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

By, Diana Manos

CHICAGO – Officials of HIMSS Analytics, the not-for-profit subsidiary of the Healthcare Information and management System Society (HIMSS), announced Wednesday they would be adding new questions to their annual study on meaningful use to gauge hospitals’ readiness.

With hospitals expected to complete the first phase of deadlines for meaningful use by 2011 to qualify for bonuses under the American Recovery and Reinvestment Act of 2009, HIMSS Analytics will ask hospitals about their inclusion of structured document standards to convert narrative data to a structured format importable to an electronic medical record (EMR).

HIMSS Analytics tracks the EMR implementation status of more than 5,000 U.S., non-governmental hospitals through its annual study with hospital CIOs. The data gathered provides a detailed look at the clinical and financial application environments in U. S. hospitals.

HIMSS Analytics also developed the Electronic Medical Record Adoption ModelSM - or EMRAM - to score hospitals in the HIMSS Analytics Database on their .progress in completing the eight stages to creating a paperless patient record environment.

“In our evaluation of EMR Adoption Model scores over 2008-2009, we found that hospitals are continuing to advance the care delivery capabilities of their EMR environment,” said John Hoyt, vice president of HIMSS Healthcare Organizational Services.

“ARRA funding incentives are driving EMR implementation,” Hoyt said. “With this expanded arsenal of data, HIMSS Analytics can help healthcare providers better understand and follow the Meaningful Use requirements while moving higher on the EMRAM scale.”

According to Liora Alschuler executive committee representative of the Health Story Project, which helped write the new questions for HIMSS Analytics, much of the information in a patient’s medical record may be entered by the physician or nurse in chart form, such as notes taken during a clinic visit, lab reports or other information that contributes to the completeness of individual health history.

Health Story produces data standards for the flow of information between common types of healthcare documents and electronic medical records, Alschuler said.

Alschuler, principal, at Alschuler Associates, LLC, said the Health Story standards are based on HL7 Clinical Document Architecture reusing templates from the Continuity of Care Document. The Health Story Project, founded a little over two years ago, is a nonprofit collaborative of healthcare vendors, providers and associations.

“The members of Health Story believe that all of the clinical information required for good patient care, administration, reporting and research should be readily available electronically, including information from narrative documents,” Alschuler said. “With the data gathered from the HIMSS Analytics Study, we will know how hospitals are using document standards to enrich the flow of information to their EMRs.”

Officials at HIMSS Analytics said they expect to begin reporting on hospital readiness for meaningful use in September 2010.

Source: http://www.healthcareitnews.com/news/himss-analytics-gauge-hospital-readiness-meaningful-use

By Neil Versel

If nothing else, it should at least be easy to register to receive federal incentive payments for meaningful use of EMRs.

CMS has awarded a $1.6 million contract to CGI Federal, a Fairfax, Va.-based unit of Montreal-based technology consulting firm CGI Group, to revise the existing Provider Enrollment Chain Ownership System (PECOS) so physicians and hospitals can attest to meeting the requirements for meaningful use that will qualify them for Medicare bonuses. PECOS currently manages and verifies enrollment of Medicare providers and vendors.

Build-out of the online system to accommodate EMR incentive enrollment should take about 10 months, CMS says. Hospitals, however, could be eligible for the bonuses as soon as the end of December, since the rules for meaningful use, as currently proposed, only requires providers to meet the standards for 90 consecutive days in 2011. Medicare Part A, which applies to inpatient care, follows the federal fiscal year, which begins Oct.1.

For more information:
- see this Government Health IT story
- read this CMS notice about the contract award

Above article publish on http://www.fierceemr.com/story/providers-will-attest-meaningful-use-cms-registration-system/2010-04-22

By Neil Versel

A short implementation timeline, a perceived lack of attention to specialists and, naturally, financial concerns, have critics believing that the federal stimulus won’t be enough to convince many doctors adopt EMRs. At a two-day meeting of the Health IT Policy Committee that wrapped up yesterday, physicians in small practices, and who work in underserved communities, said that there are too many problems with the proposed definition of “meaningful use” of health IT for the American Recovery and Reinvestment Act to have its intended effect of increasing efficiency and boosting the quality of care.

The American College of Obstetricians and Gynecologists expressed the view that the requirements, as proposed in July, are not related to EMR adoption within its particular specialty. “The meaningful use measures for ARRA should determine whether a physician has met the objectives shown in the meaningful use matrix, not whether the EMR is being used to report clinical quality measures that rarely apply to that physician’s patients,” ACOG representative Dr. Albert L. Strunk testified, according to Healthcare IT News.

A hospital CEO from Nebraska said that the new EMR requirements would hinder an existing quality improvement strategy. Community hospitals, this witness said, also would like to see more specificity about interoperability to make sure the hospital can communicate electronically with independent physicians.

Above article published on http://www.fierceemr.com/story/hit-policy-committee-hears-critics-meaningful-use-proposal/2009-10-29

By Neil Versel,

National health IT coordinator Dr. David Blumenthal isn’t allowed to say what the final rules for meaningful use of EMRs will look like until HHS releases its formal proposal, but every time he gives a speech, he drops a new hint or two about what he’s thinking. Monday in San Francisco, Blumenthal largely gave attendees at the American Medical Informatics Association’s annual symposium what they wanted to hear by reiterating his philosophy that technology simply is an enabler of quality improvement, not a panacea for healthcare.

“The meaningful use framework will be about the goals of care, not the technology,” Blumenthal said. While he didn’t elaborate on that statement, he did state the position of the Obama administration–one largely held by the informatics community, if not the broaded healthcare industry–that the billions of dollars in federal subsidies aren’t simply meant to buy EMRs for providers. “It’s not the money that will turn out to be the most important,” Blumenthal said.

Instead, the net $19 billion investment is a way to demonstrate that EMRs should and will be accepted in the fairly near future as “symbolic of professionalism in medicine,” just as much as the stethoscope or examination table are today. “The idea that government should subsidize health IT will be as foreign an idea that the government should buy stethoscopes or exam tables for doctors,” Blumenthal explained.

“Information is really the lifeblood of medicine,” Blumenthal added. “Health information technology is its circulatory system.”

During the Q&A portion of the session, legendary medical informaticist Dr. Clement McDonald, the longtime director of the Regenstrief Institute for Health Care in Indianapolis and now the head of the Lister Hill National Center for Biomedical Communications of the National Library of Medicine, questioned this analogy. McDonald said HHS should approach health IT the way the Environmental Protection Agency regulates water quality. “Put a little onus on the polluters,” McDonald said, referring to providers of “dirty” data that’s useless. He drew a small round of applause.

Above article published on http://www.fierceemr.com/story/meaningful-use-will-focus-goals-care-not-technology-blumenthal-says/2009-11-16

By Neil Versel

Dr. David Blumenthal has been national coordinator for health information technology for a little more than six months now, and for all the health IT meetings I go to, teleconferences I listen in on and webinars I participate in, Wednesday was the first time I’d had the opportunity to hear him speak.

In delivering the opening keynote to the College of Healthcare Information Management Executives (CHIME) Fall CIO Forum in Indian Wells, Calif., Blumenthal didn’t break a whole lot of new ground, but he did bring the national EMR strategy into sharper focus, give an update on some progress within the federal government, demonstrate his deep passion for healthcare quality improvement, and even put the vendor community on notice. (See the story in this week’s issue for more on his vendor-related comments.)

“You all are the very core of our success,” Blumenthal told this gathering of CIOs in the California desert. It was nothing they didn’t already know. He did say, however, that even without the healthcare reform being debated in Washington right now, the HITECH Act–the health IT portion of the American Recovery and Reinvestment Act–still is “unprecedented” in the scope of change it will effect.

Blumenthal highlighted four things that flow from HITECH: “meaningful use” of EMRs–something we all know about; the Health IT Policy Committee and Health IT Standards Committee to advise HHS; privacy and security of health data, symbolized by the tightening of HIPAA; and, of course, the federal subsidy program. Blumenthal believes that the last point probably gets more attention than it deserves. “There’s the money, which is important, but it isn’t the whole thing,” he said.

“What Congress has basically asked us to do with this legislation is to change the practice of medicine,” Blumenthal said. “It’s really a matter of change management rather than technology.”

Blumenthal is prohibited by federal ethics standards from discussing deliberations on the forthcoming parameters for meaningful use, but he reiterated that a proposed rule will be out by the end of the year, and that HHS is still on target to finalize the definition next spring, following a 60-day public comment period on the proposal. He also said that his office is talking with other federal agencies with experience encrypting and securing sensitive electronic data, something that will be hugely important in healthcare as more patient information is computerized.

Blumenthal added that the health IT extension centers will be modeled after the long-established USDA Agricultural Extension Service. “This is all about technology transfer from government to industry,” he said. He also called on the hundreds of healthcare CIOs in attendance to provide leadership and educate hospital CEOs about the importance of

Above article published on http://www.fierceemr.com/story/blumenthal-doesnt-tip-hand-meaningful-use-highlights-non-financial-aspects-arra/2009-10-29#ixzz0WdXFxKVB

By Mary Mosquera

The National Institutes of Health awarded Kaiser Permanente $54 million in grants for projects that will tap clinical information from the provider’s mammoth electronic health record database to study links between genes and conditions such as heart disease, obesity, diabetes and aging.

The NIH funding originated with the HITECH Act, which allocated $400 million to NIH to support comparative effectiveness research.

The largest of the 22 awards provides $24.8 million to study the influence of genes and the environment on health, disease and longevity over time and across diverse groups of people. The grants will fund genotyping of 100,000 Kaiser members in Northern California. The University of California in San Francisco is also a partner in the research.

The analysis will link genetic information with historical clinical data taken from health surveys and Kaiser’s electronic health record database, according to Raymond Baxter, senior vice president for Kaiser. Researchers will add to the study environmental information, such as air and water quality and proximity to parks and healthy foods.

Dr. Richard Hodes, NIA director of the National Institute on Aging, said genetic information generated by the project may help researchers discover genetic factors that explain differences between people in response to medications.

“This would help doctors provide patients with the best medicines for them individually,” he said.

The grant package included $7.2 million in funding to develop a cardiovascular surveillance system for a collaborative of 14 different health plans across the U.S.

A $3.3 million grant will create a National Research Database to organize Kaiser Permanente’s electronic health records.

A $1,005,372 portion of the funding will be used to integrate the Kaiser Permanente electronic medical record to measure rehabilitation outcomes for stroke patients. Another $99,971 was allocated to study the use of natural language processing to extract data from the electronic medical record.

Above article published on

http://www.govhealthit.com/newsitem.aspx?tid=10&nid=72202

By Neil Versel

The Health Resources and Services Administration is allocating some of its $2 billion in federal stimulus funding to help safety-net healthcare providers purchase EMRs and other health IT. This week, the HHS agency awarded $27.8 million in grants to 27 organizations that serve low-income and uninsured populations. The majority of the money–$22.6 million, covering 18 grants–will go toward EMR implementation projects. Another five of the grants are meant to help organizations that already have EMRs use their systems to improve patient outcomes, while others will go toward health information exchange.

“The grants make sure that our most vulnerable citizens will benefit from health information technology,” national health IT coordinator Dr. David Blumenthal says. The Office of the National Coordinator for Health Information Technology will coordinate the awards alongside the $1.2 billion ONC is allocating to state-level health information exchange and health IT extension centers.

Above article published on

http://www.fierceemr.com/story/hrsa-grants-will-support-emrs-safety-net-clinics/2009-10-01#ixzz0TiERtHS7

By Wendy Johnson

Physician practices and hospitals that have yet to select or implement an EMR system should get a move on. Those who wait until next year will face a “high risk” of failing to achieve “meaningful use” of health IT in time for the 2011-12 federal incentives, Mark Leavitt, chairman of the Certification Commission for Healthcare Information Technology, warned at the annual AHIMA conference on Monday in Grapevine, Texas.

“You’re dreaming if you think you can achieve it in less than a year,” Leavitt said, referring to hospitals. Achieving meaningful use of an EMR system will take at least 18 months, if not two years, he warned.

HHS expects to publish its criteria for certification of EMRs under the American Recovery and Reinvestment Act, as well as its definition of “‘meaningful use” for qualifying for ARRA Incentives, by the end of the year. Both measures should be finalized by spring 2010 after a public comment period. All told, the federal government will pony up $34 billion in incentives for meaningful use of certified EMR technology–the equivalent of what the U.S. spent to send the first man to the moon, Leavitt said.

Above article published on

http://www.fierceemr.com/story/dont-wait-until-next-year-implement-emr-leavitt-warns/2009-10-06#ixzz0TiG540KQ

HHS Secretary Kathleen Sebelius today announced awards totaling $27.8 million to health center-controlled networks and large multi-site health centers to implement electronic health records (EHR) and other health information technology (HIT) innovations. The funds are part of the $2 billion allotted to HHS’ Health Resources and Services Administration (HRSA) under the American Recovery and Reinvestment Act of 2009 (ARRA) to expand health care services to low-income and uninsured individuals through its health center program.

“The increased use of health information technology is a key focus of our reform efforts because it will help to improve the safety and quality of health care generally while also cutting waste out of the system,” said Secretary Sebelius.

“These funds to expand and upgrade electronic health records systems will make a huge difference for health centers struggling to provide health care to the growing number of people in need,” said HRSA Administrator Mary Wakefield, Ph.D., R.N.

“Broad use of health information technology has the potential to improve health care quality, prevent medical errors, and increase the efficiency of care provision,” added David Blumenthal, National Coordinator for Health Information Technology. “This program supports the Department’s overall efforts to assist physicians and hospitals in adopting and becoming meaningful users of health information technology.”

Eighteen grants totaling more than $22.6 million will support EHR implementation. Grants totaling more than $2.6 million will help four grantees implement a variety of HIT innovations, including the creation of health information exchanges among different providers and the incorporation of HIT at dental delivery sites. Another five grants totaling over $2.5 million will help health centers devise plans to use existing EHRs to improve patient health outcomes.

HRSA received $2 billion through the Recovery Act to expand health care services to low-income and uninsured individuals through its health center program. To date, more than $1.3 billion of these funds have been awarded to community-based organizations across the country. HRSA-supported health centers treated 17 million patients in 2008, 40 percent of whom have no health insurance.

In addition, HRSA received $500 million in Recovery Act workforce funds—$300 million to expand the National Health Service Corps (NHSC) and another $200 million for other health care workforce programs. The NHSC funds will pay for student loan repayments for primary care medical, dental, and mental health clinicians who will practice for a minimum of two years in NHSC sites that treat underserved and uninsured people. Recently, awards totaling $33 million—part of the $200 million total—were announced to expand the training of health care professionals.

The list of grant recipients follows:

alth Resources and Services Administration (HRSA), part of the U. S. Department of Health and Human Services, is the primary Federal agency for improving access to health care services for people who are uninsured, isolated, or medically vulnerable.  For more information about HRSA and its programs, visit www.hrsa.gov.

Above article published on

http://www.hhs.gov/news/press/2009pres/09/20090929a.html