In a comment letter sent Friday, the College of Healthcare Information Management Executives stressed the importance of ensuring that the electronic health record certification process can adequately handle the demand to certify EHR systems, Healthcare IT News reports (Merrill, Healthcare IT News, 4/30).

CHIME also said EHR systems that receive certification under the temporary certification program being established this year should be able to have that certification carry over to the permanent program that will be established in 2012 (Goedert, Health Data Management, 4/30).

The comments are in response to the Office of the National Coordinator for Health IT’s Notice of Proposed Rulemaking on EHR certification.

CHIME also recommended that ONC:

• Ensure that the certification program has the capacity to handle demand;
• Focus on EHR certification before expanding to other technologies (Healthcare IT News, 4/30);
• Provide details on how it will coordinate the EHR testing and certification process with the National Institute of Standards and Technology;
• Explain what constitutes a self-developed EHR;
• Require vendors to disclose what functions their products are certified to perform and any known compatibility issues; and
• Give vendors adequate time to recertify their products if a certifying body loses its authority to certify products (Health Data Management, 4/30).

Above article publish on http://www.ihealthbeat.org/articles/2010/5/3/chime-offers-input-on-electronic-health-record-certification-plans.aspx

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?tid=10&nid=72449

Stephen Barlas

With billions of dollars for electronic health record (EHR) technology purchases hanging in the balance, psychiatrists need to be paying attention to the Department of Health and Human Services (HHS) deliberations on the definition of “meaningful use.” HHS Secretary Kathleen Sebelius is supposed to set an interim definition in a few months. This is important to all office-based physicians because it will set the requirements they will have to meet for proving they are making meaningful use of EHR software and hardware they previously purchased. If they can make the case, starting in 2011, they would qualify for federal grants to partially compensate them for those previous software and hardware purchases.

Those grants are available for 5 years, and if obtained starting in 2011, they could amount to as much as $64,000 per practice for psychiatrists whose patient mix is at least 30% Medicaid recipients. That figure falls to $44,000 for physicians who cannot meet the Medicaid percentage and who see Medicare patients, with no specific percentage of the latter being designated.

There is also a penalty for physicians who do not meet the meaningful use definition. It comes into play after 2016; the Medicare fee schedule for professional services is reduced by 1% in 2015, by 2% in 2016, by 3% for 2017, and by between 3% to 5% in subsequent years.

The grants were authorized by the American Recovery and Reinvestment Act (ARRA)—which is the stimulus bill Congress passed last winter. Sebelius will set interim requirements based on recommendations from 2 new advisory committees that were established by the ARRA: a health information technology policy and a standards committee. The meaningful use requirements will be different, in part, for office-based physicians and hospitals, but they will have escalating requirements in 2011, 2013, and 2015.

The ARRA gave HHS some guidelines as to what the meaningful use definition should include. The overriding requirement is that a physician be able to exchange certain categories of patient data electronically with other providers and to report quality measures to the HHS and Centers for Medicare and Medicaid Services (CMS).

Complying with a meaningful use definition may have some general and specific challenges for psychiatrists. To begin with, it looks likely that all physicians would have to use computer physician order entry (CPOE) for all patients. In 2011, CPOE would have to perform certain basic tasks. For example, it would need to be able to implement drug-drug, drug-allergy, drug-formulary checks; maintain an up-to-date problem list of current and active diagnoses; and generate and transmit permissible prescriptions electronically. In addition, certain quality measures would have to be reported to the CMS. Those would include, on the basis of the policy committee’s final recommendations, percentages of:

• Diabetic patients whose glycosylated hemoglobin levels are under control

• Hypertensive patients whose blood pressure is under control

• Patients with dyslipidemia whose LDL levels are under control

• Smokers to whom smoking cessation counseling and other measures are offered

At meetings with HHS officials this summer, and in comments, the American Psychiatric Association (APA) pointed out that the elements of the meaningful use definition were shaped for generalists—not specialists such as psychiatrists, for whom some of the requirements might pose serious adherence problems. For example, about the reporting of quality measures, none of those endorsed by the policy committee included mental illnesses. “Additionally, there are some quality measures which could be incorporated into primary care and some specialty settings which were not included on the committee’s proposal, such as those pertaining to major depressive disorder,” said James Scully Jr, MD, medical director and chief executive officer of the APA in a letter to HHS this summer.

It is not that quality measures for psychiatrists do not exist. They do. The New York State Office of Mental Health has developed a decision support and quality improvement system for what in that state are called “Article 31” hospitals, which are for psychiatric patients. The Psychiatric Services and Clinical Knowledge Enhancement System affects only psychiatrists at those hospitals.

According to Hao Wang, PhD, deputy commissioner, chief information officer, office of mental health, state of New York, the state weeds through Medicaid data for indications that psychiatrists at Article 31 hospitals may be outside the boundaries of good practice in 2 areas in which the state has developed quality indicators: polypharmacy and cardiometabolic syndrome indicators. Psychiatrists who appear to need some help in those 2 areas are required to report to the state office of mental health to ensure they are improving their stats. Wang suggests that those 2 quality indicators have utility beyond psychiatrists and could be used by HHS if it wanted to make its quality measures reporting definition more relevant to psychiatric practice.

Wang stated what everyone already knows: that psychiatrists—and physicians more broadly—have not exactly flocked to EHRs. But psychiatrists may have a particular disincentive, Wang explained, “because they can’t find a good behavioral health care product.” He added that hospitals are more concerned about patients with physical conditions, because they generate more revenue. And EHR vendors have responded to that by producing systems that have little utility for physicians who see high percentages of patients with mental health conditions.

Above article published on http://www.psychiatrictimes.com/display/article/10168/1482754?verify=0

The Social Security Administration has set aside $24 million to expand a program under which it contracts with hospitals and health information exchanges willing to electronically share electronic health data on patients seeking disability benefits.

Each year, SSA makes more than 15 million patient-authorized requests for medical information from treating providers, but most of this exchange is paper based and as such is very inefficient, SSA officials say. They’re hoping the use of health IT will greatly improve the process.

SSA is looking for a provider willing to link to the agency via local HIEs and the Nationwide Health Information Network. Contracts for the project, proposals for which are due Sept. 18, will be funded through the stimulus law.

Using the NHIN, providers will get a standardized electronic request for medical records along with a patient’s authorization. Providers will then be able to automatically respond to SSA requests with a standardized Continuity of Care Document.

To be eligible for the project, providers must use a certified electronic health record app and be able to demonstrate the technical ability to create a sample Continuity of Care Document with de-identified EMR information.

Above article published on http://www.fiercehealthit.com/story/social-security-budgets-24m-exchange-health-data-hospitals-and-hies/2009-08-10

Diana Manos, Senior Editor

President Barack Obama took his health reform cause to a higher level Wednesday night in an address to a joint session of Congress.

It’s rare for a president to address a joint session of Congress, aside from the annual state of the union speech, but Obama has felt that the hotly debated healthcare reform issue merits the attention.

Obama has long supported healthcare IT as a foundation for change. Preventive treatment, best practices and fraud prevention–all part of his reform plan–rely on healthcare IT.

In his speech, he highlighted healthcare facilities such as Intermountain Healthcare in Utah and the Geisinger Health System in rural Pennsylvania – both of which, he said, offer high-quality care at costs below average. Both facilities have been committed to health IT adoption and use for decades.

Obama said healthcare reform is fundamental to saving the American economy. “Our collective failure to meet this challenge – year after year, decade after decade – has led us to the breaking point,” he said.

Four of five Congressional committees assigned to draft a health reform bill have completed their work, with the Senate Finance Committee announcing Wednesday they are nearing completion of their bill.

“Our overall efforts have been supported by an unprecedented coalition of doctors and nurses, hospitals, seniors’ groups and even drug companies – many of whom opposed reform in the past,” Obama said. “And there is agreement in this chamber on about 80 percent of what needs to be done, putting us closer to the goal of reform than we have ever been.”

The president’s speech drew praise from a number of analysts and healthcare experts.

“It was encouraging to see the president’s commitments to efficiency, effectiveness and innovation while reducing waste and fraud in our healthcare system,” said Justin T. Barnes, vice president of marketing and government affairs at Greenway Medical Technologies and chairman of the Electronic Health Record Association.

“Healthcare reform can’t even exist without a health IT foundation,” he said. “No matter what direction you go in health reform you have to go with health IT.”

Barnes, who works closely on Capitol Hill and with the administration, said Obama has consistently advocated healthcare IT. “He personally ensured the health IT adoption incentives stayed in the stimulus package because he knew that health IT is the essential framework needed to support any healthcare reform that truly could slow the growth of costs, increase access while creating better outcomes, increasing care quality and saving lives,” he said.

Thomas M. Leary, senior director of federal affairs at the Healthcare Information and Management Systems Society said, “President Obama’s speech reinforces the necessity for the adoption and meaningful use of healthcare IT solutions outlined in the American Recovery and Reinvestment and Act, and emphasizes the essential role interoperable tools will have in ensuring the quality, access, and cost effectiveness improvements the president is seeking.”

Above article published on

http://www.healthcareitnews.com/news/obama-endorses-healthcare-it-joint-session-congress

By: Howard Anderson, HDM Breaking News

Although the federal economic stimulus package will spur an increase in spending on clinical applications in the months ahead, many hospitals and clinics are now taking their time studying their options, two researchers say.

“The steady drumbeat of inevitability is changing the debate from not ‘if’ we’ll get an electronic health record but ‘when’,” says Eric Brown, research director at Forrester Research Inc., Cambridge, Mass. “There’s a tipping point at which we’ll see big growth, but we’re not there yet.”

Because of the conservative nature of health care organizations, the growth in demand will be “a slow, steady progression” rather than a spike, Brown contends. “Health care rarely meets pundits’ expectations for growth.”

Under the American Recovery and Reinvestment Act, hospitals and physician group practices can qualify for billions of dollars in extra payments from Medicare and Medicaid if they make meaningful use of qualifying electronic health records systems. But to achieve maximum payments, they must hit certain deadlines. For example, physician groups must have a qualifying EHR system in place by 2012.

“What we’re seeing now is a lot of intense research going on” at hospitals and clinics, says Chris O’Neal, director of corporate reporting at KLAS Enterprises, an Orem, Utah-based research firm that rates provider satisfaction with software. “The spike in demand is coming.”

A KLAS survey in May of 155 health care CIOs and other executives regarding the stimulus incentives found that 43% had no plans for immediate changes but were watching the market, while 30% said the stimulus likely would speed up their I.T. investments.

Providers are doing careful research on EHR vendors, O’Neal believes, because “they cannot afford a misstep” which might cause them to miss a critical deadline for qualifying for a stimulus payment.

Among hospitals, O’Neal expects strong demand for computerized physician order entry systems, which most organizations lack, as well as clinical documentation for nurses. The stimulus program likely will require both of these components for hospitals to qualify for EHR incentive payments, he notes.

Brown says many hospitals will face a difficult challenge when persuading physicians to actually use CPOE. “Will they pay physicians a percentage of the money they get from the stimulus if they use CPOE?” Brown asks. “I’m not sure.”

O’Neal says many smaller clinics will consider using remotely-hosted EHRs accessible over the Internet. Brown says this model could prove attractive to risk-averse small practices with limited budgets that want to get a piece of the stimulus action.

Above article published on

http://www.healthdatamanagement.com/news/stimulus-38773-1.html

By Joseph Conn

There may soon be one more incentive for hospitals and physician offices to buy and install electronic health-record systems on or before 2011. The added push could come from the prospect of increasingly higher thresholds of initial federal eligibility requirements for EHR subsidies under the American Recovery and Reinvestment Act of 2009, according to discussions at today’s meeting of the Health Information Technology Policy Committee.

A work group of that committee delivered its first draft of recommended definitions of “meaningful use” of EHRs, a standard that providers must meet to qualify for subsidy payments estimated at $34 billion to be handed out by Medicare and Medicaid. The work group recommended instituting a series of increasingly complex meaningful-use requirements between 2011, the first “payment year” of the subsidy program, and 2015, the final year payments will be made before financial penalties for not adopting begin.

During those discussions, Anthony Trenkle, director of the CMS’ office of e-Health Standards and Services, said the requirements will not be “tiered” based on when the provider adopts an EHR after 2011. Instead, whatever meaningful use standards are applicable for the year the provider applies for an EHR subsidy are the standards that provider must meet, regardless of whether it is the provider’s first year of EHR implementation.

A 10-day public comment period opens today on the work group’s initial recommendations. Trenkle said the CMS hopes to have a final definition of “meaningful use” to put out for a 60-day comment period later this year, with final rulemaking not expected until early next year.

Above article published on

http://www.modernhealthcare.com/article/20090616/REG/306169965/-1