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

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The findings of a new Bridges to Excellence study suggest that more than two-thirds of U.S. physicians will respond to the health IT incentives included in the economic stimulus package because they are “significant” incentives, however, participation likely will be skewed toward practices with more than three physicians, Healthcare IT News reports (Merrill, Healthcare IT News, 5/7).

The stimulus package includes about $17 billion for Medicare and Medicaid incentive payments over five years for doctors and hospitals that use electronic health records (iHealthBeat, 3/16).

BTE, a national effort to recognize and reward high-performing physicians, assessed physician response rates to rewards using its Master Physicians Lists from each of its initial pilot sites — Louisville, Ky., Cincinnati, Albany, N.Y., and Boston. The analysis found that physicians’ participation largely depends on the size of the incentive or bonus for which they are eligible.

Because smaller physician practices are less likely to respond to the health IT provisions included in the federal stimulus package, BTE recommends that HHS support smaller practices with technical assistance in addition to the financial incentives to ensure widespread participation (Healthcare IT News, 5/7).

Above article published on

http://www.ihealthbeat.org/Articles/2009/5/7/Study-
Estimates-Success-of-Health-IT-Incentives-in-Stimulus-Package.aspx

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/

Stimulus funds would help replace paper medical files.

By Kristi E. Swartz

The Atlanta Journal-Constitution

Hurricane Katrina illustrated what can happen when medical records are on paper instead of stored on a computer.

They washed away, rendering thousands of people unable to get prescriptions, notify doctors about allergies or receive medical help.

“We have to bring our best technology to bear in the health care system,” said Dr. David Satcher, former U.S. surgeon general and director of the Satcher Health Leadership Institute at Morehouse School of Medicine.

Federal stimulus money is available for health care providers in Georgia to convert paper medical records to electronic ones, Satcher and others said Thursday at Georgia State University. Though such technology has been available for years, fewer than 4 percent of doctors have made their medical records completely electronic, said Janet Marchibroda, chief health care officer for IBM, who said the stimulus dollars will help with some of the conversion challenges.

Stimulus money will be funneled through Medicare and Medicaid programs as well as through the National Coordinator for Health Information Technology. Marchibroda cautioned that it be spent wisely.

“We could really mess this up by just pushing a lot of money out there but not focusing on improving health information technology,” she said.

Georgia’s Department of Community Health has received $339.6 million in the first batch of stimulus money. Rhonda Medows, the state’s health officer and commissioner of the community health department, said the agency is waiting for federal guidance on how it can use that money to reimburse health care providers who buy an electronic health record system.

Above article published on

http://www.ajc.com/services/content/printedition/2009/05/15/healthstim0515.html

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

The law offers bonuses for health IT adoption but will penalize physicians who don’t have adequate systems by 2015.

By Doug Trapp, AMNews staff.

Washington – President Obama on Feb. 17 signed a $787 billion stimulus bill that directs about $150 billion toward speeding adoption of health information technology and maintaining health care coverage, among other provisions.

The sweeping measure — the American Recovery and Reinvestment Act of 2009 — provides nearly $90 billion in temporary increased federal Medicaid funding, delays four cost-cutting Medicaid regulations and spends a net of about $19 billion to encourage physicians and others to adopt health IT.

Obama said the enactment of the stimulus package and the Feb. 4 enactment of the Children’s Health Insurance Program reauthorization are big steps in health care. “We have done more in 30 days to advance the cause of health care reform than this country has in a decade.”

The American Medical Association applauds the investments in health IT and coverage for the poor and newly unemployed, wrote AMA Executive Vice President and Chief Executive Officer Michael D. Maves, MD, MBA, in a Feb. 11 letter to Sen. Max Baucus (D, Mont.), chair of the Senate Finance Committee.

The stimulus also provides $500 million to help train physicians through the National Health Service Corps, a provision widely supported by physician organizations. “This program is integral to rebuilding the primary care physician pipeline,” said Ted Epperly, MD, president of the American Academy of Family Physicians.

$19 billion of the stimulus bill is for incentives to encourage health IT adoption.

But few Republicans backed the stimulus measure. The House adopted the bill Feb. 13 with no Republican support. The Senate approved it the same day with votes from only three moderate Republicans: Sens. Olympia Snowe and Susan Collins of Maine and Arlen Specter of Pennsylvania. The final bill is a compromise between earlier versions adopted by the House and Senate.

Many Republicans, including Senate Minority Leader Mitch McConnell (R, Ky.), lambasted spending in the measure that they said would not stimulate the economy quickly. McConnell also criticized Democrats for not accepting more GOP input on such a massive spending bill.

Some Republican lawmakers, such as Phil Gingrey, MD (R, Ga.), also worried that the stimulus is not offset by new revenues and therefore will increase the national debt. “I don’t know how our children and grandchildren are going to pay for this,” Dr. Gingrey said.

“Significant” health IT support

Under the stimulus law, physicians and other health professionals are eligible for tens of thousands in health IT incentive payments via Medicare or Medicaid through 2016. But in 2015, penalties for non-adopters begin.

Medicare-participating physicians who adopt a certified electronic health record system by 2011 or 2012 and use it in a way that the government deems “meaningful” — a term to be defined later — could receive up to $44,000 over a period of up to five years. The incentives will be limited to 75% of the physician’s Medicare charges in any one year.

Health IT grants and loans from the federal government won’t become available until 2010.

Physicians who have caseloads of at least 30% Medicaid patients and who also meet the health IT adoption standards are eligible for nearly $64,000 in support during the same time frame. Medicaid incentive payments are limited to 85% of physicians’ Medicaid charges. Pediatricians can qualify if their patient mix is 20% Medicaid, but they would be eligible for only two-thirds of the incentive payments available to physicians meeting the 30% standard.

This health IT funding is “very significant,” said Robert Doherty, the American College of Physicians’ senior vice president for governmental affairs and public policy. “Our sense is for a lot of physician practices, that may be the tipping point where it begins to make business sense to consider plunging into that pool and buying a certified EHR.”

Physicians cannot apply for incentives in both Medicare and Medicaid, but hospitals can, said Erica Drazen, ScD, managing partner for emerging practices at health IT consultant CSC’s Global Healthcare Sector.

Also, while physicians must use an EHR system to qualify for the stimulus incentive payments, they need not own one. The measure provides $2 billion to the Office of the National Coordinator for Health Information Technology for health IT grants and loans, but those won’t become available until 2010, Drazen said. She expected private firms to offer new financing options for the EHR systems or to offer them through leases.

But the stimulus measure will penalize physicians, beginning in 2015, if they have not become meaningful EHR users. These doctors face a 1% reduction in Medicare fees that year. The yearly cut would phase up to 3% in 2017 and beyond.

The ACP would prefer that the penalties not apply if, for example, a shortage prevents EHRs from being available to physicians or if another factor not in physicians’ control prevents them from meeting the health IT standards, Doherty said.

Drazen said existing EHR vendors and consultants will be strained by the demand created by the health IT stimulus. “We’re going to have a real short supply of people who know how to do this well.”

Sustaining Medicaid

The $87 billion in stimulus going to state Medicaid programs should help avoid health coverage cuts to low-income people. But states still may need to trim other parts of their Medicaid programs, because many have budget shortfalls exceeding their stimulus funding, said Ann Kohler, director of the National Assn. of State Medicaid Directors.

The enactment could be significant for physicians in California. State lawmakers and Gov. Arnold Schwarzenegger have been struggling to close a roughly $42 billion budget deficit.

California’s Medicaid program would receive more than $11 billion in stimulus funding over 27 months, according to the California Medical Assn. But to qualify for the additional funds, states first must maintain or restore Medicaid eligibility and renewal procedures to their status on July 1, 2008. California lawmakers would need to reverse legislation enacted late in 2008 requiring people on Medicaid to re-enroll twice a year instead of once.

“This is another great opportunity for state lawmakers to maximize federal assistance,” said CMA President Dev A. GnanaDev, MD.

The stimulus offers another boost to states by extending moratoriums on three Medicaid rules through July 1, 2009. Those regulations, issued by the Centers for Medicare & Medicaid Services, would have reduced federal Medicaid spending by billions. The new law also delays until July a CMS rule that reduces some states’ Medicaid rates by aligning the program’s hospital outpatient services definition with that of Medicare.

This content was published online only.

Above article published on http://www.ama-assn.org/amednews/2009/02/23/gvl20223.htm

A recent study looked at why Massachusetts has the highest adoption rate in the nation.

By Pamela Lewis Dolan

What’s working to bolster electronic health record adoption in Massachusetts could prove successful for the rest of the country, according to a recently released report.

Blue Cross Blue Shield of Massachusetts commissioned two studies by the Falls Church, Va.-based technology services company CSC, which examined the adoption rates of health IT in hospitals and physician practices. It found adoption rates in Massachusetts, where the Blues provided considerable incentive money, to be much higher than the national average.

The use of advanced systems in Massachusetts is also much higher than in the rest of the country. For example, 18% of hospitals participating in the survey used computerized physician order entry. That rate is almost double the national average.

The study said the incentives offered through Blue Cross Blue Shield of Massachusetts played a big role in adoption. And

“I think more insurers will step up to the plate,” said Erica Drazen, ScD, managing director of emerging practices at CSC, and one of the study’s authors. Technology experts long have held the view that insurers could drive technology adoption by providing systems, because they have the money and the incentive to while study authors expect the federal incentives included in the stimulus package will boost nationwide adoption of health IT, private insurers will continue to play a big role.do so.

Massachusetts is being looked at as a national example with nearly all its hospitals and 36% of its physician practices using at least a baseline EHR system.

This content was published online only.

http://www.ama-assn.org/amednews/2009/04/06/bise0408.htm