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.

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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

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.

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Building on the historic $19 billion investment provided through the American Recovery and Reinvestment Act of 2009 (Recovery Act), efforts continued today to further the national adoption and implementation of health information technology (HIT) — an essential tool to modernize the health care system and bring about improved health for all Americans. The Health Information Technology (HIT) Policy Committee, a Federal Advisory Committee (FACA) to the U.S. Department of Health and Human Services (HHS), met today to begin the process of defining “meaningful use” of electronic health records (EHRs). This meeting is a first step for the department, as it investigates possible definitions for meaningful use.

“We are moving fast to achieve the President’s goal to improve the health and well-being of every American through the on-going use of health information technology,” stated HHS’ National Coordinator for Health Information Technology David Blumenthal, M.D., M.P.P. “The work of the policy committee is a first step toward assuring that technology — the electronic health record — is used in a meaningful way to provide better patient care.”

The Recovery Act provides Medicare and Medicaid incentive payments to eligible providers, such as physicians and hospitals, in order to increase the adoption of EHRs. To receive the incentive payments, providers must demonstrate “meaningful use” of a certified EHR. Building upon the work done

by the HIT Policy Committee, the Centers for Medicare & Medicaid Services (CMS), along with the Office of the National Coordinator for Health Information Technology (ONC), will be developing a proposed rule that provides greater detail on the incentive program and proposes a definition of meaningful use. CMS expects to issue the proposed rule in late 2009, which will be followed by a comment period.

The recommendations discussed today represent extensive work by the Committee’s Meaningful Use Workgroup to review and evaluate diverse ideas and contributions from Workgroup members along with information from a public hearing on meaningful use convened in April by the National Committee on Vital and Health Statistics (NCVHS). The NCVHS hearing brought together key healthcare and information technology stakeholder groups. The workgroup also reviewed written comments from additional diverse stakeholders.

A public comment period on today’s recommendations will be open through the close of business on Friday, June 26, 2009. Instructions on how to submit public comment can be found at http://healthit.hhs.gov.

“The workgroup’s recommendations demonstrate the breadth of meaningful use and the linkage of use to individual care and population health outcomes,” stated Dr. Blumenthal. “ONC and CMS recognize that achieving meaningful use will not be easy, but it is a journey we must take if we are to improve care through the use of EHRs.”

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Rep. Ann Kirkpatrick announced today that the Department of Health and Human Services (HHS) will be making $1,437,515 available to North Country HealthCare to help improve access to quality care in Greater Arizona. The funds are part of $851 million in grants that HHS will release to address facility and equipment needs at health care centers nationwide through the American Recovery and Reinvestment Act.

The announcement comes as the Congresswoman finishes her “Standing Up for Rural Arizona” tour, which included a stop at the opening of a new North Country clinic in Show Low. That facility was established with $1.3 million in Recovery Act funds. North Country will use this new grant to expand their clinics in Winslow and Kingman and to improve information technology and electronic health records infrastructure at their eleven sites across northern

Arizona.

“Rural Arizonans are being underserved by our current health care system, and this sort of investment allows us to benefit from 21st-century technology while reducing our costs,” said Rep. Kirkpatrick. “The staff at North Country does a great job with the resources they have. This grant will enable them to help even more folks in our communities access the services and treatment they need.”

The grants are being allocated through the Capital Improvement Program, which will support the construction, repair and renovation of over 1,500 health center sites across the country. Arizona health centers are benefitting from more than $16 million in funding for health technology improvements, with over $4 million granted to community health clinics in the First District.

“North Country HealthCare is busier than ever, and we are seeing more people show up who have lost their insurance,” said Ann Roggenbuck, North Country HealthCare president. “If they have a medical home, they are more likely to get the health care services they need and take care of medical problems before they get out of hand.”

This is the third round of health center grants provided through the Recovery Act. On March 2, HHS announced that $155 million would be available to establish 126 new health center sites, including the new Show Low clinic. Later that month, HHS released $338 million in Increased Demand for Service grants to help health centers provide care for additional patients. This included $449,304 for North Country, which provided 113,000 patient visits for medical, dental, and behavioral health care last year.

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By John Moore

New York State has awarded about $60 million in grants for localized health information technology projects, one of three rounds of grants recently issued under the state’s Health Care Efficiency and Affordability Law for New Yorkers (HEAL NY) initiative.

Gov. David Paterson announced grants totaling $436 million on Sept. 25. In addition to health IT, the grants will fund collaborative projects among hospitals and improvements to long-term care.

The state will allocate the funds through its Department of Health and the Dormitory Authority of the State of New York.

The health IT portion of the grants, HEAL NY Phase 10, targets community-based projects focused on information sharing. Examples include a $6.7 million grant to the Fort Drum Regional Health Planning Organization to help launch electronic health records and health information exchange to “improve coordination of care for adult patients with chronic pulmonary disease,” according to the health department.

HEAL NY Phase 11, meanwhile, provides more than $174 million in grants that aim to promote collaborative arrangements among hospitals in an effort to boost the quality and efficiency of care delivery. In HEAL NY Phase 12, more than $172 million in grants will be issued to 19 applicants for long-term care related projects.

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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.

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