WASHINGTON – Federal officials released the final rule on meaningful use Tuesday, which will allow physicians and hospitals to qualify for thousands of dollars in stimulus funding incentives for the adoption of electronic health records.

The 864-page final rule, several weeks late from its anticipated delivery before June 21, outlines the specific qualifications providers must meet to achieve the meaningful use of electronic health records.

At a news conference Tuesday morning, federal healthcare officials praised the advance of electronic health records, while acknowledging the difficulties providers face at the onset of adoption.

According to David Blumenthal, MD, national coordinator for health information technology, the final rule differs from the proposed rule issued last January: It allows providers more flexibility in choosing which measures to use for qualifications.

According to Blumenthal, the proposed rule required doctors to comply with 23 measures, and hospitals 25 measures. The government received more than 2,000 comments on the rule, many of them asking for more flexibility in allowing clinicians to qualify.

Blumenthal said the final rule took those comments into account. The final rule requires doctors to comply with a set of 15 core objectives during the first year - or Stage 1- of adoption. Hospitals are required to comply with 14 core objectives. In addition to the core objectives, both hospitals and doctors will have to choose five more objectives from a “menu” of 10, he said. The remaining objectives will be deferred to Stage 2 of adoption.

The final rule also reduced the number of electronic prescriptions a doctor is required to make from 75 percent to 40 percent, Blumenthal said.

Kathleen Sebelius, Department of Health and Human Services Secretary, said the Federation of American Hospitals is an “enthusiastic supporter” of the new rule. The federal government hopes other groups will join them, she said.

Blumenthal, a physician, said he is confident the use of electronic health records will become a core professional competency among physicians, who will eventually lead the way in adoption. Until then, the government will encourage healthcare IT adoption through financial incentives, such as these set up under the meaningful use rule. The government will also supply “shoulder-to-shoulder” support for providers through the regional extension centers.

Key changes in the final CMS rule include:

• Greater flexibility with respect to eligible professionals and hospitals in meeting and reporting certain objectives for demonstrating meaningful use. The final rule divides the objectives into a “core” group of required objectives and a “menu set” of procedures from which providers may choose any five to defer in 2011-2012.  This gives providers latitude to pick their own path toward full EHR implementation and meaningful use.
• An objective of providing condition-specific patient education resources for both EPs (eligible providers) and eligible hospitals and the objective of recording advance directives for eligible hospitals, in line with recommendations from the Health Information Technology Policy Committee.
• A definition of a hospital-based EP as one who performs substantially all of his or her services in an inpatient hospital setting or emergency room only, which  conforms to the Continuing Extension Act of 2010
• CAHs (critical access hospitals) within the definition of acute care hospital for the purpose of incentive program eligibility under Medicaid.

A CMS/ONC fact sheet on the rules is available on the CMS Web site.

Source :  http://www.healthcareitnews.com/news/flexibility-built-final-rule-meaningful-use

By Asrat Kebede

Nearly $1.2 billion in economic stimulus law funds are now available as grants for health information technology, Vice President Joe Biden announced today. About half of the funding will go to establish dozens of regional education centers across the country, and the other half will help state agencies set up health information exchange systems.

Congress approved the funding as part of the economic stimulus law to promote the adoption of electronic health record (EHR) systems. Lawmakers included $45 billion in incentive payments to doctors’ offices and hospitals that buy and meaningfully use digital health records, and $2 billion to promote health information exchange.

The Health and Human Services Department will issue rulemaking later this year to define the terms of certification and meaningful use.

“With electronic health records, we are making health care safer; we’re making it more efficient; we’re making you healthier; and we’re saving money along the way, ” Biden said in a statement today.

Grants totaling $598 million will be used to get 70 Health IT Regional Extension Centers up and running. The centers will give hands-on help to doctors and hospital staff in selecting, acquiring and deploying certified EHR systems.

An additional $564 million in grants is available to states to support the development of mechanisms for sharing of patient medical information within a framework of an “emerging nationwide system of networks,” the statement said.

Both sets of grants will be issued starting in fiscal 2010. The extension program grants will be awarded on a rolling basis: 20 in the first quarter of the fiscal year, 25 in the third quarter, and the remainder in the fourth quarter.

HHS will dedicate $50 million to creating the Health IT Research Centers will help the regional extension center identify and share best practices and collaborate with each other, the statement said.

The centers together will support at least 100,000 primary care providers, through participating nonprofit organizations, in achieving meaningful use of EHRs, the statement said.

The health information exchange grants will be awarded through the State Health Information Exchange Cooperative Agreement Program. States may choose to enter multistate arrangements. State agencies will be required to provide matching funds starting in 2011.

A group sponsored by the National Governors Association recently advised state agencies to begin their planning on health information exchanges, which will be required to achieve meaningful use of digital health records.

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Two weeks ago, the Obama administration offered nearly $1.2 billion in stimulus-funded grants to set up state-run health information exchanges, and create 70 “health IT regional extension centers” to help physicians adapt to the digital era, a term officials defined in greater detail during a conference call late last week, Modern Healthcare reports. “As many as 1,250 participants logged- or dialed-in to hear and ask questions about the ground rules to apply” for the grant money “to be awarded over a four-year period to about 70 not-for-profit organizations that will run the regional extension centers.”

The centers will spend more than $500,000 a year, mostly on services for physicians; serve approximately 1,000 doctors each, mainly at smaller primary care offices; help doctors select an effective electronic record system; help them implement it and achieve “meaningful use,” the administration’s requirement for doctors hoping to get other stimulus payments; provide “in-depth” technical support on “a narrow list of vendor systems.” A caller pointed out that the government’s role in recommending and supporting individual, private vendors raised a potential conflict of interest for state officials choosing the potential grantees that will set up the centers.

Half of the grant money will go directly to states to help establish “a widespread and sustainable health information exchange,” American Medical News reports. “Legal, financial and technical support is necessary to enable secure exchange of sensitive patient data across health care systems, according to HHS. The program will help fund efforts at the state level to implement directories and technical services to enable interoperability within and across states. Some health IT experts say such assistance is vital in helping physician practices become meaningful users”.

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By Anne Zieger

The Agency for Healthcare Research and Quality has announced that it will provide a series of grants totaling $48 million that can be used to develop national patient registries for comparative effectiveness research. Clinical registries are one of a number of approaches to helping providers identify the long-term effects of treatments, along with clinical data networks and other forms of health IT networking.

This is part of a larger $300 million grant and contract package designed to fund comparative effectiveness projects funded by the federal stimulus package. The AHRQ will offer grants to study treatment benefits focused on 14 common conditions, including diabetes, obesity and heart and blood vessel problems.

AHRQ will also seek $74 million in contracts for analyzing and generating evidence, along with $19.5 million to establish an infrastructure for identifying the right treatment issues to focus on as part of comparative effectiveness reviews.

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As the Obama administration works to garner support for healthcare reform, about $1.2 billion in grants were announced on Friday to help hospitals and healthcare providers implement and use electronic health records.

Announcing the grants in Chicago, US Vice President Joe Biden said the $1.2 billion would be funded by the $787 billion economic stimulus plan.

“With electronic health records, we are making health care safer; we are making it more efficient; we are making you healthier; and we are saving money along the way. These are four necessities we need for healthcare in the 21st-century,” Biden said during an appearance at a hospital with Health and Human Services secretary Kathleen Sebelius.

Expanding the use of electronic health records is fundamental to reforming the country’s healthcare system, Sebelius said, adding that electronic health records would help reduce medical errors, make healthcare more efficient and improve the quality of medical care for all Americans.

“You are going to be able to save a lot more lives and save tens of billions of dollars,” Biden told about 100 medical professionals.

Of the total money, $598 million would be used to establish 70 health information technology regional extension centers, which would help hospitals select and implement electronic health record systems.

Grants totalling $564 million would go to States and Qualified State Designated Entities to support the development of mechanisms for information sharing within an emerging nationwide system of networks.

The grants would be awarded beginning fiscal year 2010. Biden also expressed confidence that the healthcare legislation would be passed.

“Soon we are all going to get much better health care at a more rationale price…We are not taking the system that works away from any American. We are making the stuff that doesnt work, work better,” he added.

Pointing out that the economic stimulus package is working to improve the economy, Biden said, “We stopped the free fall. Now we are beginning to ascend again”.

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The U.S. healthcare system works better for insurance companies than it does for citizens, President Barack Obama wrote in a New York Times op-ed piece Sunday.

Obama said Congress must pass healthcare reform this year to weaken the power of insurance companies and protect the millions of U.S. residents who lack insurance or pay too much for it.

“If we maintain the status quo, we will continue to see 14,000 Americans lose their health insurance every day,” Obama wrote. “Premiums will continue to skyrocket. Our deficit will continue to grow. And insurance companies will continue to profit by discriminating against sick people.”

Under his administration’s plan, those without health insurance would have a choice of affordable coverage whether they move, change jobs or lose their job, he said.

Healthcare costs would be reduced by cutting hundreds of billions of dollars in waste from Medicare and Medicaid while eliminating unwarranted subsidies to insurance companies, Obama wrote, adding Medicare would be made more efficient by ensuring tax dollars go directly to care for seniors instead of going to insurance companies.

“I don’t believe anyone should be in charge of your healthcare decisions but you and your doctor — not government bureaucrats, not insurance companies,” Obama said.

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By Joseph Conn

Another month, another matrix in the development of definitions of “meaningful use,” the key criteria providers must meet to unlock tens of billions of dollars of federal healthcare information technology subsidies under the American Recovery and Reinvestment Act of 2009.

The Health Information Technology Policy Committee, a creature of the stimulus law, received a third set of recommendations from its meaningful-use work group. The recommendations were again detailed, as were their predecessors handed over by the group in June and July, in a spreadsheet or “matrix” format.

The HIT Policy Committee accepted the recommendations, which under the order of events set out in the stimulus law the committee will forward to the Office of the National Coordinator for Health Information Technology at HHS, which will hand them over to the CMS for official rulemaking. All of these hand-offs will occur fairly seamlessly since David Blumenthal, the physician head of the ONC, is chairman of the HIT Policy Committee and Tony Trenkle, director of the Office of eHealth Standards and Services at the CMS, is a policy committee member. Both men attended Friday’s meeting.

This latest batch also stuck to the original staging schedule first proposed by the work group in June of creating three sets of increasingly more complex meaningful-use criteria, which hospitals and office-based physicians must meet to qualify for the subsidy payments. The matrix includes a dozen broad goals, more specific objectives and proposed metrics by which compliance with the goals and objectives can be measured. The lowest bar is set for 2011, the first year electronic health-record subsidy payments can be made under the Medicare portion of the technology funding program.

For example, one care goal is to provide a patient healthcare team access to “comprehensive patient health data.” In 2011, one objective proposed for meeting that goal is a requirement that all hospitals use computerized physician order entry, or CPOE, systems for at least 10% of orders by doctors, nurses and physician assistants. By 2013, the work group proposed raising the bar, requiring that 100% of hospital orders be initiated using CPOE. In 2015, the objective switches from using a specific system, CPOE, to achieving “minimal levels of performance” that can be measured using clinical outcomes standards to be agreed upon sometime between now and then.

The other highlight of the meeting was the report and recommendations by the policy committee work group on EHR system certification and adoption. Under the stimulus law, only certified EHR systems qualify for federal subsidies, and only if they are used in a “meaningful manner.” In the past, the federal government deemed the certification of an EHR by the not-for-profit Certification Commission for Health Information Technology as good enough to meet its certification requirements for Stark and anti-kickback exceptions for EHR subsidies made by hospitals to office-based physicians. CCHIT took its cues on certification criteria from the American Health Information Community, the Bush administration’s counterpart to the HIT Policy Committee, and developed a program that tested vendors’ products on their ability to perform more than 300 functions.

But the stimulus act, which became law in February, did not specify that CCHIT would be even an acceptable certification body for EHRs for stimulus law subsidies, much less the only certification body with deeming authority as in the past.

To guide the new way forward, the certification and adoption work group made five recommendations, which were accepted by the policy committee.

First, the group recommended that certification under the stimulus law should focus solely on the functions needed to meet the meaningful-use standards. The statute provides eight specific areas that the HIT Policy Committee must consider in making its recommendations on meaningful use, plus 10 other areas that the policy committee might also consider.

Still, at least initially, the number of criteria against which systems will be tested under the stimulus law is likely to be far fewer than the 300 or so in the most recent CCHIT testing regime. In June, CCHIT announced its intention to continue to offer its comprehensive testing program, but also would add new testing and certification schemes tailored to the meaningful-use criteria as they are developed.

Second, according to the recommendations, progress needs to be made on testing and certifying systems that have the functionality to meet privacy, security and interoperability requirements called for in the stimulus act. Those include some amendments to the federal privacy law under the Health Insurance Portability and Accountability Act of 1996, such as the requirement that the systems be able to produce and report audit trails of where and when disclosures of patient information has been made, and to manage patient consents to release information, including a new authority that patients can block the release of their treatment information to their insurance company if they pay for treatment out-of-pocket.

Third, the work group recommended generally that the certification process be made more objective and transparent, with a specific recommendation that the federal National Institute of Standards and Technology, an agency of the Commerce Department, be tasked with helping the ONC develop a process to establish a separate and independent accreditation procedure for certification organizations such as CCHIT and any additional organizations that might join CCHIT in certifying EHRs to stimulus law criteria.

Fourth, the work group suggested that the certification process needs to be standardized so there is a level playing field for all seekers of EHR certification, whether they are commercial vendors of proprietary software systems, provider organizations that have developed home-grown systems, or communities or service providers of open-source EHR systems.

Finally, the work group recommended that the ONC and the CMS leverage as much as possible the work that has been done to date developing a certification program. Since an initial, official definition of meaningful use isn’t expected from the CMS until early next year, the work group recommended establishing a “preliminary certification process” so vendors can begin preparing their systems to what will be a likely set of criteria. CCHIT, for example, has prepared an analysis of its current testing and certification criteria and how they stack up against what might be expected to meet meaningful use under a new certification regime.

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By Mary Mosquera

The Obama administration is expected to announce as early as Friday plans to award a series of grants to assist healthcare providers acquire and use health IT properly as well as to help states set up health information exchanges.

National health IT coordinator Dr. David Blumenthal is scheduled to join Vice President Joe Biden and HHS Secretary Kathleen Sebelius Aug. 20 for a discussion with physicians, nurses and administrators from Chicago’s Mt. Sinai Hospital. They are expected to discuss health reform, including health IT infrastructure and preventative care, according to a White House statement.

The American Recovery and Reinvestment Act provided the Office of the National Coordinator $2 billion to promote the meaningful use of health IT. Up to $300 million was intended to help establish state HIEs; another share would fund regional training centers to help physicians and hospitals incorporate health IT into their practices.

In an e-mailed statement today, Blumenthal laid out the administration’s case for the importance of the health IT funding targets.

Nationwide electronic HIE “provides the best opportunity for each patient to receive optimal care,” Blumenthal said. The technology will make patients’ complete medical information securely available to their health care providers where and when it is needed, “when clinician and patient are together facing medical decisions that can make a lasting difference.”

“My personal belief in this transformation is not based on theory or conjecture,” said Blumenthal, who has been a primary care physician for 30 years.

“I spent the first 20 shuffling papers in search of missing studies and frequently hoping, during middle-of-the-night emergencies, that I knew enough about patients’ medical histories to make good decisions. All that changed when I began to have access to patients’ electronic medical records,” he said, adding that it made him a better doctor. He started using electronic records 10 years ago.

With the U.S. spending $2.5 trillion annually on healthcare, it is clear that change is necessary, he said. “Better, faster, more reliable and efficient care also ultimately reduces system-wide costs,” he said.

To realize the benefits of a nationwide health information system will also require that personal health information remain private and secure. “Putting into place safeguards for the privacy and security of this information, when it is in electronic form, will be an ongoing priority that influences and guides all of our efforts,” he said.

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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.

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State governments around the country are working to facilitate, and in some cases, enhance, Washington’s stimulus-funded incentives for doctors and hospitals that adopt new health information technology. “A group of the nation’s governors and state officials has released a guide for state implementation of the Health Information Technology for Economic and Clinical Health Act,” the formal name for the portion of the stimulus bill, McKnight’s Long-Term Care News reports. A key recommendation is that state leaders create health information exchanges so providers can readily share information to improve coordination of care (8/7).

Meanwhile, members of the National Lieutenant Governors Association called for support of “advance interoperable health IT and its adoption among providers” in a resolution this week, Modern Healthcare reports. They call on states to adopt systems with the stamp of approval of the Certification Commission for Health Information Technology, a group affiliated with an e-health industry association (DerGurahian, 8/6).

Louisiana went a step further with “a bill that would create a loan program for physicians and hospitals hoping to buy an electronic health record system,” American Medical News reports. The state health department will seek other stimulus funding to seed the loans. The bill also will create the Louisiana Rural Health Information Exchange (Dolan, 8/6). (Other states, such as Maryland, have taken similar action in recent weeks).

At the local level, Florida officials are reviving two e-health projects in the Miami and Palm Beach areas to pursue the stimulus funding, the Sun-Sentinel reports. One project, run by the South Florida Health Information Exchange, had succeeded in digitizing the records for dozens of clinics and setting up protocols to share them with a local hospital, before funding dried up and the program became dormant (LaMendola, 8/6).

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