WASHINGTON – At a keynote speech at the annual conference of the American Medical Association Monday, President Obama said healthcare IT is the first step to reforming care in the U.S. He said there is already “widespread agreement” on steps necessary to improve the healthcare system, including the use of health IT.

“First, we need to upgrade our medical records by switching from a paper to an electronic system of record keeping. And we’ve already begun to do this with an investment we made as part of our Recovery Act,” he said.

“It simply doesn’t make sense that patients in the 21st century are still filling out forms with pens on papers that have to be stored away somewhere,” Obama said.”

You shouldn’t have to tell every new doctor you see about your medical history or what prescriptions you’re taking. You shouldn’t have to repeat costly tests. All that information should be stored securely in a private medical record so that your information can be tracked from one doctor to another — even if you change jobs, even if you move, even if you have to see a number of different specialists. That’s just common sense.”

The president said that electronic health records will not only mean less paper-pushing and lower administrative costs, but it will also mean physicians will have an easier time doing your jobs.

“It will tell you, the doctors, what drugs a patient is taking so you can avoid prescribing a medication that could cause a harmful interaction,” he said to AMA conference attendees. “It will prevent the wrong dosages from going to a patient. It will reduce medical errors, it’s estimated, that lead to 100,000 lives lost unnecessarily in our hospitals every year.”

“So there shouldn’t be an argument there. And we want to make sure that we’re helping providers computerize so that we can get this system up and running.”

The speech comes as Congress works on comprehensive legislation to reform U.S. healthcare, with partisan battles expected before a final law is passed before the president’s deadline of Oct. 1.

During the president’s campaign, he called for $50 billion for health IT over five years. The American Recovery and Reinvestment Act slated a downpayment of more than $20 billion in incentives to begin the advance of health IT. Policy experts are not certain how health IT will fare in the upcoming reform bill, but most of the goals the Democrats and the administration are pushing include the need for health IT.

In the AMA speech, Obama promoted disease prevention and better chronic care, both of which will need health IT.

He added, however: “But as important as they are, investments in electronic records and preventive care, all the things that I’ve just mentioned, they’re just preliminary steps. They will only make a dent in the epidemic of rising costs in this country.”

Above article published on

http://www.healthcareitnews.com/news/obama-names-health-it-first-step-reform

By Rosemary D’Amour/Daily News correspondent

GHS

The $4 billion in federal stimulus health care money headed to the Bay State over the next three years will help provide care for those who can’t afford it and it is hoped help stem hemorrhaging costs by funding new technologies.

The bulk of the health care stimulus funding - some $3.5 billion - will keep mostly safety-net programs afloat with Medicaid/Federal Medical Assistance Percentage funds.

But a portion of federal stimulus money is targeted for cost-saving innovation. Massachusetts is expected to receive $1.3 billion in technology and research funds, with more than $500 million slated for initiatives to help create electronic patient records in the commonwealth.

State officials hope the federal investment will lead to a secure statewide database of patient information.

Nationwide, some $19 billion will go to electronic records programs with a goal of freeing health workers from an paper-based system by 2014. President Barack Obama has touted the potential costs-savings from the program.

Stimulus funds will be used to reward those who have already installed the record system and provide money to hospitals and physicians who implement it. The state would also penalize those who fail to upgrade.

Physicians who meet the state criteria for electronic files could receive reimbursements of up to $44,000 each over four years directly from the federal government. There are about 20,000 physicians in the state, according to Health and Human Services.

Partners Healthcare could be a big winner in the stimulus sweepstakes because it has already implemented an electronic records system. With individual reimbursements for its 3,000 members, including teaching hospitals Brigham and Women’s and Massachusetts General Hospital, the health care consortium could receive $10 million to $50 million.

The state’s Health Care Quality and Cost Council estimates that it takes a small medical practice an average of four months to adopt an electronic system at an up-front cost of up to $40,000 per physician.

Up-front costs have been one of the biggest obstacles in creating an electronic system. But Massachusetts, which has nearly twice the national average of doctors using these systems, could face an easier transition with quicker federal reimbursements.

“The adaptation in Framingham was smoother because there wasn’t an existing paper record, so our advisors picked it up very quickly,” said Paula Kaminow, executive director of the Framingham Community Health Center, which began using electronic records when it opened five years ago.

Community health centers are important sources of medical information, Kaminow said, because they serve a wide population that doesn’t have personal physicians. Installation of electronic records in 12 centers could increase staff productivity, allow for expansion in the number of patients and ensure easier and faster sharing of patient information with hospitals.

“From a risk-management standpoint it’s much easier for providers to find the information they need,” Kaminow said. “The handwriting is clean, you can find different chart notes very quickly, and can integrate information from different sources.”

The electronic system could save the nation $530 billion over 10 years, according to the Health Care Quality and Cost Council, which estimates that the stimulus’ initiative could reduce the nation’s health care spending by up to 30 percent.

Kaminow said the most important characteristic for an electronic record is the ability to interface with other types of records.

“The challenge is to make sure that all the different pieces can speak to each other, such as a management system that can speak to an electronic health record, or a lab report,” she said.

The central project for the state is the Health Information Exchange, which is not funded by federal dollars. The state’s newly-established Health Information Technology Council will provide $15 million in initial funding to help install the exchange by 2014.

The exchange would combine electronic record projects for individual practices, hospitals, and community health centers, sharing patient information in a secure statewide database. Anyone in the system treating a patient could quickly learn about the patient’s allergy data, medication and test results.

The initiative has another reward: Job creation.

Private-sector jobs could grow among vendors installing database systems, with positions ranging from entry-level programmers to high-level project managers.

Massachusetts has a leg up in this respect with an already developed system of software and hardware vendors.

“We’re looking to bring on more staff and extend our hours,” said Kaminow. “After a start-up period, our costs are covered through billing, so in that way we’d be able to sustain increased employment.”

The other big slice of the health care stimulus package is the $764 million coming to Massachusetts for over the next two years.

Funds will be used primarily to maintain services-securing jobs, meeting health care standards and safety net services, with $190 million going to offset fiscal 2009 budget holes, according to Health and Human Services.

Stimulus money provide a nationwide increase in federal matching dollars to Medicaid/Federal Medical Assistance Percentage funds of 6 percent, with potential increases depending on the state’s unemployment rate during the stimulus period.

Massachusetts receives an increase from 50 percent in federal matching dollars to 56.2 percent. Given the state’s shaky unemployment rate, which rose to 7.4 percent in March - a full point since December - the commonwealth could see an increase as high as 11.6 percent in the medical assistance dollars.

In fiscal 2010, $255 million would go to securing jobs and health care services provided by the state. The breakdown for this portion of funds is as follows:

• $160 million for hospitals
• $10 million to community health centers
• $45 million to nursing homes
• $15 million to community mental health $20 million to the “Community First” initiative, which transitions those with mental and intellectual disabilities from institutional care to community-based care $5 million to other health care providers $222 million toward maintaining coverage and eligibility for members of the state’s MassHealth and Commonwealth care health insurance programs.
• Finally, $97 million would help protect safety-net services by maintaining or restoring portions of funds to the Departments of Mental Health, Developmental Services, Commissions and Veterans, Children and Families, Youth Services, Public Health and MassHealth.

The Executive Office of Administration and Finance will be in charge of overseeing and coordinating spending for Medicaid/Federal Medical Assistance Percentage funding.

Rosemary D’Amour is a reporter in the Boston University State House Program.

Above article published on

http://www.metrowestdailynews.com/state/x2068280815/
Stimulus-cash-gives-health-care-records-technology-a-boost

The Department of Health and Human Services has released the outlines of the program to offer Medicare and Medicaid incentive payments for meaningful use of electronic health records systems.

The payments are authorized under the economic stimulus law. Medicare incentives to eligible hospitals will start in October 2010, HHS has clarified. Medicare incentives to physicians, as well as Medicaid incentives to physicians and hospitals, will start in January 2011.

By the end of 2009, HHS expects to:

1. coordinate with the Office of the National Coordinator for Health Information Technology to develop related policies for the incentive programs, such as the definition of meaningful use;
2. develop proposed rules to allow public input to the incentive program policies;
3. plan systems and other requirements to support the incentive programs; and
4. plan a national outreach program.
5. By the end of 2010, HHS expects to:
6. conduct outreach to eligible professionals and providers and to state Medicaid agencies;
7. develop systems to support the payment of incentives;
8. develop final rules to establish policies to pay incentives; and
9. develop systems to monitor and evaluate incentive payments.

The Centers for Medicare and Medicaid Services has been appropriated $145 million a year for FY 2009 through 2015, and $65 million for 2016, for administration of the incentive programs.

Above article published on

http://www.healthdatamanagement.com/news/stimulus-28229-1.html?CMP=OTC-RSS

By Rosemarie Nelson

The economic stimulus bill (the American Recovery and Reinvestment Act of 2009, or ARRA) provides incentive payments up to a maximum of $44,000 per physician over five years for “meaningfully using health information technology.”

Although we don’t yet have definition of “meaningful use,” we can be pretty sure doctors will need to be e-prescribing, exchanging information electronically, and reporting clinical quality measures.

Rather than wait for that definition, start your EMR selection and implementation project now. And start it with an educational demo.

An educational demo is an opportunity for a vendor to help you understand what his EMR can do for your practice, so that as you evaluate products and services, you’ll have a better understanding of how to get a good fit.

The demo serves as an introduction to the possibilities that an EMR brings to a practice for improved operational workflow. That workflow includes both the patient flow when the patient visits the practice and the paper flow that occurs in anticipation of a visit or as the result of a visit (follow-up test results, telephone calls, correspondence, etc.).

Technology changes what is feasible and the demo will help open up ideas that you might not be able to anticipate without some background about the potential.

Pay attention to all the “set-up” and “follow-up” work the EMR can help with “around” the patient visit. In other words, do not get too hung up on the use of the EMR inside the exam room.

The chart is handled and touched and prepped and moved about three times as much outside the exam room as it is inside the exam room. This is especially important for the physicians viewing the demo to remember, because there will be a tendency to think about how it effects the doctor in the room with the patient.

You need to look at the breadth of the interaction with that chart around its entire use.

Look at two aspects of how the prescription function works. One being the first time you prescribe a medication and the second being how the reissue of a prescription will work, including the “messaging” between the nurse on the phone and the provider approving the reissue.

Also look at the messaging and communication systems in general — how will the ability to report and communicate in-office lab test results improve the workflow?

Get comfortable with the “home” page or your “desktop” (all vendors call it something different) where you will “run” your day. Look at the incoming messages and how they are highlighted or categorized.

Look at your schedule for the day with patient information, and how that is integrated/passed from the practice management system.

Get a sense of how you can navigate from a message to the patient’s last office visit documentation and then how you can generate an order (in house or outside the practice).

Know where you’ll find information about the patient’s insurer so you know which ancillary services can be provided by which testing centers, etc.

Try to learn, too, about how external documents will flow through the system — where is the point of entry in the practice and then how does the document get into the patient’s record and to the correct person for review?

Keep the 80-20 rule in mind. In other words, you will have instances that pop into mind about that one-off or atypical encounter and you’ll get caught up in the demo about how to accommodate that. Stop and ask yourself, how often is that an issue? Chances are it’s not worth spending time in the EMR demo on such problems. No EMR can accommodate every situation.

These may seem like a lot of things to consider in a 90-minute demo, but they can all be covered.

And be sure to ask questions, especially if things are not obvious or demonstrated for you.

But above all, get started! There’s economic stimulus money to be had.

Above article published on

http://www.medpagetoday.com/Columns/14250

Scott N. Wolfe

A major focus of the American Recovery and Reinvestment Act (Stimulus Act) that President Obama signed in February is to improve the quality and expand the scope of health information technology in the United States. One of the central goals is to develop a nationwide health IT infrastructure and transfer all Americans’ health records to electronic format by the year 2014.

Under the Stimulus Act, the Office of the National Coordinator for Health Information Technology (ONCHIT) received a $2 billion appropriation to achieve these goals. The funds will remain available until expended; however, the law requires that certain portions of the funds must be allocated to specified groups. ONCHIT will be advised by two policy committees comprised of members from the various sectors of the health-care industry. ONCHIT is charged with a number of oversight activities, including the development of uniform health IT standards to allow interoperability among diverse health IT systems. “Making the electronic health records dream a reality will depend upon the successful development of uniform HIT standards,” said Andrew Gantt, a partner in the Health Care and Life Sciences Group at the Washington D.C. office of Latham & Watkins. “This is critical to ensuring that multiple electronic health records technologies are able to communicate effectively with each other.”

One of the named recipients under the Stimulus Act is the National Institute of Standards and Technology (NIST). NIST will receive $20 million of the budget allocation to continue advancing the use of health IT. The law also earmarks $300 million to support sub-national and regional efforts in their advancement toward health information exchange.

The Stimulus Act also contains various financial incentives to specified groups who adopt and increase their use of electronic health records and health IT. Medicare providers, for example, are entitled to receive up to $44,000 ($48,400 for providers in a professional shortage area) of funding if they adopt and engage in a “meaningful use” of certified electronic health records technology. The standards that providers must meet to satisfy the “meaningful use” requirement in order to receive incentive payments include, among other things, the ability to connect in a way that provides for the electronic exchange of health information and a willingness to report information on clinical quality measures to the Department of Health and Human Services.

The law also incentivizes Medicare providers by penalizing them if they do not become electronic health users by 2015 through a one to five percent reduction in payment the providers would otherwise receive. Similar financial incentives, which can total $63,750, are available for Medicaid providers who implement electronic health records technology. Providers eligible for both Medicare and Medicaid incentives may only receive incentives from one or the other.

Hospitals are also entitled to receive funding under the Stimulus Act if they can demonstrate that they are “meaningful users” of electronic health records technology. A formula determines the amount that hospitals can receive, with the amount starting at $2 million. Grants will also be available to universities that develop centers designed to generate innovative approaches to the use of health IT.

State or state-designated entities are also eligible to receive grants if they submit a plan describing activities to be carried out to facilitate the exchange of health IT. In addition, regional centers that assist in the promotion and advancement of health IT may receive grants for the continued development of technological approaches. To secure their grants, however, these groups must contribute matching funds up to a certain percentage of the federal funds they intend to receive.

Universities and clinical health education programs that expand educational programs focusing on medical information are eligible to receive grants, if they contribute matching funds of at least 50 percent of the cost of the program. In addition, the Stimulus Act authorizes the establishment of loan programs, administered by states and Indian tribes, to health care providers who facilitate the adoption of certified electronic health records technology. Like many other incentives, however, the entity receiving the grant must match the federal funds received with a percentage of the amount received.

Advancing and expanding the use of electronic health records across the United States is a top priority under the Stimulus Act. With financial incentives being provided to various groups to facilitate the shift to electronic records, and a renewed drive to develop uniform health IT standards, the goal of having all Americans’ health records in electronic format is more likely to be attained.

Scott N. Wolfe is the Chair of the Corporate Department and partner-in-charge of the San Diego North County office of Latham & Watkins LLP

Above article published on

http://www.xconomy.com/san-diego/2009/05/08/
a-brief-guide-to-stimulus-act-funding-for-health-information-technologies/

By now you’ve heard about the $850 billion American Recovery and Reinvestment act of 2009 - the stimulus bill recently passed by Congress. The bill is aimed at spurring economic growth across multiple industries by way of government spending.

What’s in it for you?

Well if you are a healthcare provider, you can take advantage of the $51 billion that has been allocated to the health care industry, $19 billion of which will be used to incentivize medical practices to adopt and implement Electronic Health Records (EHRs), also known as Electronic Medical Records (EMRs).

How does the subsidy work?
Starting in 2011, providers deemed to be “meaningful users” of EHR systems will be eligible to receive $40,000 - $60,000 in incentive payments paid out over five years in the form of increased Medicare and Medicaid premiums.

For the first year a physician is deemed to be a meaningful user, he or she will be eligible for payments of 75% of that year’s Medicare and Medicaid charges, up to a maximum of $15,000. The maximum payment is increased to $18,000 if the first year is 2011 or 2012. The incentive payments decline for each subsequent year within the five year period; $12,000 will be paid in year two, $8,000 in year three, $4,000 in year four, and $2,000 in year five.

No incentive payments will be available after 2015, and no payments will be offered to physicians who first become eligible after 2014. This creates a decreasing incentive for late adopters.

What is a “meaningful user”?
To qualify as a “meaningful user,” eligible providers must demonstrate use of a “qualified EHR” in a “meaningful manner.” The bill defers to the secretary of Health and Human Services (HSS) to set specific guidelines for determining what constitutes a “qualified EHR”; however, it does specify that e-prescribing, electronic exchange of medical records, and interoperability of systems will be determining criteria.

HSS will be working throughout 2009 to set the necessary criteria for certifying systems, and is expected to have a final report by January of 2010. Many expect CCHIT certification to play a major role in setting standards of interoperability. (See “Should CCHIT Influence Your EHR Selection” for more information). After all, HHS funded the creation of CCHIT to start certifying EHRs a few years ago.

How do I qualify for the maximum payment?
In order to receive the maximum payment, physicians must qualify as a meaningful user in 2011. Eligible physicians will receive a first year bonus of $18,000 (up from $15,000) and will max out the payment schedule over the next five years.

The table below illustrates the amount of a subsidy paid each year (columns) based on the year the provider first becomes eligible (rows):

No payments will be offered to physicians who first become eligible after 2014.

Practices with multiple physicians will be eligible to receive incentive payments for each provider. Remember that payments will be based on 75% of the correlating year’s Medicare and Medicaid charges. Therefore, in order to qualify for the maximum payment of $18,000 in the first year, each provider must bill Medicare or Medicaid a minimum of $24,000.

Should I purchase an EHR now or wait until 2010?
An obvious concern is whether an EHR implemented in 2009 will meet the standards set by HHS in 2010. Although a legitimate concern, waiting until 2010 to implement a system may be a mistake. Researching and selecting the right EMR can be a lengthy process, and many providers who wait may find it difficult to have a system in place in time.

Practices would be well-served to begin the research process now, allowing ample time to create a short-list of systems, perform demos with several vendors, check references, meet with vendors in person, negotiate terms, and complete the implementation and training process. To alleviate buyers’ concerns, vendors may provide binding agreements, guaranteeing their system will comply with all emerging standards.

Furthermore, buyers’ should consider CCHIT an important Certification relative to the requirement for “qualified EHRs.” While we have discussed the many opinions for and against CCHIT, we expect it to play a critical role in the EHR subsidy qualification.

What if I choose not to purchase an EHR?
Unfortunately, for physicians who choose not to implement an EHR, the stimulus bill is a double-edged sword. Not only will they forego thousands in incentive payments, but starting in 2015, they will be penalized by way of decreased Medicare and Medicaid payments. Physicians who fail to qualify as meaningful users will face decreases of 1% in 2015, 2% in 2016, and 3% in 2017, with a maximum reduction of 5% by 2020.

Above article published on

http://www.softwareadvice.com/articles/medical/
the-stimulus-bill-and-meaningful-use-of-qualified-emrs-1031209/

Care for uninsured, electronic records receive cash

The $4 billion in federal stimulus health care money headed to the Bay State over the next three years will help provide care for those who can’t afford it and - it is hoped - help stem hemorrhaging health care costs by funding new technologies.

The bulk of the health care stimulus funding - some $3.5 billion - will keep most safety net programs afloat with Medicaid/Federal Medical Assistance Percentage funds.

But a portion of the federal stimulus money is targeted for cost-saving innovations. Massachusetts is getting $1.3 billion in technology and research funds, with more than $500 million going toward eHealth initiatives in the commonwealth.

The initiatives will fund the creation of electronic patient records. State officials hope the federal investment will lead to a secure statewide database of patient information, or in government parlance, an interoperable Health Information Exchange.

The program could have a long-standing impact by providing doctors quick, seamless access to patient records, offering the possibility of savings in time, money and lives. Nationwide, some $19 billion will go to e-records programs with a goal of freeing a profession from an archaic paper-based system by 2014. President Barrack Obama has touted the potential costs savings from the program.

Massachusetts, which is ahead of many states in initiating electronic medical records, stands to gain from significant federal reimbursements.

Stimulus funds will be used to reward those who have already installed the record system and provide money to hospitals and physicians who implement it. The state would also penalize those who fail to upgrade to e-records.

Physicians who meet the state criteria for electronic files could receive reimbursements of up to $44,000 each over four years directly from the federal government. There are about 20,000 physicians in the state, according to the Department of Health and Human Services.

Partners Healthcare could be a big winner in the stimulus sweepstakes because it has already implemented a records system. With individual reimbursements for its 3,000 members, including teaching hospitals Brigham and Women’s and Massachusetts General Hospital, the health care consortium could receive from $10 million to $50 million.

The state’s Health Care Quality and Cost Council estimates that it takes a small medical practice an average of four months to adopt an EMR at an up-front cost of up to $40,000 per physician.

Up-front costs have been one of the biggest obstacles in creating an electronic system. But Massachusetts, which has nearly twice the national average of doctors using EMRs, could face an easier transition with quicker federal reimbursements.

“The adaptation in Framingham was smoother because there wasn’t an existing paper record, so our advisors picked it up very quickly,” said Paula Kaminow, executive director of the Framingham Community Health Center, which began using EMRs when it opened five years ago.

Community health centers are important centers of medical information because they serve a wide range of the population that doesn’t have personal physicians. Installation of electronic records in 12 centers could increase staff productivity, allow for expansion in the number of patients and ensure easier and faster sharing of patient information with hospitals.

“From a risk-management standpoint, it’s much easier for providers to find the information they need,” Kaminow said. “The handwriting is clean, you can find different chart notes very quickly and can integrate information from different sources.” The electronic system could save the nation $530 billion over 10 years, according to the Health Care Quality and Cost Council, which estimates that the stimulus’ national eHealth initiative could reduce the nation’s health care spending by up to 30 percent.

Kaminow said the most important characteristic for an electronic record is the ability to interface with other types of records.

“The challenge is to make sure that all the different pieces can speak to each other, such as a management system that can speak to an electronic health record or a lab report,” she said.

The central project for the state is the Health Information Exchange, which is not funded by federal dollars. The state’s newly established Health Information Technology Council will provide $15 million in initial funding to help install the exchange by 2014.

The exchange would combine electronic record projects for individual practices, hospitals and community health centers, sharing patient information in a secure statewide database. Anyone in the system treating a patient could quickly learn about the patient’s allergy data, medication and test results.

The IT initiative has another reward: job creation. Private sector jobs would grow among vendors installing database systems, with positions ranging from entry-level programmers to high-level project managers.

Massachusetts has a leg up in this respect with an already developed system of software and hardware vendors.

Although federal stimulus funds end after two years, the reimbursements that follow implementation of the systems could create jobs in the long term.

“We’re looking to bring on more staff and extend our hours,” Kaminow said. “After a start-up period, our costs are covered through billing, so in that way we’d be able to sustain increased employment.”

The other big slice of the health care stimulus pie is the $764 million coming to Massachusetts for this year and next.

Funds will be used primarily to maintain services - securing jobs, meeting health care standards and safety net services, with $190 million going to offset fiscal year 2009 budget holes, according to the Department of Health and Human Services.
Above article published on

http://www.thesunchronicle.com/articles/2009/05/12/news/4900258.txt

By TOM BREEN

Health care providers across the country are moving to replace their old paper records with sleek new electronic systems, a process the Obama administration wants to speed along with over $17 billion in stimulus dollars.

That’s a tall order for doctors and hospitals, because an estimated 90 percent of health care offices still stack their records in floor-to-ceiling shelves crammed with manila folders.

The administration’s goal is to implement systems that allow doctors and nurses instant access to patient records and to avoid harmful errors in prescriptions and medical charts. But some worry the software isn’t yet ready to replace the ease of use of paper records, and say the cost of the systems may be too steep.

Dr. Theodore Hole, a family physician in Ventura, Calif., said when he sees patients who have electronic records from other physicians, they’re often a collection of checked boxes and fill-in blanks that are meaningless to doctors outside of the group using the system.

Health care providers such as doctors and hospitals would be reimbursed by higher Medicare and Medicaid payments if they put the systems in place by 2011. Doctors can receive up to $60,000 and hospitals up to $11 million. If they don’t switch, they could see their Medicare and Medicaid dollars decline.

The health care industry has been moving toward electronic records for years, but the rate of adoption has been slow. Some providers are intimidated by startup costs, which can range anywhere from tens of thousands of dollars for a doctor’s office to $100 million for a large hospital.

“It’s not going to be enough to pay for it; it’s going to be enough to make you want to engage with it,” Sentara Healthcare Chief Information Officer Bert Reese said of the stimulus incentives.

The southeastern Virginia network of seven hospitals and hundreds of doctors is in the midst of a decade-long, $237 million conversion project, with all hospitals scheduled to be on board next year. The stimulus plan could mean as much as $40 million to the network, he said.

Though the systems vary, advocates say computerized records are safer and more efficient. There are fewer mistakes that come from trying to read handwriting, and anyone in a medical system can access the information. When a patient comes into the hospital complaining of chest pains, for example, emergency room staffers don’t have to hunt down past medical records for allergies, medications and other information because it’s immediately available on a computer screen.

The idea is also to shorten the time involved in basic procedures. Under a paper system, Sentara’s Reese said, a doctor entering a medication order for a hospital patient can expect to wait up to an hour before the first dose is administered. With electronic records zapping the order directly from the doctor to the hospital pharmacy, Reese said, it can take about five minutes.

The Obama administration believes converting to electronic medical records will improve patient safety and overall health as well as bring down costs across the spectrum from public to private care, according to the DHHS.

“It’s an excellent use of the stimulus money,” said Dr. Margaret Staggers, a Fayetteville physician who, as a member of West Virginia’s House of Delegates, will help determine how the plan shapes the state budget. All seven of West Virginia’s state-owned hospitals have the system in place. “Doctors are interested in getting these systems, but there’s so much upfront cost.”

Trinitas Hospital in Elizabeth, N.J., estimates it can get $11 million in stimulus funds for its $30 million electronic health records system, according to Ken Raske, president of the Greater New York Hospital Association, which represents about 300 hospitals in the Northeast.

“It’s not a bad down payment, but it gives you an idea of the proportion that comes from the stimulus package as opposed to the money they need to invest,” he said.

Still, conversion could be slow. An April article in The New England Journal of Medicine concluded there are no reliable estimates on how many hospitals have electronic records, mainly because providers have implemented systems with a piecemeal approach. But it estimates roughly 7.6 percent have at least a “basic” system. For physician practices, the figure is probably around 4 percent.

There are also questions about ease of use, maintenance, compatibility with other systems and keeping all that data secure. Perhaps most urgently, no one yet knows what systems will qualify for reimbursements and keep providers from seeing reduced Medicare and Medicaid payments.

Because of the uncertainty, it’s too soon to tell whether the stimulus plan is getting more providers to make the switch, said John Morrissey, spokesman for the Certification Commission for Healthcare Information Technology.

“With so many unanswered questions, it’s kind of ludicrous to go too far into it,” said Joe Letnaunchyn, president of the West Virginia Hospital Association. “You run the risk of spending money inappropriately.”

Above article published on http://www.businessweek.com/ap/financialnews/D9810JVG0.htm

By John Haughton, MD

The economicstimulus bills are a great step forward for health information technology and medicine.

The two bills, “HR1” and “S1,” continue to barrel down the legislative track and continue being amended, but as currently written they create real incentives for adopting certified electronic health records – upwards of $40,000 per physician starting in 2011.

The legislation emphasizes rewarding designs that improve care and create a path for certification of records with added functions, such as decision support, order entry, connections to other systems and reporting on quality measures. The bill focuses on implementation by tying the physician bonuses to proven, effective use. The stimulus package also formalizes the Office of the National Coordinator for Health information Technology (ONC).

Of the nearly $900-billion stimulus package, about $20 Billion would go to Health and Human Services, with $6 billion for the Office of the Secretary of Health and Human Services. Of that $6 billion, $2 billion would be for the Office of the National Coordinator (ONC) to support information technology.

The package also authorizes the Medicare Trust Fund to offer physicians financial incentives starting in 2011 to adopt and use certified electronic health records (C-EHRs). The incentives – in the form of a 75 percent increase in Medicare Part B fees — could add up to more than $40,000 per physician over a five-year period. But the payments would come only after physicians prove they effectively used the EHRs. In essence, the government says it won’t pay for equipment that never gets used. Physicians that haven’t adopted EHRs by 2016, will face financial penalties starting at 1% and escalating to 3% of Medicare Part B fees.

It looks as if there will be a new set of certification criteria for “qualified electronic health records” that meet the new features defined in the bill. Given the dollars involved, providers will want to adopt products that meet the bonus criteria. To do so, they must understand what is a “qualified record” and what it means to “effectively use” one.

The legislation defines a qualified electronic record as one that:

• Includes patient demographic and clinical health information, such as medical history and problem lists
• Has the capacity to provide clinical decision support; allow physician order entry; capture and query information relevant to health care quality; and exchange and integrate electronic health information with other sources.

The legislation leaves some of the ability to define meaningful use of the certified EHR up to the HHS regulators, but it requires the participating providers to submit clinical quality measures and be “connected for the electronic exchange of health information to improve the quality of health care, such as promoting care coordination.”

The bonuses for adoption and use break down to about $15,000 the first year and declining each year to about $2,000 in the fifth year, with a maximum payout of more than $40,000.

This economic stimulus bill offers real incentives for effective adoption of electronic systems designed to improve care. Physicians have meandered toward EHR adoption. It is inconclusive whether the slow uptake is due to reluctant physicians, lack of a business case for adoption of HIT, or insufficient system capabilities to improve care and save time.

Starting next year, we may finally get the answer. With the stimulus, the economy hopefully will get a significant jolt, and health care may reap a massive improvement boost as well.

http://www.thehealthcareblog.com/the_health_care_blog/2009/02/ stimulus-bill-offers-docs-big-incentives-for-technology-but-demand-effective-use-.html

Written by Patricia King

Editor’s note: Health care attorney Pat King outlines and explains provisions of the pending economic stimulus package that deal with electronic health records (EHR/EMR 1) use by physicians.

The American Recovery and Reinvestment Act of 2009 finally passed both houses of Congress this week. As this article is written, a final vote is expected on Saturday, February 14. While there are significant differences between the House² and Senate³ version in some areas, incentives for health information technology adoption by physicians and hospitals are substantially similar in both bills. The cost of incentives is estimated to be $17 billion in increased Medicare and Medicaid payments.

The Act uses the same “carrot and stick” approach adopted last year to encourage electronic prescribing. The incentive portion starts in 2011: a physician who is a “meaningful user” of electronic health records (EHR) is eligible to receive additional payments under the Medicare program that can extend over five years. The penalty portion starts in 2015, when physicians who are not meaningful EHR users will begin to see declines in their Medicare payments. Neither the incentive nor the penalty applies to hospital-based physicians.

Incentives for EHR use

For the first year that a physician qualifies as a meaningful EHR user, the physician is eligible for an incentive payment of 75% of his/her Medicare charges for the year, up to a maximum of $15,000 (the Senate bill provides that the ceiling is $18,000, if the first payment year is 2011 or 2012). The ceiling declines each year: $12,000 for the second year; $8,000 in the third year; $4,000 in the fourth year; $2,000 in the fifth year; and zero for subsequent years. Late adopters are penalized through phase down of the incentives: if the physician does not qualify as a meaningful user until 2014, then the payment ceiling for that physician’s first year is $12,000, the ceiling for the second year is $8,000, and so on. Under the House bill, there are no extra payments for physicians who do not qualify before 2015.

The Secretary of the Department of Health and Human Services (HHS) has discretion to determine whether the incentive payment will be paid in a single lump sum, or in installments. If the physician provides services to Medicare beneficiaries through more than one practice, HHS will determine how to allocate the incentive payment among the practices.

Penalties for not using EHR

Under the penalty provisions, physicians who are not meaningful EHR users in 2015 will see a 1% reduction in their fee schedule amount. The reduction increases to 2% in 2016, and 3% in 2017 and each subsequent year. If HHS finds that by 2017, the proportion of physicians who are meaningful EHR users is less than 75%, HHS may continue to ratchet down payments by 1% a year (but may not reduce payments below 95%). Hardship exceptions may be issued on a case-by-case basis, such as exceptions for physicians who practice in rural areas without adequate Internet access.

How to be considered an EHR user

To be a “meaningful EHR user”, the physician must satisfy three criteria:

• The physician must use “certified EHR technology” in a meaningful manner, including electronic prescribing. The law calls for creation of a health information technology (HIT) Policy Committee, and an HIT Standards Committee. The HIT Policy Committee will focus on development of a nationwide health information infrastructure, while the HIT Standards Committee will recommend standards, implementation specifications and certification criteria. The Office of the National Coordinator for Health Information Technology (ONCHIT) is to adopt an initial set of standards, implementation specifications and certification criteria before December 31, 2009.
• The physician must demonstrate that the certified EHR technology is connected in a manner that provides for the electronic exchange of health information to improve the quality of health care, such as promoting care coordination.
• The physician must submit information on clinical quality measures specified by HHS.

HHS will designate the way in which a physician is recognized as a meaningful user (through attestation, submission of claims with codes indicating that a patient encounter was documented using certified EHR technology, survey responses, submission of quality reports, or other means).

The Act also authorizes state Medicaid programs to provide additional payments to physicians, at least 30% of whose patient volume is services to Medicaid beneficiaries.

In addition to the incentive program, $2 billion is available to ONCHIT for implementation of the program, including grants to states to establish loan programs for physicians seeking to acquire certified EHR systems.

Above article published on http://www.netdoc.com/Physician-Practice-Articles/General-Medical
-Practice/Stimulus-package-and-EMR-use-by-physicians/