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

Diana Manos, Senior Editor

The Centers for Medicare and Medicaid Services is now releasing healthcare IT funding from the stimulus package to state Medicaid programs.

According to a CMS letter mailed Wednesday to state Medicaid directors, the American Recovery and Reinvestment Act enables the government to pay a 100 percent federal financial participation (FFP) match to states that help Medicaid providers adopt, implement or upgrade certified electronic health record technology to demonstrate meaningful use.

It will also pay a 90 percent FFP match to cover a state’s administrative costs for running an HIT Medicaid incentive program. States may now request the 90 percent FFP match for administrative planning activities, according to the letter.

Medicaid directors should contact their CMS regional office for further guidance and maintain ongoing communication while initiating planning activities. State health IT incentive programs should be part of larger statewide efforts to promote healthcare IT use and exchange.

CMS advised states who plan to apply for a FFP match to plan how they will audit their healthcare IT incentive payment programs for errors.

CMS is working on a final rule, due by the end of the year, with more information on how Medicaid providers will have to show meaningful use to qualify for health IT incentive payments.

Above article published on

http://www.healthcareitnews.com/news/states-can-now-apply-health-it-medicaid-funding-cms-says

Today, the Health IT Policy Committee approved a work group’s revised recommendations for defining “meaningful use” of electronic health records, Health Data Management reports.

The federal economic stimulus package requires hospitals and physicians to demonstrate meaningful use of EHRs to qualify for Medicare and Medicaid incentive payments.

The work group released its initial draft recommendations last month.

Revised Benchmarks

For the new recommendations, the work group revised objectives for EHRs to meet by certain deadlines. The revised 2011 criteria call for qualified health care providers to:

• Allow patients to access their health records in a timely manner;
• Develop capabilities to exchange health information where possible;
• Implement at least one clinical decision support rule for a specialty or clinical priority;
• Provide patients with electronic copies of discharge instructions and procedures;
• Submit insurance claims electronically; and
• Verify insurance eligibility electronically when possible.

The group also called for health care providers to allow all patients to access personal health records by 2013, two years earlier than under the initial recommendations.

In addition, the revised recommendations include an objective for all providers to participate in a national health data exchange by 2015.

Sliding Scale

For the new recommendations, the work group suggested that health care providers could meet the EHR adoption benchmarks on a shifted timeline.

For example, if a health care provider first started implementing health IT processes in 2012, the 2011 criteria would apply to the provider’s first adoption year. The 2013 criteria then would apply to the provider’s third adoption year.

CPOE

The work group also clarified criteria related to computerized physician order entry systems.

The new recommendations call for health care providers to use CPOE systems for 10% of all orders of any type.

However, the work group did not offer guidance on whether the 10% requirement would apply to each individual order type or all orders in total.

HIPAA

In addition, the new recommendations clarify how violations of the HIPAA medical privacy rule could affect incentive payments.

The work group recommended that CMS withhold incentive payments from health care providers until HIPAA violation charges are resolved.

Next Steps

The revised meaningful use recommendations now go to the Office of the National Coordinator for Health IT and other HHS units.

HHS will use the recommendations to help shape regulations regarding the federal incentive programs.

The federal government is expected to release a proposed rule by the end of 2009 (Goedert, Health Data Management, 7/16).

Blumenthal Notes Progress on Health IT

In related news, National Coordinator for Health IT David Blumenthal on Wednesday said HHS is moving forward on efforts to promote health IT adoption among medical providers nationwide.

Speaking during an event at the Center for American Progress, Blumenthal said ONC is prioritizing efforts to define meaningful use of EHRs.

Blumenthal said his office will publish a notice of proposed rulemaking on meaningful use within several months. Stakeholders then will have an opportunity to submit public comment before officials finalize the definition in early 2010, he added.

Coming Up

Next week, the Health IT Standards Committee will meet to discuss criteria for relating meaningful use to equipment and manufacturing decisions. HHS aims to release certification criteria by the end of the year, Blumenthal said.

Blumenthal added that ONC will unveil its plans for a health IT infrastructure this summer. He said the office also will release a blueprint for developing a health data exchange (Noyes, CongressDaily, 7/15).

Above article published on

http://www.ihealthbeat.org/Articles/2009/7/16/Health-IT-Policy-
Panel-Approves-Revisions-on-Meaningful-Use.aspx

Delegates call for eliminating Medicare penalties for failing to show “meaningful use” of electronic records by 2015. But some fear incentives could also go.

By Emily Berry, AMNews staff.

Chicago – Physician-delegates at the AMA Annual Meeting in June formally came out against planned penalties included in this year’s federal stimulus bill that would dock Medicare pay for physicians who do not have a qualifying electronic health record.

The “adjustments” start at 1% of the physician’s Medicare fee schedule and are set to begin in 2015, after four years of available incentives for adoption. The penalties are set to increase each subsequent year to a maximum of 5%.

Delegates passed a resolution calling for the Association to ask the federal government to eliminate the penalties and advocate for federal assistance with up-front and maintenance costs of EHR use.

The stimulus package, officially titled the American Recovery and Reinvestment Act of 2009, sets out incentives for both physicians and hospitals who can demonstrate “meaningful use” of an EHR, including the use of an e-prescribing component. Qualifying physicians will be eligible for additional Medicare payments of as much as $44,000 over the course of five years, beginning in 2011.

The national Health IT Policy Committee, an advisory group charged with defining principles for “meaningful use,” released its first draft recommendations June 16, but the Centers for Medicare & Medicaid Services has indicated proposed rules won’t be released until late 2009.

There is a case-by-case exemption written into the law for physicians who can demonstrate “significant hardship, such as in the case of an eligible professional who practices in a rural area without sufficient Internet access.”

Delegates at the Annual Meeting argued that the penalties violate the AMA’s pay-for-performance policies and unfairly punish physicians who can’t afford the up-front cost of adopting an electronic record system.

“My financial calculations say it’s cheaper for me to take the penalty than to put the system in, and that’s what I’m going to do,” said David McKalip, MD, a neurosurgeon and alternate delegate for the Florida Medical Assn.

No coverage for up-front costs

There are no provisions in the stimulus package that cover the up-front cost of adopting an EHR for a physician in private practice, and some physicians are concerned about buying an EHR now without knowing exactly what type of system will qualify them for incentives.

“Whatever you’re buying now is going to be obsolete in the near future,” said Stephen Sebert, MD, a family physician and president of the West Virginia State Medical Assn.

Other physicians speaking to the issue in reference committee urged delegates to “not throw the baby out with the bathwater” and pointed out the incentives represent the first assistance the government has offered for health IT adoption.

“I think if we ask for this to be rescinded, what we’ll wind up with, possibly, is nothing,” said Steven Kanig, MD, a nephrologist and delegate for the New Mexico Medical Society.

Above article published on

http://www.ama-assn.org/amednews/2009/06/29/prsd0629.htm