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 - The Obama administration announced $975 million in grants to help states, doctors and hospitals move from paper to computerized record-keeping.

Studies show electronic medical records help reduce medical errors and improve the quality of patient care. The grant money comes from the economic stimulus passed by Congress last year and is part of a push to get health care providers to adopt electronic record-keeping.

The White House says the awards will help make electronic record-keeping technologies available to more than 100,000 hospitals and primary care physicians by the year 2014 while helping train thousands of people for careers in health care and information technology.

The grants come from two federal agencies.

Health and Human Services Secretary Kathleen Sebelius announced $386 million in grants to advance electronic health records at the state level. Sebelius is also granting $375 million to 32 nonprofits for regional training of health care workers on these technologies.

Labor Secretary Hilda Solis announced around $225 million to support 55 job-training programs in 30 states. The administration says around 15,000 people should get training in the health records technology field. Solis said the training will lead those people to jobs offering career-track employment and good pay and benefits.

Above article publish on http://www.startribune.com/business/84237597.html

Molly Merrill, Associate Editor

President Barack Obama called for fixing the broken healthcare system by building upon investments made in electronic medical records in a town hall meeting held last month.

The town hall was held at Northern Virginia Community College in Annandale, Va., where the president took questions the public had submitted online regarding healthcare reform.

I know that people say the costs of fixing our problems are great and in some cases, they are, Obama said. The costs of inaction, of not doing anything, are even greater. They’re unacceptable. And that’s why this town hall and this debate that we’re having around healthcare is so important.

The president highlighted the continued use of electronic medical records as one way to help drive down costs.

We already made those investments in the Recovery Act because when everything is digitalized, all your records your privacy is protected, but all your records on a digital form that reduces medical errors. It means that nurses don’t have to read the scrawl of doctors when they are trying to figure out what treatments to apply. That saves lives; that saves money; and it will still ensure privacy, the president said.

Obama said the government has already identified $950 billion over 10 years that will be used to pay for healthcare reform. He said this doesn’t even include the savings that we’re going to get from prevention, or the savings that we’re going to get from health IT because in using congressional jargon, which I’m never supposed to do because nobody understands it, it’s not scorable.

And what that means is, is that the Congressional Budget Office can’t identify exactly how much you would save - even though everybody believes that it will end up saving a lot of money, we can’t put a hard number on it, Obama said.

The president ended his speech by calling for the American people to stand up and say now is the time.

We can create a healthcare system that gives you choice, allows you to keep your doctor, drives down costs, makes sure that every American doesn’t have to worry if they lose or change their jobs. That’s our aim. That’s our goal. We’re going to make it happen this year.

Above article published on

http://www.healthcareitnews.com/news/obama-stresses-it-key-health-reform

By Gautham Nagesh

The Centers for Medicare and Medicaid Services will reimburse states that issue incentive payments to health care providers to encourage adoption of electronic medical records, according to guidance released on Sept. 1.

A letter from CMS Director Cindy Mann to state Medicaid directors details a program under the 2009 American Recovery and Reinvestment Act that offers financial incentives for eligible Medicare and Medicaid providers to adopt interoperable electronic health records. Approximately $20 billion will be distributed to providers by 2014, mostly in the form of grants.

The payments will help defray the costs of deploying electronic health record systems and can be used to pay for hardware, software, support services and training. But the grants will not necessarily cover the entire cost of installing such systems.

“The incentive payments are not direct reimbursement for such activities. Rather they are intended to serve as an incentive for eligible providers to adopt and meaningfully use certified EHR technology,” Mann said in her letter.

The funds can be used only for electronic health records technology that is certified and interoperable with state or federal administrative management systems.

“Therefore, states risk making unallowable incentive payments prior to receiving guidance on how to make these systems compatible,” Mann wrote.

States are immediately eligible to request 90 percent reimbursement for administrative costs associated with planning and issuing the payments. But that money comes with significant conditions attached. For administrative reimbursement, states must obtain prior approval from CMS for any planning activities or expenditures. They also must provide documentation demonstrating adequate oversight of their incentive programs.

Under the Recovery Act payments would be limited, based on average costs of setting up electronic health record systems, which have yet to be determined. Mann said the secretary of Health and Human Services will establish guidance on those limits.

CMS plans to issue a proposed rule by the end of the year that will contain more detailed information, and will work with states to determine when they are ready to begin issuing payments.

Above article published on

http://www.nextgov.com/nextgov/ng_20090904_7905.php?oref=topnews

The Social Security Administration plans to make wider use of electronic medical records to process disability applications.

By Marianne Kolbasuk McGee

The Social Security Administration is planning to award $24 million in contracts to implement electronic medical records that would improve its disability program’s application process.

Under the agency’s new Medical Evidence Gathering and Analysis Through Health IT program, Social Security will electronically receive clinical information from healthcare providers treating patients who are seeking disability benefits. Currently, the bulk of the information the agency receives about applicants’ medical conditions is provided manually, using paper-based medical records and other documents.

Social Security has been testing the use of EMRs in the application process for about a year. In pilot programs with Beth Israel Deaconess Medical Center in Boston and MedVirginia, a health information exchange in Virginia, the agency says it has significantly reduced processing time for those applications.

Now, Social Security is looking to expand that program. It wants to electronically collect disability applicants’ clinical information–with patients’ authorization–and apply a business rules engine to help it make benefits determinations, said Social Security officials at a webinar on Tuesday about the program.

During the current recession, the Social Security Administration says it has seen a significant increase in disability applications. Officials said they expect to receive more than 3.3 million applications in fiscal year 2010, a 27% increase over fiscal 2008. To process these applications, the agency sends more than 15 million requests for medical records to health care providers. EMRs will “vastly improve the efficiency of this process,” the agency said in a statement.

Under the new program, medical record data will be securely transmitted through the National Health Information Network, an initiative of the Dept. of Health and Human Services.

The new contracts are among health IT programs being funded through the American Recovery and Reinvestment Act. More details are available on the Social Security Administration’s Web site about its request for proposal, in which it’s seeking healthcare providers, provider networks, and health information exchanges to participate in the program.

Above article published on

http://www.informationweek.com/news/healthcare/EMR/showArticle.jhtml?articleID=219200230

By Jim Dawson

Inside Science News Service

WASHINGTON (ISNS) –The progress and problems in developing a national system of electronic medical records topped the agenda Thursday as the Obama Administration’s “best and brightest” from the world of science, medicine and technology gathered in Washington for the inaugural meeting of the President’s Council of Advisors on Science and Technology (PCAST).

David Blumenthal, the national coordinator for health information technology, said there was an “appalling lack of use of technology” in the U.S. medical record-keeping system. “Only 20 percent of physicians and 10 percent of hospitals have meaningful electronic records,” he told the 21-member panel. The transition from the paper-based medical record-keeping system to an electronic one is a priority in President Barack Obama’s push for health care reform, Blumenthal said, as a way to save money over the long run and improve the quality of health care.

In February, Obama signed the American Recovery and Reinvestment Act, which would put $20 billion toward what Blumenthal called a “completely revised, interoperable, integrated health information system.” The system, which is supposed to be functional by 2014, will actually be many different electronic records systems developed by private companies that meet a host of federal standards and requirements that are currently being developed.

“Paper records put us in a suboptimal position [to improve health care],” said Eric Lander, a co-chair of PCAST and the director of the Broad Institute, a medical genetics research program in Cambridge, Mass., run by both Harvard University and the Massachusetts Institute of Technology. An electronic records system, in addition to allowing a patient’s medical records to be shared among doctors, could allow medical researchers to “mine data and combine data” to do faster, more sophisticated medical studies, he said.

Blumenthal said the point of the system isn’t the technology itself, but how that technology is used. “There is very little about the health care system that doesn’t concern us or that we can’t affect in some way,” he said. “We are enabling information to be more accurate and available at the point of care.”

“Use” is one of three area of concern for the scientists and others developing the records system. The other areas focus on getting doctors and hospitals to adopt the electronic system, and, once they have it, how to use it to efficiently exchange information.

The “adoption” issue addresses the difficult question of “which technology should be used, which [computer] platforms are mostly likely to support innovation and change,” Blumenthal told the committee. “And we have to realize that anything that is adopted now will be primitive by the time this entire system is put into place.”

The “exchange” issue involves a host of questions and problems, he said. Should the records system be centralized? How can the system make medical records easy to study and share among doctors, but at the same time guard the privacy of patients and make them secure? “Privacy and security must be assured,” Blumenthal said.

PCAST member Eric Schmidt, the Chairman of Google, in Mountain View, Calif., asked if patients would own their electronic medical records. Aneesh Chopra, the chief technology officer at the administration’s Office of Science and Technology Policy, replied that patients would be given summaries of their records. Schmidt shook his head and said, “that isn’t the same.”

In describing ways an electronic system could benefit medical research, Chopra noted that 40 percent of the U.S. population will at some point be diagnosed with cancer, “but today less than 5 percent of cancer patients have their information in a shareable form that is suitable for research. Why can’t every cancer patient be treated like someone in a clinical trial?” he asked. With electronic medical records, they could be, he said.

John Glaser, a doctor and advisor to the national coordinator for health information technology, detailed a list of benefits in patient treatment that would come from an electronic records system. The system would allow small hospitals and medical practices to have access to patient information on a more sophisticated, interconnected level, he said.

Patients typically see several doctors and they often assume the doctors are talking to each other. They usually aren’t, he said, but with the new records system they would be. Drug interactions would be more apparent, and treatments and procedures done by one doctor could create patterns that reveal a disease like diabetes to another physician working with the records.

The trick, Blumenthal said, is “structuring the [health] market to use the system and allow for innovation, but also maintain order. And we have to assure privacy and integrity in the system. If someone is talking to their doctor about STDs (sexually transmitted diseases), they want to know their records are secure,” he said.

He concluded by noting that while Denmark and other Scandinavian countries are far ahead of the U.S. in the use of electronic records, “nobody has developed an exchange system [of electronic medical records] in a country that is anything like the U.S. in size, population, cultural value differences, and economic structure.”

“We have to live in the world we have,” he said to the scientists and others working to establish the new system.

Above article published on

http://www.aip.org/isns/reports/2009/090807_pcast.html

Molly Merrill, Associate Editor

ANNANDALE, VA – President Obama called for fixing the broken healthcare system by building upon investments made in electronic medical records in a town hall meeting held Wednesday.

The town hall was held at Northern Virginia Community College in Annandale, Va., where the president took questions the public submitted online regarding healthcare reform.

“I know that people say the costs of fixing our problems are great - and in some cases, they are,” Obama said. “The costs of inaction, of not doing anything, are even greater. They’re unacceptable. And that’s why this town hall and this debate that we’re having around healthcare is so important.”

The president highlighted the continued use of electronic medical records as one way to help drive down costs.

“We already made those investments in the Recovery Act - because when everything is digitalized, all your records - your privacy is protected, but all your records on a digital form - that reduces medical errors. It means that nurses don’t have to read the scrawl of doctors when they are trying to figure out what treatments to apply. That saves lives; that saves money; and it will still ensure privacy,” the president said.

Obama said the government has already identified $950 billion over 10 years that will be used to pay for healthcare reform. He said this “doesn’t even include the savings that we’re going to get from prevention, or the savings that we’re going to get from health IT - because in using congressional jargon, which I’m never supposed to do because nobody understands it - it’s not scorable.”

“And what that means is, is that the Congressional Budget Office can’t identify exactly how much you would save - even though everybody believes that it will end up saving a lot of money, we can’t put a hard number on it,” Obama said.

The president ended his speech by calling for the American people to “stand up and say now is the time.”

“We can create a healthcare system that gives you choice, allows you to keep your doctor, drives down costs, makes sure that every American doesn’t have to worry if they lose or change their jobs. That’s our aim. That’s our goal. We’re going to make it happen this year.”

Above article published on

http://www.healthcareitnews.com/news/obama-highlights-it-tool-fix-healthcare

Electronic Medical Records: An Obamanomic Step Toward Improved Health Care

Mary Anne Simpson

The Obama Administration’s goal to improve the entire health care system in the USA begins with an incremental first step by introducing nearly 500,000 physicians to electronic medical records via the American Recovery and Investment Act 2009. Some physicians, hospitals and clinics throughout the world all ready use some form of health care management software which includes electronic medical record programs.

The focus of the latest efforts is to digitize all existing patient medical records, store the records on a portal which is available to both patient and provider for the purpose of engaging patient participation and of equal importance cut down on medical errors. As with all seemingly benign objectives certain concerns have been expressed on the how, why and where of achieving this primary goal.

The Idea Was Born in Science:

The National Academies is comprised of the National Academy of Sciences, National Academy of Engineering, Institute of Medicine and the National Research Council. In 2007, the Rosenthal Foundation sponsored the lecture series, “Transforming Todays Health The focus of the latest efforts is to digitize all existing patient medical records, store the records on a portal which is available to both patient and provider for the purpose of engaging patient participation and of equal importance cut down on medical errors. As with all seemingly benign objectives certain concerns have been expressed on the how, why and where of achieving this primary goal.

The Idea Was Born in Science:

The National Academies is comprised of the National Academy of Sciences, National Academy of Engineering, Institute of Medicine and the National Research Council. In 2007, the Rosenthal Foundation sponsored the lecture series, “Transforming Todays Health Care Workforce to Meet Tomorrow’s Demands.” The preeminent Harvey V. Fineberg, M.D. PhD and President of the Institute of Medicine and his colleagues set forth a new attitude and direction for medical care delivery which included electronic medical records.

Citing the analogy of Bob Evans, a Canadian health care economist, “before adding more sugar to a cup of tea, make sure you stir the sugar all ready in the cup.” The problem of shortages for primary health care physicians, physician assistants and registered nurses comes down to poor utilization of their time. Dr. Kevin Brumback, M.D. Professor and Chair of the Department of Family and Community Medicine at the University of California, San Francisco says way too much time is being spent by physicians doing rudimentary tasks that someone with limited training or a computer could do.

Dr. Brumback doesn’t believe electronic medical records, (EMR) is a panacea for all that ails the health care system, but it will free up time physicians spend reviewing paper files, scheduling lab tests and notifying patients of results. The main point is to bring the patient into the health care system, by putting the health records on-line using a secure HIPAA web site wherein patients could see their medical file, schedule appointments, view lab results and form questions for their next physician visit. The active patient could order age appropriate tests like mammograms, colon cancer screenings and other annual tests

Care Workforce to Meet Tomorrow’s Demands.” The preeminent Harvey V. Fineberg, M.D. PhD and President of the Institute of Medicine and his colleagues set forth a new attitude and direction for medical care delivery which included electronic medical records.

Citing the analogy of Bob Evans, a Canadian health care economist, “before adding more sugar to a cup of tea, make sure you stir the sugar all ready in the cup.” The problem of shortages for primary health care physicians, physician assistants and registered nurses comes down to poor utilization of their time. Dr. Kevin Brumback, M.D. Professor and Chair of the Department of Family and Community Medicine at the University of California, San Francisco says way too much time is being spent by physicians doing rudimentary tasks that someone with limited training or a computer could do.

Dr. Brumback doesn’t believe electronic medical records, (EMR) is a panacea for all that ails the health care system, but it will free up time physicians spend reviewing paper files, scheduling lab tests and notifying patients of results. The main point is to bring the patient into the health care system, by putting the health records on-line using a secure HIPAA web site wherein patients could see their medical file, schedule appointments, view lab results and form questions for their next physician visit. The active patient could order age appropriate tests like mammograms, colon cancer screenings and other annual tests

Above article published on

http://www.physorg.com/news161935473.html

The recently adopted package increases support for research into the best treatments for the same medical conditions or illnesses.

By Doug Trapp, AMNews staff.

Washington – A conservative backlash against comparative effectiveness research provisions in the stimulus package could be the first sign of a difficult health reform debate to come.

The stimulus act enacted Feb. 17 provides $1.1 billion to federal agencies for evaluations of the effectiveness of different drugs, devices and procedures on the same medical condition. The infusion is a huge increase over existing funding for comparative effectiveness research.

But the provision attracted unwanted attention as the stimulus bill moved forward. The House Appropriations Committee’s summary of the version it approved on Jan. 15 said the bill would help determine which drugs, procedures and medical interventions are “less effective and in some cases, more expensive.” Mentioning cost savings as a potential benefit of the research language was enough to lead conservative media outlets, from the Washington Times to radio host Rush Limbaugh, to conclude that an era of government-rationed health care was coming.

The speculation also was fueled by bill language creating a panel of federal government leaders to recommend federal priorities for comparative effectiveness research. A November 2008 white paper by Sen. Max Baucus (D, Mont.), chair of the Senate Finance Committee, cited a Congressional Budget Office estimate that $700 billion of the nation’s annual $2.3 trillion health spending is ineffective, said Dennis Smith, former director of the Centers for Medicare & Medicaid Services’ Center for Medicaid and State Operations and a senior fellow at the Heritage Foundation.

Some GOP members of Congress, including Sen. Mike Enzi (R, Wyo.), spoke out against what was seen as a potential for additional government power over health spending. “The bureaucracy, not doctors and patients, will have the power to make decisions about which treatments folks can and can’t have,” Enzi said Feb. 13.

Robert Doherty, the American College of Physicians’ senior vice president for governmental affairs and public policy, said some conservatives were looking far into the future when they objected to the act’s research provisions. “This was viewed by some as the opening skirmish in a broader battle over the role of government in health care,” Doherty said. The ACP and the American Medical Association supported the comparative effectiveness provisions and funding in the stimulus package, called the American Recovery and Reinvestment Act of 2009.

The final version of the bill did not specifically include cost as part of comparative effectiveness research. The House Appropriations panel’s report summarizing the House-Senate negotiations that produced the final version said the research funding “is not to be used to mandate coverage, reimbursement or other policies for any public or private payer.”

“There are a lot of dots [conservatives] are connecting. And the dots are certainly not connected in the bill,” Doherty said.

Adding “clinical” to “comparative effectiveness” in the bill’s language would have clarified that the research won’t include costs as a factor, but the stimulus act didn’t do that, said Gail Wilensky, PhD, a former Medicare administrator and senior fellow at Project Hope, an international health advocacy organization. “That is, in my mind, a permissive difference,” she said.

Smith agreed on the need to compare treatments, but he worries about any payer, especially Medicare and Medicaid, having too much influence in the medical payment system.

Doherty said the concerns about government intrusion are overblown. “All it really does is provide additional funding to the National Institutes of Health and the Agency for Healthcare Research and Quality to build upon their existing work they are doing in comparative effectiveness.”

Doctors and patients need more rigorous evidence about treatments’ effectiveness, Doherty said. Informed patients might be more likely to choose a less-invasive treatment if its outcome is similar to surgery or another more invasive option.

Government funding of research isn’t a perfect solution, said Roy Poses, MD, a clinical associate professor of internal medicine at Brown University in Rhode Island who has researched clinical epidemiology and evidence-based medicine. “But in the absence of research, the government might use something else to make coverage decisions that might be even less valid,” he said.

Doherty said several ACP members contacted him after the association said it supported the stimulus bill, which was controversial among conservatives for a variety of reasons. “So it was hard to separate the health care provisions from one’s overall views of the stimulus bill. For more conservative physicians … a lot of them didn’t like the idea of the stimulus bill, period.”

The print version of this content appeared in the March 16, 2009 issue of American Medical News.

Above article published on http://www.ama-assn.org/amednews/2009/03/09/gvsb0309.htm