Key step in national initiative toward adoption of electronic health records

The Certification Commission for Health Information Technology (CCHIT), Chicago, Ill. and the Drummond Group Inc. (DGI), Austin, Texas, were named today by the Office of the National Coordinator for Health Information Technology (ONC) as the first technology review bodies that have been authorized to test and certify electronic health record (EHR) systems for compliance with the standards and certification criteria that were issued by the U.S. Department of Health and Human Services earlier this year.

Announcement of these ONC-Authorized Testing and Certification Bodies (ONC-ATCBs) means that EHR vendors can now begin to have their products certified as meeting criteria to support meaningful use, a key step in the national initiative to encourage adoption and effective use of EHRs by America’s health care providers.

“Less than two months following the issuance of final meaningful use rules, we have approved our initial ONC-ATCB certifiers.  EHR vendors can begin immediately to get their products certified.” said David Blumenthal, M.D., national coordinator for Health Information Technology.  This is a crucial step because it ensures that certified EHR products will be available to support the achievement of the required meaningful use objectives, that these products will be aligned with one another on key standards, and that doctors and hospitals can invest with confidence in these certified systems.”

Applications for additional ONC-ATCBs are also under review.

Certification of EHRs is part of a broad initiative undertaken by Congress and President Obama under the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was part of the American Recovery and Reinvestment Act (ARRA) of 2009.  HITECH created new incentive payment programs to help health providers as they transition from paper-based medical records to EHRs.  Incentive payments totaling as much as $27 billion may be made under the program.  Individual physicians and other eligible professionals can receive up to $44,000 through Medicare and almost $64,000 through Medicaid.  Hospitals can receive millions.

To qualify for the incentive payments, providers must not only adopt, but also demonstrate meaningful use of, certified EHR systems.  The law envisions that defined meaningful use requirements will help ensure that the patient and provider benefits of EHRs are realized.  Initial meaningful use criteria were defined in a final rule issued by the Centers for Medicare & Medicaid Services (CMS) on July 28.

In addition to the CMS rule, ONC also issued standards and certification criteria for EHRs on July 28, aimed at ensuring that EHR systems will support the specific tasks required under meaningful use.  Also, through regulations issued on June 24, ONC created a system by which technology review organizations could also qualify as ONC- ATCBs that will certify EHR products as meeting the requirements necessary for meaningful use.

With the initial two ONC-ATCBs now named, EHR vendors can apply to them for certification of their products.  By purchasing certified products, providers will have assurance that the products will support achievement of the meaningful use objectives.

“Multiple steps are underway to carry out the intent of Congress in supporting rapid and effective adoption of EHRs throughout our health care system,” Dr. Blumenthal said.  “The naming of initial ONC-ATCBs is one important step.  Actual certification of multiple vendors’ systems by the ONC-ATCBs is an important next step.  CMS is also working to create an online system for providers to register and attest for the EHR incentive programs. The first incentive payments are targeted to be made in May 2011.  Meanwhile, ONC is also carrying out new programs of technical assistance and training, especially for smaller hospitals and physician practices.”

Dr. Blumenthal said the Health IT initiative “is on an aggressive schedule to meet the urgent targets set by Congress and the President toward realizing the quality and safety improvements that we can achieve through health information technology.”

To learn more about the ONC-ATCBs named today visit www.cchit.org  and www.drummondgroup.com.

For more information about the ONC certification programs visit http://healthit.hhs.gov/certification.

For more information about other HHS Recovery Act Health Information Technology funding and programs, visit http://www.hhs.gov/recovery/programs/index.html#Health.

This news is published on : http://www.hhs.gov/news/press/2010pres/08/20100830d.html

CHICAGO – The American Board of Medical Specialties (ABMS) is creating a new measurement tool to incorporate meaningful use into its Maintenance of Certification (MOC) program, which requires physician specialists to conduct an ongoing measurement of six core competencies.

ABMS officials said the not-for-profit organization will work with the three ABMS primary care Member Boards: the American Board of Family Medicine (ABFM), the American Board of Internal Medicine (ABIM) and the American Board of Pediatrics (ABP) to develop initial products.

ABMS officials say that incorporating meaningful use into MOC certification may include:

• Developing two new knowledge self-assessment modules to evaluate:

1. A physician’s knowledge of health IT for incorporating evidence-based medicine into their practice, decision support and data acquisition, and analysis and reporting related to correct use of the health IT.
2. A physician’s knowledge of the uses of health IT to promote patient safety such as computerized physician order entry, medication reconciliation, e-prescribing and coordination of care.

• Augmenting the knowledge self-assessment modules described above with the addition of simulation, creating patient scenarios that demonstrate EHR functionality, including the development and use of a registry for quality improvement that will provide “hands-on” experience for physicians in gaining the skills they need to apply health IT effectively in quality improvement efforts.
• Developing data interchange utilities to enable physician submission of Physician Reporting Quality Initiative (PQRI) and health IT meaningful use measures to the Boards in the same format used by the Centers for Medicare & Medicaid Services (CMS). This will enable certified physicians to satisfy both PQRI and MOC requirements, and qualify for the PQRI bonus and potentially meaningful use bonus without redundant data submissions.
• Expanding and enhancing practice improvement modules (PIMs), which are Web-based self-evaluation tools that guide physicians through collecting data from their own practice using medical chart reviews, patient surveys and a practice system survey to create a comprehensive assessment of current practice performance in a specific clinical area. Select PIMs will be enhanced to enable physicians to use EHRs to track their practice data and improve care.

According to ABMS, the meaningful use measures physicians will receive federal incentives for meeting overlap with core competencies that are continually measured through ABMS MOC: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communications skills, professionalism, and systems-based practice.

“More than 750,000 U.S. physicians are certified by an ABMS Member Board, so it’s readily apparent that building meaningful use of health IT into MOC will benefit patients,” said Kevin B. Weiss, MD, ABMS president and CEO. “Aligning MOC and meaningful use of HIT will help to facilitate physicians’ knowledge, skill and use of health IT, and in turn can improve physician performance and patient outcomes.”

Source   :   http://www.healthcareitnews.com/news/american-board-medical-specialties-include-mu-certification-program

WASHINGTON – An alliance that claims more than 2,300 community-based hospitals as members is pressing Congress for a legislative fix to the final rule on meaningful use to ensure that every hospital receives its fair share of incentive payments under the HITECH Act.

After having tried in vain to have the issue addressed before the federal rule was final, the Premier healthcare alliance submitted its statement Tuesday to the House Committee on Ways and Means Subcommittee on Health at a hearing on meaningful use EHR. The panel chairman is Pete Stark (D-Calif.).

At issue: health systems with multiple inpatient facilities operating under one provider number.

The final meaningful use rule would allow only one Medicare incentive base payment per year for multiple inpatient facilities operating under the same Medicare provider number. By contrast, an identical health system whose inpatient facilities each operate under its own Medicare provider number would receive a base payment for each facility, Premier noted.

“This is a crucial issue for Premier alliance hospitals and could financially handicap co-located and multi-campus hospitals’ ability to implement EHRs in a timely manner,” the alliance wrote in its statement. “More than 50 Premier alliance hospital systems representing more than 100 inpatient facilities are affected by this methodological error by CMS, which will cost them millions of dollars in EHR incentive payments.”

“Despite receiving hundreds of comments on this specific issue in response to its proposed rule published on Jan.13, the Centers for Medicare & Medicaid Services (CMS) chose not to make any changes to its methodology for calculating a qualifying hospital’s Medicare and Medicaid EHR incentive payment,” Premier said. “By not modifying its methodology, CMS creates an arbitrary and inequitable distinction between identical hospital systems based solely on whether a system has multiple inpatient facilities operating under a single Medicare provider number.”

The government released the final rule on meaningful use on July 13. Initial industry reaction was mostly positive, with kudos given to CMS and the Office of the National Coordinator for Health Information Technology for having dropped an all-or-nothing approach and provided greater flexibility in the rule.

Source  :  http://www.healthcareitnews.com/news/alliance-calls-legislative-fix-meaningful-use

WASHINGTON – Federal officials released the long-awaited final rule on meaningful use Tuesday, with Wednesday morning showing most major organizations still wading through the more than 800 pages of regulations for an in-depth reaction. Initial response seemed to be cautiously optimistic, but the American Hospital Association expressed concerns.

Leaders of the American Hospital Association said on Tuesday they are still conducting an in-depth review of the regulation. They are initally pleased with the added flexibility and removal of some of the “unnecessary administrative burdens” in the final rule, they said.

But that’s where the positive reaction ends. Overall, AHA leaders said they remain concerned that the requirements may be out of reach for many hospitals. “Unfortunately, CMS continues to place some barriers in the way of achieving widespread IT adoption,” AHA said in its statement.

AHA concerns include:

• Individual hospitals in multi-campus settings are unfairly excluded from incentive payments. Hospitals within a healthcare system should each be eligible for incentives;
• The rule may adversely impact rural hospitals and exacerbate the digital divide in healthcare;
• The rule requires hospitals to immediately use Computerized Provider Order Entry (CPOE), “which can be complicated, costly to implement and takes time to do right;”
• The rule, in combination with the certification process, “penalizes early adopters” by requiring them to upgrade or replace already functional systems;
• The rule limits how quickly hospitals can adopt a certified EHR that can benefit patient care.

“Given limited vendor capacity and workforce shortages, many hospitals will not have timely access to certified products, since no certified EHR systems are available today,” AHA said.

Others more optimistic

William F. Jessee, president and CEO of the Medical Group Management Association said MGMA is pleased the federal government acknowledged many of MGMA’s serious concerns regarding the proposed rule.

“While challenges remain, the final rule provides a better approach to the ‘real-world’ issues faced by practices as they move toward ‘meaningful use’ of EHRs,” he said.

“Improvements sought by MGMA contained in the final rule include a reduction in the originally unrealistic thresholds related to e-prescribing, administrative transactions and computerized physician order entry, among others,” Jessee said.

Jessee said MGMA will “work closely” with the Centers for Medicare and Medicaid Services to incorporate additional changes.

The Healthcare Information and Management Systems Society (HIMSS) is expected to have an initial reaction ready by sometime Wednesday, with an in-depth analysis forthcoming, HIMSS leaders said.

H. Stephen Lieber, HIMSS president and CEO said HIMSS members “appreciate and understand the cultural and technical challenges that healthcare providers face in meeting the requirements for meaningful use,”and “HIMSS will be a leader in the transformation.”

Leaders of the College of Healthcare Information Management Executives (CHIME) said on Tuesday they are “actively reviewing” the final rule.

“It’s definitely time to begin a coordinated effort to implement electronic health records by providers nationwide,” said CHIME President and CEO Richard Correll. “We have been supportive of the federal government’s actions to encourage widespread implementation of EHRs, and we are increasing our educational programming in support of our members’ efforts to succeed in this new era of IT adoption”

The Markle Foundation, the Center for American Progress, and the Engelberg Center for Health Care Reform at Brookings issued a joint statement backing health IT adoption incentives.

“The requirements must be ambitious enough to make the investments worthwhile, but not so onerous that they discourage large numbers of doctors and hospitals from participating,” leaders of the organizations said.

Carol Diamond, MD, managing director of the Markle Foundation said the final rule has added flexibility to encourage provider participation.

The organizations are still reviewing the regulation in detail, they said.

Source  :  http://www.healthcareitnews.com/news/stakeholders-still-assessing-final-meaningful-use-rule

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