HHS recently released a package of regulations clarifying the definition of achieving “meaningful use” of electronic health record systems. Eligible providers and hospitals must meet the meaningful use criteria to qualify for government incentives and bonus payments for the adoption of EHR systems. The regulations signify a milestone accomplishment in moving forward our nation’s commitment to the universal adoption of EHRs.

Each day, the American health care system conducts more transactions than the New York Stock Exchange, most of them on paper and at risk of human error. The Institute of Medicine estimates there are between 44,000 and 98,000 deaths attributed to medical errors each year, and while not all errors can be precluded by the adoption of EHRs, there is no question that standardized, interoperable systems will move us in the direction of improved quality and efficiency and reduced errors and waste.

We expect to experience bumps along the way. The core criteria for meaningful use cover several domains, and stakeholders provided a great deal of feedback to HHS after the proposed rule was issued. While changes were made, there remain some issues that may not directly be addressed by HHS but have widespread implications. I offer several for discussion below and request feedback from iHealthBeat readers.

1. EHRs and health care professionals ineligible for government incentives: In its current form, the monetary incentives provided by the federal government (which could total $44,000 under Medicare and $63,750 under Medicaid for eligible providers) are not broadly applied to the entire spectrum of care providers. For example, while physician assistants and nurse practitioners are eligible for the Medicaid EHR incentive program, they are not eligible for the Medicare EHR incentive program. In parts of our nation, particularly in rural and isolated areas, nurse practitioners and physician assistants provide independent and critical care to Medicare patients. While they always work closely with physicians, they may be located hundreds of miles away.
2. Meaningful use ehr, bending the cost curve and quality of care: The widespread adoption of EHRs is expected to significantly improve the quality of clinical care; however, without concerted effort and commitment, the opportunity for bending the cost curve and improving quality of care could go unrealized. Most health systems have already made and will continue to make large investments in interoperable EHR systems, spending tens of millions of dollars on systems that will push them farther along the meaningful use spectrum. This does not, however, inevitably translate to an immediate return on investment; moreover, it may not be enough to change the quality paradigm of an institution. For example, the Veterans Health Administration has an EHR system that goes above and beyond the meaningful use criteria, but recent studies have shown that the VHA’s quality of care is variable across the country. This demonstrates that even the most sophisticated and robust EHR is not alone a panacea.
3. Implications for patient-centered care: There is no question that wiring the country is a step in the right direction, but will patients notice? And if so, will they like what they see? Many patients (including my own) express concern that their doctors spend more time typing on the computer than talking to them. In an age when we are embracing patient-centered care, where can health IT fit in the patient-doctor relationship? What functions of health IT do patients care most about?  Potentially the following:

• The ability to schedule appointments with clinicians online during or after official office hours;
• A mechanism to receive relevant health advice or recommendations online; and
• An integrated and meaningful capacity for discharge instructions after a hospitalization. (Given the emphasis on discharge instructions and clinic visits in the core set of criteria, the next step is a patient-centered approach to ensuring that a clinic visit in the outpatient setting related to a hospital discharge is also “bundled” together with the original hospital visit, creating a more integrated picture of a particular patient’s care continuum.)

Health reform has brought many changes to the health sector, most of which have been long overdue. With 58.5% of practices still using only pen and paper, we need to take advantage of this wave of change, push our comfort limits, and think about how best to augment, complement and modify the existing criteria to rekindle and reinvigorate the very reason we all went into health professions — to deliver the best care for our patients to the best of our ability.

Source :  http://www.ihealthbeat.org/perspectives/2010/making-meaningful-use-meaningful-for-patients-and-health-care-providers.aspx

CMS soon will release modifications for certain provisions in the final rule for Stage 1 of the meaningful use ehr incentive program, Government Health IT reports.

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

Tony Trenkle — director of the Office of e-Health Standards and Services at CMS — said the adjustments to the meaningful use criteria currently are undergoing a federal clearance process, which is the final step before publication. Trenkle spoke on Wednesday during a Health IT Policy Committee meeting.

Trenkle added that CMS also will release guidance for health care providers on how to meet quality measures in the incentive program.

Discussion of Stages 2, 3

During the meeting, the Policy Committee also considered what incentive requirements to include in the next stages of the meaningful use program.

Committee members discussed whether Stage 2 meaningful use requirements — which are expected to go into effect in 2013 — should be incrementally built on requirements from Stage 1, or if there should be a set of larger steps framed around measuring and improving patient outcomes.

Paul Tang — chair of the meaningful use work group and chief medical information officer at the Palo Alto Medical Foundation — said the committee would prefer to establish the Stage 3 goals for 2015 first and then backtrack to form Stage 2 requirements.

Committee member Latanya Sweeney — director of the data privacy lab at Carnegie Mellon University — said future meaningful use criteria should incorporate privacy regulations (Mosquera, Government Health IT, 10/20).

National Coordinator for Health IT David Blumenthal said that the rollout of Stage 1 of the meaningful use criteria “was very rushed” (Conn, Modern Healthcare, 10/21). He added that the next stages should focus on infrastructure and interoperability.

Time Frame

Tang said that the meaningful use work group aims to have draft requirements for Stages 2 and 3 by Nov. 19, adding that it will revise the draft after taking comments from the full Policy Committee.

He said final recommendations could be submitted to the Office of the National Coordinator for Health IT by the third quarter of 2011, while CMS could release a notice of proposed rulemaking on the next stages by the fourth quarter of next year (Manos, Healthcare IT News, 10/21).

Source  :  http://www.ihealthbeat.org/articles/2010/10/21/officials-preparing-adjustments-to-meaningful-use-final-rule.aspx

BALTIMORE – The Centers for Medicare and Medicaid Services plans to correct a few inconsistencies in the meaningful use final rule it published in July and will post on its web site more detailed guidance for providers on how to meet quality measures required by the health IT incentive program.

The minor revisions, including more detailed descriptions of each of the meaningful use objectives and measures, “should help clarify issues and help the (Health IT Policy Committee) plan for recommendations for future stages,” said Tony Trenkle, director of CMS’s Office of e-Health Standards and Services.

Trenkle, who spoke at a Sept. 22 meeting of the policy committee’s meaningful use workgroup, did not offer further information on the clarifications. They would be released “shortly,” he said.

The panel met to propose preliminary requirements for the second stage of meaningful use in 2013, such as raising the level of performance required for computerized physician orders, electronic prescribing and other measures that were begun in the first stage.

In doing so, Paul Tang, chairman of the meaningful use work group, reminded the panel of its main goal: to move clinical practices operating without EHRs into the digital age.

“We want to pay particular attention to smaller practices and hospitals,” said Tang, who is also chief medical information officer of the Palo Alto Medical Foundation. “We want to raise the tides but not sink the boats.”
To set preliminary requirements for stage 2 in 2013, the panel is taking a ‘backfilling’ approach by splitting the difference between existing stage 1 requirements and where it wants to end up by 2015 for stage 3 of meaningful use of ehr.

For example, to set the stage 2 requirement that physicians should use e-prescribing for 60 percent of their prescriptions in 2013, it picked the midpoint between the current stage 1 requirement of 30 percent and the stage 3 goal that 90 percent of prescriptions should be ordered electronically.

Compared with the first set of meaningful use requirements, stage 2 should also incorporate more standard and coded data from EHRs, which should reduce the reporting burden on providers. “We hope that they are capturing the information as part of patient care and not a separate activity,” Tang said.

Staking out new ground, the group introduced objectives for a glide path to care coordination, starting with a measure that calls for providers to link members of their care teams electronically with at least 20 percent of their patients.

The work group will present its preliminary recommendations on stage 2 meaningful use measure in October. In December, the panel will put out a request for comments on the proposals.

In April, the panel will be able to get indications of the number of providers reporting stage one measures and a sense of the market, Tang said. The policy committee wants to make final recommendations by April to give vendors sufficient time to add functionality to EHRs.

Source  :  http://www.healthcareitnews.com/news/meaningful-use-final-rule-see-minor-revisions

It was inevitable, given the short timeline and the apparent seat-of-the-pants nature of the rulemaking process, but CMS is preparing a guidance document intended to clarify several details and fix some inconsistencies in the final Stage 1 rule for meaningful use of EMR.

At last week’s meeting of the Health IT Policy Committee’s workgroup on meaningful use, Tony Trenkle, director of the CMS Office of e-Health Standards and Services, said the guidance will provide more detail on the objectives and measures in the rule and “should help clarify issues and help the [committee] plan for recommendations for future stages,” Government Health IT reports. The clarifications should be out “shortly,” Trenkle promised.

Meanwhile, the workgroup is looking ahead to Stage 2 of meaningful use, 2013-14, which will have higher thresholds of compliance than Stage 1, while trying not to deter hospitals and physicians from adopting EMRs. “We want to pay particular attention to smaller practices and hospitals,” workgroup chair Dr. Paul Tang said, according to Government Health IT. “We want to raise the tides but not sink the boats.”

For the next stage, the workgroup likely will attempt to find a happy medium between the initial standards for 2011-12 and the more rigorous requirements for Stage 3, which is set to begin in 2015. For example, Stage 1 requires physicians to write 30 percent of their prescriptions electronically and federal officials ultimately would like to see a 90 percent e-prescribing rate, so expect the Stage 2 standard to be 60 percent.

The Health IT Policy Committee would like to take some of the reporting burden off of providers, so Stage 2 probably will call for EMRs to have more standard and coded data for easier extraction. “”We hope that they are capturing the information as part of patient care and not a separate activity,” Tang said.

Expect the workgroup to have Stage 2 recommendations ready for public consumption by October, and to seek comments on its preliminary plan in December.

Source       :         http://www.fiercehealthit.com/story/cms-developing-meaningful-use-guidance-remove-contradictions/2010-09-27?utm_medium=nl&utm_source=internal

BOSTON – The Physicians Foundation, a national organization that supports the interests of physicians and their patients, announced Tuesday it awarded 15 individual grants in 13 states totaling nearly $2 million for numerous health IT projects that support high quality patient care.

Foundation officials said the grants are particularly relevant given the national push toward digital health records, and that they hope to “shape how those changes are implemented in the months and years ahead.”

“Our country’s healthcare workforce is already overworked, and as the government encourages a large scale move to digital records, that transition is going to have a significant impact on practicing physicians,” said Foundation Board Member Ripley Hollister.  “The Foundation has made HIT a specific focus, because it wants to ensure that the move to digital records and the use of other technologies is made in a constructive, positive fashion – specifically, one that preserves and supports the doctor-patient relationship.”

Projects receiving Foundation support in this round of grants include:

•    “Meaningful Use Achievement Toolkit,” a program to develop and disseminate tools that assist physicians with achieving meaningful use of certified electronic record systems.
•    “HIT in Practice,” a program to develop a series of supports and resources for implementation of electronic health records (EHR) in small practices.
•    Grants for assisting physicians in various states with implementing digital health records.

The health IT grants are part of a larger effort this year by the Physicians Foundation, totaling more than $4.2 million.

“Our fundamental goal in making these grants was simple,” said Lou Goodman the foundation’s president. “We want to help improve the practice environment for physicians so that they can more easily do what matters most to them: spend time taking care of patients.”

Source      :       http://www.healthcareitnews.com/news/physicians-foundation-awards-15-organizations-2m-it-projects

CMS has provided $6.9 million in federal matching funds to Medicaid programs in four states to support their efforts to manage the “meaningful use” incentive payment program, Government Health IT reports.

Background

Under the 2009 economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health records can qualify for incentive payments (Mosquera, Government Health IT, 9/14).

Through the HITECH Act, which contains the health IT provisions of the stimulus package, eligible Medicaid providers can receive as much as 85% of $75,000 — or $63,750 — in incentive payments across six years for meaningful use of ehr systems (McKinney, Modern Healthcare, 9/14).

CMS Funding

The four states that were given funding are:

• Hawaii, which received $836,000;
• Massachusetts, which received $3.56 million;
• North Dakota, which received $226,000; and
• Ohio, which received $2.29 million (Goedert, Health Data Management, 9/14).

In total, CMS has provided $81.44 million in matching funds to:

• 49 states;
• The District of Columbia;
• The U.S. Virgin Islands; and
• Puerto Rico (Modern Healthcare, 9/14).

Territories and states had to submit plans to CMS for approval before receiving matching funds. The four states are the last to receive federal matching funds for Medicaid health IT efforts (Health Data Management, 9/14).

Using the Funds

States will use the funds to take inventory of their existing health IT status, which includes:

• Examining roadblocks to the use of EHRs;
• Determining health care provider eligibility for the incentive payments (Government Health IT, 9/14); and
• Creating a long-term plan for health IT use within the Medicaid program (Health Data Management, 9/14).

Source    :     http://www.ihealthbeat.org/articles/2010/9/15/cms-awards-69m-to-medicaid-programs-for-meaningful-use.aspx

CMS and the Office of the National Coordinator for Health IT are working to ensure that health care providers know how to participate in the soon-to-be launched incentive program for the meaningful use of ehr (electronic health records), InformationWeek reports (Guerra, InformationWeek, 7/26).

Last week, CMS and ONC began hosting a series of training sessions to provide clarification on the newly released final rule on meaningful use and the accompanying final rule on EHR certification.

First Session

For the first session, each agency provided an overview of the EHR incentive program, which was established under the 2009 federal economic stimulus package (CMIO, 7/26). The session focused on:

• Eligibility issues;
• The relationship between the stimulus package and other government incentive programs; and
• How the federal government and states will coordinate the Medicare and Medicaid portions of the incentive program.

Eligible Providers at Multiple Locations

Jessica Kahn, technical director for health IT at CMS, also addressed concerns related to eligible health care providers who practice at multiple locations. She said clinicians who work at several locations but do not have access to certified EHRs at each facility must:

• Have at least 50% of their total patient encounters take place at locations with certified EHR technology; and
• Base all of their meaningful use objectives only on patient encounters that take place at locations with certified EHRs (InformationWeek, 7/26).

Source  :   http://www.ihealthbeat.org/articles/2010/7/27/onc-cms-offer-meaningful-use-and-ehr-certification-guidance.aspx

In a recent survey, 90% of health care leaders said achieving “meaningful use” of Electronic Health Records to qualify for incentive payments made available by the 2009 economic stimulus package was one of their organization’s top two priorities, InformationWeek reports.

CSC, an IT services and consulting firm, surveyed 60 health care executives in June and July about critical concerns and goals. Roughly 50% of respondents were CIOs or IT leaders, while 50% were operational executives including CEOs, CFOs and COOs.

Meaningful Use Results

The survey found that compliance with meaningful use provisions was the top priority for:

• 84% of CIOs and other health IT leaders;
• 67% of all respondents; and
• 48% of non-IT executives.

In addition, 42% of all respondents said helping their networks of owned or affiliated physicians comply with meaningful use rules for ambulatory care EHR systems was their second highest priority.

Other Findings

One-tenth of respondents cited conversion to ICD-10 diagnosis coding by 2013 as their top priority (Kolbasuk McGee, InformationWeek, 7/22).

Two-thirds of respondents plan to participate in a health information exchange. Currently, 11% of respondents said their facilities take part in a statewide exchange (Manos, Healthcare IT News, 7/22).

Source     :     http://www.ihealthbeat.org/articles/2010/7/26/meeting-standards-for-meaningful-use-tops-goals-of-health-leaders.aspx

As healthcare providers examine the final “meaningful use” regulations, perhaps too much focus is centered on IT system requirements and gap analysis. Hospitals must not fail to recognize a significant reality: Federal incentives for utilizing EHRs will not come close to covering the costs associated with purchasing, deploying, and maintaining them (PriceWaterhouseCoopers; April 2009). Therefore, it’s imperative for hospitals to leverage meaningful use objectives not just to improve patient outcomes, but also to realize near-term cost savings.

Payers, in fact, expect to see cost reductions from meaningful use of ehr. Hospitals, too, should share in the benefits; benefits that amount to more than just a one-time incentive payment or the avoidance of future non-compliance penalties. Forward-thinking hospitals will do two things:

1.    Be strategic in the implementation of all meaningful use objectives.
2.    Be strategic in the selection of “menu” objectives.

One core hospital objective, for example, requires EHRs to provide patients with electronic copies of their discharge summaries. This objective offers an excellent opportunity to improve patient compliance with discharge instructions, and thus reduce preventable readmissions — which will incur payment adjustments under the Patient Protection and Affordable Care Act starting in 2012.

Case-in-point: The Portland VA Medical Center (PVAMC) reduced its 14-day readmission rate from 4.1 to 1.5 readmissions per 1,000 outpatient procedures when it automated its process for providing detailed discharge instructions specific to each patient and procedure (Patient Safety & Quality Healthcare; Jan-Feb 2010). Those instructions–additionally saved in the EHR–include information such as the correct names of the procedure, the surgeon, or the attending physician. [One new study found only 18 percent of patients could correctly name their physician, and only 57 percent could correctly state their diagnosis (Archives of Internal Medicine, August 9/23, 2010)]. But when PVAMC patients who misplace their information contact the hospital, on-call nurses now access the EHR to retrieve the exact discharge instructions. They often resolve issues without costly–and possibly unreimbursed–readmissions.

When it comes to “menu” objectives, organizations should concentrate on those able to generate a positive financial return. Consider, for instance, two that are relatively easy to execute: providing patient-specific education resources and documenting advance directives.

Furnishing patients with comprehensive educational materials improves outcomes, and is also a well-documented mechanism for reducing preventable procedure cancellations (Journal of Cataract and Refractive Surgery, January 2006 and The Journal of Nuclear Medicine, 2008). Astute hospitals immediately recognize the benefit of minimizing revenue loss associated with cancellations, and it can be accomplished with IT systems that easily interface with existing EHRs, providing patient-specific pre-procedure instructions, education materials, drug monographs and anatomical images (Healthcare IT News, April 24, 2007).

The advance directives “menu” objective is worth scrutiny as well. One landmark study found 52 percent of Medicare payments for a patient’s final year of life occur in the last 60 days (The New England Journal of Medicine, April 15, 1993). Another study shows patients who don’t have end-of-life discussions with doctors suffer significantly higher healthcare costs, worse quality of life, and no increase in survival time when compared with patients who do (Archives of Internal Medicine, March 9, 2009). “Heroic” care, therefore, is sometimes neither desired by the patient nor fully reimbursed. A recent commentary (Hospitals & Health Networks, January 19, 2010) describes how the Department of Veterans Affairs has tackled the situation by employing an automated informed consent application to record patients’ advance directives in an EHR.

For meaningful use to be economically successful in the long-term, hospitals must adopt a strategic approach that takes all IT functionality into account, not just the potentially narrow offerings of a single EHR. Many objectives can–and must–be implemented that will generate both near-term financial benefits and improved patient outcomes.

Source  :  http://www.healthcareitnews.com/blog/employing-strategic-approach-implementing-meaningful-use-objectives

by Steven Findlay

The Medicare and Medicaid electronic health record incentive program now moves into action mode. At last.

The final rules released last week made meaningful accommodations to doctors and hospitals who had complained loudly this past spring about overly burdensome draft rules.  Despite some initial grumbling last week, I strongly suspect that doctors, hospitals, IT companies and EHR vendors will get down to the business of figuring out how to make this thing work — for themselves and the nation.

Challenges for Meeting ‘Meaningful Use Of ehr‘

The task is huge, of course. It’s a complex set of rules for everyone to absorb. There are no certified EHRs on the street, for one. The rules for an interim certification process were just released on June 18, and the final technical standards and certification criteria that EHRs must meet were released only last week, at the same time as the “meaningful use” rules that providers must meet. Additions to the HIPAA privacy rule were also released just this month.

And yes, doctors in small practices across the country are only just tuning in to the opportunity, with many still skeptical.

On top of all that, the EHR incentive program is intertwined with the health reform legislation, with providers still attempting to wrap their brains around what the whole ball of wax means for themselves and their patients.

In short, there’s a lot of room for error, delay, frustration, confusion and resistance.

Yet, at the same time, the sheer magnitude of what has happened since February 2009 has propelled a sense of momentum and inevitability around significant change. Health care leaders and rank and file providers alike are beginning to more fully comprehend that it’s different this time. The loud and clear message: Stop being a part of the problem and become a part of the solution.

Rules Advance Consumer-Oriented Health Care

To that end, the meaningful use rules open rich pathways that we, in the consumer and patient advocacy community, warmly embrace. The Obama administration, Congress, the Office of the National Coordinator for Health IT and CMS, and the Health IT Policy and Standards committees got it pretty right. They aimed at things that no one could possibly disagree should be done — things that mattered, would be reasonable with the public and could be significantly impacted by EHRs.

For example, central to much of clinical practice today are prescription drugs. About half of people over age 60 take three or more medications for chronic conditions, while one in 10 take seven or more drugs. When many consumers think of their medical care, they mostly think of the medicines they are taking.

Yet, it has been widely documented for years that doctors don’t accurately track what drugs their patients are taking. That’s poor quality care and dangerous.

The meaningful use rules address this with four prescription drug objectives in the core set of 15 measures doctors must meet. That includes electronic prescribing. In addition, the “menu set” (optional list) contains two other prescription drug measures, including medication reconciliation between care settings.

On top of that, a sizable percentage of the 44 clinical quality measures EHRs must be “enabled” to support more aggressive use of medicines to control a range of chronic illnesses.

The rules attack another embarrassing gap. The vast majority of hospitals and doctors today don’t give their patients a written summary (paper or e-copy) of treatment instructions when they leave the hospital or office despite the fact that research over decades has shown that most people don’t retain much of a doctor’s oral instructions or advice.

The meaningful use rules require that doctors and hospitals provide such summaries within three business days, initially for 50% of office visits or patients. If all goes well, that can be pushed to 80% of patients in 2013 or 2015. To boot, consumers will also be able to access an e-copy of the basic health information (test results, problems lists, medications lists, etc.) that resides in their EHRs.

One final example: For over 20 years, public health leaders and doctors have known that patient-generated advance directives could help families and providers organize the care people want if a life-threatening illness or an accident occurs. Advance directives empower consumers and patients. Yet, no attempt to promote them has succeeded to date. That can now be rectified if hospitals embrace the optional (menu set) meaningful use objective that promotes recording the existence of an advance directive in a person’s EHR. It’s a start.

It’s all a start. And a solid one. HHS has an ambitious goal of 100,000 EHR “adopting” doctors by mid- to late 2012. Let’s hope that goal is reached or exceeded as we wend our way aggressively and urgently to the larger goal: an EHR for every person in the U.S. by the end of 2014.

Source     :        http://www.ihealthbeat.org/perspectives/2010/meaningful-use-marks-solid-start-for-federal-health-it-efforts.aspx