medical Group Management Association, Englewood, Colo., said he expects a quick turnaround on both rules.

“By law, they have 90 days in which to review, but I think in all practicality, OMB has been involved in the drafting of the final rules, so it’s no surprise when they get them,” Tennant said.

OMB has had HHS’ controversial final rule on the federal requirement on public and patient notification in the event of a breach of personally identifiable health information since May 15. Tennant said he expects both recently submitted rules to be released in a week or so, possibly even later this week.

Tennant also said a proposed healthcare IT privacy rule just left the OMB review list, so “it should be published in the next couple of days.”

Source:http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20100706/NEWS/307079976/1153#

The Office of the National Coordinator for Health IT has started accepting applications from organizations seeking to be named as testing and certification bodies for electronic health record systems, Modern Healthcare reports.

Under the 2009 federal economic stimulus package, health care providers who demonstrate “meaningful use” of certified EHR systems will qualify for federal incentive payments.

ONC issued the final rule on the temporary testing and certification program on June 18, and the rule appeared in the Federal Register on June 24.

The stimulus package gave ONC the option of retaining the Certification Commission for Health IT as the sole EHR certification group or recognizing a new organization, according to Modern Healthcare. ONC opted to expand its search for a new group, and CCHIT has joined a pool of applicants for the distinction.

Carol Bean, a standards harmonization analyst for ONC, said HHS to date has received about 40 application inquiries and 14 requests for applications. She said ONC has 30 days after receiving an application to decide whether the organization qualifies as an “authorized testing and certification body” under the temporary certification program.

The final rules for the permanent authorization program have not yet been released, although a proposed rule was issued in March (Conn, Modern Healthcare, 7/1).

Source:http://www.ihealthbeat.org/articles/2010/7/2/onc-starts-accepting-applications-for-ehr-certification-groups.aspx

Last Monday, CMS launched a new website intended to help health care providers better understand the criteria to meet federal requirements for the “meaningful use” of electronic health record systems, Government Health IT reports.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of EHRs will qualify for Medicare and Medicaid incentive payments (Mosquera, Government Health IT, 6/21).

Website visitors can download fact sheets detailing the proposed program requirements and the proposed definition of meaningful use.

The site also clarifies various terms, such as “eligible professional” and “certification,” that are included in the HITECH Act (McKinney, Modern Healthcare, 6/21).

In addition, the site includes:

• An overview of the incentive program;
• Information about what health care providers are eligible for incentive payments;
• Information on how to register for the program; and
• Guidance on what health care providers can do to prepare for meaningful use.

CMS also said that it would use the website to publicize EHR training and events related to the incentive program (Government Health IT, 6/21).

According to Modern Healthcare, the website will offer more specific information about the incentive eligibility requirements after CMS issues the final rule on the EHR incentive programs later this summer (Modern Healthcare, 6/21).

Source: http://www.ihealthbeat.org/articles/2010/6/22/cms-unveils-new-website-on-meaningful-use-incentives.aspx

The Electronic Healthcare Network Accreditation Commission has recommended a series of changes to the federal government’s proposed rule on electronic health record certification, Healthcare IT News reports.

EHNAC, a not-for-profit standards group, issued the recommendations in response to the Office of the National Coordinator for Health IT’s Notice of Proposed Rulemaking on EHR certification.

ONC’s proposed rule calls for the establishment of a temporary EHR certification program, which eventually would be replaced by a permanent certification program. The temporary program would allow ONC-authorized certification bodies to test and certify EHRs and EHR modules.

Recommendations

EHNAC officials said the group is concerned that the current definition of ONC-authorized certification bodies would exclude EHNAC and other organizations from consideration as certifiers of health information exchanges.

The group said its recommendations would enable EHNAC to be named a health data exchange certifier without needing official designation as an EHR certifier.

In its recommendations, EHNAC called for ONC to:

• Allow certifiers to establish a “virtual” office for conducting certification tasks;
• Extend the deadline for organizations to develop certification programs to encourage more groups to apply for designation as temporary certifiers;
• Eliminate unscheduled site visits and provide organizations with sufficient time to prepare for planned visits; and
• Refrain from considering a certified testing program a necessary requirement for the certification of health IT products (Monegain, Healthcare IT News, 5/25).

Above article publish on http://www.ihealthbeat.org/articles/2010/5/25/standards-organization-calls-for-onc-to-revisit-ehr-certification-rule.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

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