CMS must pay special attention to ensure that the final version of the proposed “meaningful use” rule for electronic health records fits with other rules for standards and certification, as well at the interim final rule for the certification of EHRs, Government Health IT reports.

Earlier this year, CMS published a notice of proposed rulemaking describing how health care providers can demonstrate meaningful use of certified EHRs to qualify for incentive payments under the 2009 federal economic stimulus package.

The Office of the National Coordinator for Health IT also published an interim final rule describing required certification standards for EHR technology.

Tony Trenkle, CMS director of e-health and standards, recently stressed how the interplay between different regulations will be important in determining what health care providers will need to demonstrate to qualify for the incentive payments.

ONC policy analyst Steve Posnack said that CMS and ONC are coordinating their regulations to ensure that the standards set for determining meaningful use are in step with rules governing certification of EHRs (Mosquera, Government Health IT, 3/18).

Above article publish on http://www.ihealthbeat.org/articles/2010/3/19/cms-aims-to-coordinate-meaningful-use-rules-with-other-regulations.aspx

Final awards of state health information exchange cooperative agreement program work to build health information exchange infrastructure throughout the states

U.S. Department of Health and Human Services Secretary Kathleen Sebelius today announced awards to help states facilitate health information exchange and advance health information technology (health IT).  Funded by the American Recovery and Reinvestment Act of 2009, today’s  awards are part of the $2 billion effort to achieve widespread meaningful use of health IT and provide use of an electronic health record by every citizen by the year 2014.  Every state and eligible territory has now been awarded funds under this program.

“These critical investments will help unleash the power of health information technology to cut costs, eliminate paperwork, and help doctors deliver high-quality, coordinated care to patients,” said Secretary Sebelius. “States are important partners in improving and expanding our electronic health records system.  By improving the secure exchange of electronic health records between providers and hospitals within and across states, these awards mark a significant step in bringing our health system into the 21^st century.”

The health information exchange HIE awards announced today provide approximately $162 million to 16 states and qualified state designated entities (SDEs) to facilitate non-proprietary health information exchange that adheres to national standards.  Health information exchange is critical to enabling care coordination and improving the quality and efficiency of health care.

“Today’s announcement of awards to 16 states and SDEs marks a significant milestone with all states now empowered to start their journey towards identifying innovative ways to break down theses barriers that prevent the seamless exchange of information, so that we can give patients the access to care they deserve and expect,” stated Dr. David Blumenthal, national coordinator for health information technology.  “States play a critical leadership role in advancing the development of the exchange capacity of healthcare providers and hospitals within their states and across the nation. Health information exchange will enable eligible healthcare providers to be deemed meaningful users of health IT and receive incentive payments under the Medicare and Medicaid electronic health record (EHR) incentive program.”

These cooperative agreements were awarded under the authority of Title XIII of ARRA, the Health Information Technology for Economic and Clinical Health (HITECH) Act which amends Title XXX of the Public Health Service Act by adding Section 3013, State Grants to Promote Health Information Technology. Section 3013 provides for the awarding of competitive grants to promote health information technology.  On February 12, 2010, HHS awarded $385 million to 40 states and SDEs.  The awards announced today complete the awarding of cooperative agreements funded by this program.

A listing of the state HIE competitive agreements announced today follow:

Additional information about the state HIE program may be found at http://healthit.hhs.gov/portal/server.pt?open=512&objID=1488&parentname=CommunityPage&parentid=2&mode=2&in_hi_userid=10741&cached=true

And http://www.whitehouse.gov/the-press-office/sebelius-solis-announce-nearly-1-billion-recovery-act-investment-advancing-use-heal

Above article publish on http://www.hhs.gov/news/press/2010pres/03/20100315a.html

The American Academy of Family Physicians is calling for significant changes to “meaningful use” criteria that will be used to determine whether health care providers are eligible for federal subsidies for health IT usage, Modern Healthcare reports.

In a seven-page letter to acting CMS Administrator Charlene Frizzera, Ted Epperly, chair of AAFP’s board of directors, wrote that the group agrees with many of the criteria’s stated goals, but urged CMS to reconsider:

• Requirements to report computerized physician order entry measures that he maintains could force health workers to manually enter results from laboratories that do not have an interoperable interface;
• A requirement that a patients’ health information be shared with them within 48 hours; and
• Language that requires physicians to meet all of the proposed requirements to receive incentive payments.

In addition, Epperly asserts that the term “health information” is used throughout the proposed criteria but is never defined explicitly (Robeznieks, Modern Healthcare, 3/7).

Above Article Publish on http://www.ihealthbeat.org/articles/2010/3/8/aafp-asks-cms-for-significant-changes-to-meaningful-use-criteria.aspx

Healthcare IT News in this article published the list of 25 meaningful use objectives that professionals and hospitals must meet in order to receive stimulus funds from the government provided through Recovery Act. This list was taken from the proposed rule: “Medicare and Medicaid Programs; Electronic Health Record Incentive Program.

[1] Objective: Use CPOE

Measure: CPOE is used for at least 80 percent of all orders

[2] Objective: Implement drug-drug, drug-allergy, drug- formulary checks

Measure: The EP has enabled this functionality

[3] Objective: Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT®

Measure: At least 80 percent of all unique patients seen by the EP have at least one entry or an indication of none recorded as structured data.

[4] Objective: Generate and transmit permissible prescriptions electronically (eRx).

Measure: At least 75 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology.

[5] Objective: Maintain active medication list.

Measure: At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient is not currently prescribed any medication) recorded as structured data.

[6] Objective: Maintain active medication allergy list.

Measure: At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient has no medication allergies) recorded as structured data.

[7] Objective: Record demographics.

Measure: At least 80 percent of all unique patients seen by the EP or admitted to the eligible hospital have demographics recorded as structured data

[8] Objective: Record and chart changes in vital signs.

Measure: For at least 80 percent of all unique patients age 2 and over seen by the EP, record blood pressure and BMI; additionally, plot growth chart for children age 2 to 20.

[9] Objective: Record smoking status for patients 13 years old or older

Measure: At least 80 percent of all unique patients 13 years old or older seen by the EP “smoking status” recorded

[10] Objective: Incorporate clinical lab-test results into EHR as structured data.

Measure: At least 50 percent of all clinical lab tests results ordered by the EP or by an authorized provider of the eligible hospital during the EHR reporting period whose results are in either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data.

[11] Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach.

Measure: Generate at least one report listing patients of the EP with a specific condition.

[12] Objective: Report ambulatory quality measures to CMS or the States.

Measure: For 2011, an EP would provide the aggregate numerator and denominator through attestation as discussed in section II.A.3 of this proposed rule. For 2012, an EP would electronically submit the measures are discussed in section II.A.3. of this proposed rule.

[13] Objective: Send reminders to patients per patient preference for preventive/ follow-up care

Measure: Reminder sent to at least 50 percent of all unique patients seen by the EP that are 50 and over

[14] Objective: Implement five clinical decision support rules relevant to specialty or high clinical priority, including for diagnostic test ordering, along with the ability to track compliance with those rules

Measure: Implement five clinical decision support rules relevant to the clinical quality metrics the EP is responsible for as described further in section II.A.3.

[15] Objective: Check insurance eligibility electronically from public and private payers

Measure: Insurance eligibility checked electronically for at least 80 percent of all unique patients seen by the EP

[16] Objective: Submit claims electronically to public and private payers.

Measure: At least 80 percent of all claims filed electronically by the EP.

[17] Objective: Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, and allergies) upon request

Measure: At least 80 percent of all patients who request an electronic copy of their health information are provided it within 48 hours.

[18] Objective: Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies)

Measure: At least 10 percent of all unique patients seen by the EP are provided timely electronic access to their health information

[19] Objective: Provide clinical summaries to patients for each office visit.

Measure: Clinical summaries provided to patients for at least 80 percent of all office visits.

[20] Objective: Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically.

Measure: Performed at least one test of certified EHR technology’s capacity to electronically exchange key clinical information.

[21] Objective: Perform medication reconciliation at relevant encounters and each transition of care.

Measure: Perform medication reconciliation for at least 80 percent of relevant encounters and transitions of care.

[22] Objective: Provide summary care record for each transition of care and referral.

Measure: Provide summary of care record for at least 80 percent of transitions of care and referrals.

[23] Objective: Capability to submit electronic data to immunization registries and actual submission where required and accepted.

Measure: Performed at least one test of certified EHR technology’s capacity to submit electronic data to immunization registries.

[24] Objective: Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice.

Measure: Performed at least one test of certified EHR technology’s capacity to provide electronic syndromic surveillance data to public health agencies (unless none of the public health agencies to which an EP or eligible hospital submits such information have the capacity to receive the information electronically).

[25] Objective: Protect electronic health information maintained using certified EHR technology through the implementation of appropriate technical capabilities.

Measure: Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308 (a)(1) and implement security updates as necessary.

Above article publish on http://www.healthcareitnews.com/news/eligible-provider-meaningful-use-criteria

The American Recovery and Reinvestment Act establishes an incentive program that provides incentive payments to eligible physicians (EP) and eligible hospitals for meaningfully using electronic health records (EHR). While many specialists are learning the conditions under which they can capitalize on these incentive payments, anesthesiologists will learn that they do not qualify as EPs, thus not able to receive incentive payments for their meaningful use of EHRs.

One requirement that a physician satisfy is that s/he is a non-hospital-based physician. “Hospital-based” physicians are defined to include those that provide 90% of their Medicare-covered services within a Place of Service (POS) of 21, 22, or 23–either an inpatient hospital, outpatient hospital, or emergency room hospital, respectively. Furthermore, the statute explicitly states that anesthesiologists–who furnish substantially all of their Medicare-covered services in a hospital setting, using the hospital’s facilities and equipment, and qualified EHRs–are not eligible to receive the incentive payments because they are not bringing their own equipment to the hospital in furtherance of the medical services they perform. If a hospital demonstrates is meaningful use of an EHR, it can qualify for incentive payments.

Above article publish on http://www.attorney-dwi.info/health/incentive-payments-for-meaningful-use-of-ehr-technology-does-not-apply-to-anesthesiologists/

On December 30, 2009, the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) at the Department of Health and Human Services issued proposed regulations on the definition of “meaningful use” and the initial set of standards, implementation specifications, and certification criteria for EHR technology.

This announcement was made in conjunction with the publishing of two separate documents and a request for public comments:

Health Information Technology Initial Set of Standards, Implementation

Medicare and Medicaid Programs; Electronic Health Record Incentive Program

Beginning on page 32 of the “Medicare and Medicaid Programs: Electronic Health Record Incentive Program” document, a definition of “meaningful use” is provided along with associated discussions such as definition background and definition considerations.

Both documents discuss the proposed stages of “meaningful use”:

Stage 1 (beginning in 2011): The proposed Stage 1 meaningful use criteria “focuses on electronically capturing health information in a coded format; using that information to track key clinical conditions and communicating that information for care coordination purposes (whether that information is structured or unstructured, but in structured format whenever feasible); consistent with other provisions of Medicare and Medicaid law, implementing clinical decision support tools to facilitate disease and medication management; and reporting clinical quality measures and public health information.”

Stage 2 (beginning in 2013): CMS has proposed that its goals for the Stage 2 meaningful use criteria, “consistent with other provisions of Medicare and Medicaid law, expand upon the Stage 1 criteria to encourage the use of health IT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible, such as the electronic transmission of orders entered using computerized provider order entry (CPOE) and the electronic transmission of diagnostic test results (such as blood tests, microbiology, urinalysis, pathology tests, radiology, cardiac imaging, nuclear medicine tests, pulmonary function tests and other such data needed to diagnose and treat disease). Additionally we may consider applying the criteria more broadly to both the inpatient and outpatient hospital settings.”

Stage 3 (beginning in 2015): CMS has proposed that its goals for the Stage 3 meaningful use criteria are, “consistent with other provisions of Medicare and Medicaid law, to focus on promoting improvements in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to self management tools, access to comprehensive patient data and improving population health.”

Pages 51 through 61 of the “Health Information Technology Initial Set of Standards, Implementation” document provide Stage 1 “meaningful use” objectives in a table alongside corresponding certification criteria to support the achievement of “meaningful use” Stage 1 by eligible professionals and eligible hospitals. In reading this table, keep in mind the provided definition of “EHR module”:

EHR Module: any service, component, or combination thereof that can meet the requirements of at least one certification criterion adopted by the Secretary

The following note is provided alongside examples of EHR modules:

While the use of EHR Modules may enable an eligible professional or eligible hospital to create a combination of products and services that, taken together, meets the definition of Certified EHR Technology, this approach carries with it a responsibility on the part of the eligible professional or eligible hospital to perform additional diligence to ensure that the certified EHR Modules selected are capable of working together to support the achievement of meaningful use. In other words, two certified EHR Modules may provide the additional capabilities necessary to meet the definition of Certified EHR Technology, but may not integrate well with each other or with the other EHR technology they were added to. As a result, eligible professionals and eligible hospitals that elect to adopt and implement certified EHR Modules should take care to ensure that the certified EHR Modules they select are interoperable and can properly perform in their expected operational environment.

Pages 79 through 81of the “Health Information Technology Initial Set of Standards, Implementation” document elaborate on this interoperability requirement for patient summary records, drug formulary checks, electronic prescribing, administrative transactions, quality reporting, submission of lab results to public health agencies, submission to public health agencies for surveillance or reporting, and submission to immunization registries. Page 85 outlines adopted privacy and security standards for Certified EHR Technology, and the document distinguishes these standards from those associated with HIPAA.

With a combined total of nearly-700 pages, the two documents discussed here necessitate a thorough review that will take some time to digest. This post simply provides an initial level of awareness that these documents have been published.

Above article publish on http://nvisia.com/techs/?p=364

HHS is gearing up to award $50 million in task orders to establish a national Health IT Research Center, Federal Computer Week reports.

Joshua Seidman — acting director of the “meaningful use” division at the Office of the National Coordinator for Health IT — discussed HHS’ plans for the research center this week during a conference sponsored by the eHealth Initiative.

He said the Health IT Research Center will provide a virtual learning community through an online portal. The center also will help users develop communities around research subjects that support the meaningful use of electronic health records.

Support for Regional Extension Centers

Seidman said the research center will serve as a resource for about 60 regional health IT extension centers.

HHS is awarding nearly $600 million in stimulus funding to establish the extension centers in communities across the country. Officials are expected to select about half of the extension centers within the next few weeks, Seidman said.

The regional extension centers aim to offer health care providers guidance on:

• Best practices in health IT privacy and security;
• EHR vendor selection and group purchasing;
• Health data exchange and interoperability;
• Health IT project implementation and management;
• Workflow redesign and work force support (Lipowicz, Federal Computer Week, 1/26).

Above article publish on http://www.ihealthbeat.org/articles/2010/1/27/hhs-to-award-50m-to-set-up-national-center-for-health-it-research.aspx

Practices that have been waiting for CMS to define the term “meaningful use” are finally in luck. But as is always the case when the feds are involved, don’t look for a quick one-sentence definition.

The American Recovery and Reinvestment Bill of 2009 (ARRA) offers annual bonuses to practices that show “meaningful use” of electronic health records, and in 2015, practices that aren’t showing meaningful use will face penalties.

On Dec. 29, CMS and the Office of the National Coordinator for Health Information Technology announced that the definition was finally available for public comment. “CMS’s proposed regulation would define and specify how to demonstrate ‘meaningful use’ of EHR technology, which is a prerequisite for receiving the Medicare incentive payments,” said Charlene Frizzera, CMS’s acting administrator, in a Dec. 30 statement.

25 measures: Stage 1 of the meaningful use criteria (which begins in 2011) includes 25 objectives/measures for eligible professionals (most Part B practices fall under this category) and 23 objectives/measures for eligible hospitals. To be considered a meaningful EHR user, you must meet all of the criteria set forth.

For example: The following includes just a sampling of what you’ll find in the list of 25 meaningful use criteria for stage one of the incentive program. To read the complete list, check out the proposal in the Federal Register.

• Use a computer physician order entry (CPOE)
• Implement drug-drug, drugallergy, drug-formulary checks
• Maintain an up-to-date problem list of current and active diagnoses based on ICD-9 or SNOMED CT
• Generate and transmit permissible prescriptions electronically
• Maintain an active medication list
• Maintain an active medication allergy list
• Record demographics (preferring language, insurance type, gender, race, ethnicity, and date of birth)
• Record and chart changes in vital signs
• Record smoking status for patients age 13 and older
• Incorporate clinical lab test results into EHR as structured data
• Generate lists of patients by specific conditions
• Report ambulatory quality measures to CMS
• Send reminders to patients for preventive follow-up care (per patient preference)
• Implement five clinical decision support rules relevant to specialty or high clinical priority
• Check insurance eligibility electronically from payers
• Submit claims electronically.

Keep in mind: You can not only qualify for a financial bonus if you use EHRs — but you could also boost your practice’s efficiency, CMS says. “Widespread adoption of electronic health records holds great promise for improving health care quality, efficiency, and patient safety,” said David Blumenthal, MD, national coordinator for health information technology, in a Dec. 30 statement.

CMS will accept public comments on the rule for 60 days, either electronically or by mail (CMS, Department of Health and Human Services, Attention: CMS-0033-P, P.O. Box 8013, Baltimore, MD 21244-8013). If you do submit comments, refer to ID CMS-0033-P.

Article publish on http://hitnews.inhealthcare.com/fact-finder/hitech-physicians-must-meet-25-criteria-to-achieve-meaningful-use/?dynamic_id=2086766482

By Mary Mosquera

The clock starts ticking today on a two-month window in which the public can comment on the Health & Human Service Department’s “meaningful use” proposal, a set of rules outlining how providers can qualify for incentives for using electronic health records.

The Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health IT officially published their rules in the Federal Register Jan. 13.

The package comes in two parts: an ONC interim final rule (IFR) covering standards and certification of EHRs and a notice of proposed rulemaking (NPRM) from the Centers for Medicare and Medicaid Services defining the “meaningful use” of health IT.

According to CMS’s meaningful use NPRM, the public has 60 days, or until March 15, in which to comment on the regulation after it is published in the Federal Register. Subsequent revisions will be made, with the final rule expected in spring of 2010.

The ONC interim final rule will become effective 30 days after it is published in the Federal Register, or Feb. 12. However, the public may comment on its possible refinement over the next 60 days, after which ONC will issue the final rule.

The rules describe how physicians and hospitals can qualify for tens of thousands of dollars in financial incentives for meeting three stages of progressively more demanding sets of measures when using health IT in their practices.

The initial set of criteria would concentrate on collecting data electronically, sharing information with other providers and patients, and reporting quality measures to the government.

The standards rule focuses only on standards that comprise a certified EHR. The actual process by which those systems will be certified will be the subject of an additional notice of proposed rulemaking ONC will announce later in 2010.

Since the announcement of the rules Dec. 30, health IT experts have offered a range of opinions about them. Writing in his blog this week, Dr. John Halamka, co-chairman of the Health IT Standards Panel, which advises ONC, said he had received hundreds of emails about the rules. Many find CMS’s proposed rule “intimidating,” he wrote Jan. 11

“Taking a typical community hospital from their current state to the degree of functionality required in the NPRM [proposed rule] is a challenge,” said Halamka, who is also chief information officer of Boston’s Beth Israel Deaconess Medical Center.

In summarizing the comments he received, Halamka said providers need specific guidance to meet the aggressive interoperability timelines in the rules. “This leaves a choice – either the standards need more detail, especially in the transmission area, or the NPRM goals need to be reduced in scope/extended in time,” Halamka said in his blog.

Above article publish on http://www.govhealthit.com/newsitem.aspx?tid=10&nid=72929

The Centers for Medicare & Medicare Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) encourage public comment on two regulations issued today that lay a foundation for improving quality, efficiency and safety through meaningful use of certified electronic health record (EHR) technology. The regulations will help implement the EHR incentive programs enacted under the American Recovery and Reinvestment Act of 2009 (Recovery Act).

A proposed rule issued by CMS outlines proposed provisions governing the EHR incentive programs, including defining the central concept of “meaningful use” of EHR technology. An interim final regulation (IFR) issued by ONC sets initial standards, implementation specifications, and certification criteria for EHR technology. Both regulations are open to public comment.

“Widespread adoption of electronic health records holds great promise for improving health care quality, efficiency, and patient safety,” said, National Coordinator for Health Information Technology David Blumenthal, M.D., M.P.P. “The Recovery Act’s financial incentives demonstrate Congress’ and the Administration’s commitment to help providers adopt and make meaningful use of EHR technology so they can give better care and their patients’ experience of care will improve. Over time, we believe the EHR incentive program under Medicare and Medicaid will accelerate and facilitate health information technology adoption by more individual providers and organizations throughout the health care system.”

“These regulations are closely linked,” said Charlene Frizzera, CMS acting administrator. “CMS’s proposed regulation would define and specify how to demonstrate ‘meaningful use’ of EHR technology, which is a prerequisite for receiving the Medicare incentive payments. Our rule also outlines the proposed payment methodologies for the Medicare and Medicaid EHR incentive programs. ONC’s regulation sets forth the standards and specifications that will enhance the interoperability, functionality, utility and security of health information technology.”

CMS and ONC worked closely to develop the two rules and received input from hundreds of technical subject matters experts, health care providers, and other key stakeholders. Numerous public meetings to solicit public comment were held by three Federal advisory committees: the National Committee on Vital and Health Statistics (NCVHS), the Health IT Policy Committee (HITPC), and the Health IT Standards Committee (HITSC). HITSC presented its final recommendations to the National Coordinator in August 2009. These recommendations, along with all other input were considered to help inform the development of the regulations announced today.

The IFR issued by ONC describes the standards that must be met by certified EHR technology to exchange healthcare information among providers and between providers and patients. This initial set of standards begins to define a common language to ensure accurate and secure health information exchange across different EHR systems. The IFR describes standard formats for clinical summaries and prescriptions; standard terms to describe clinical problems, procedures, laboratory tests, medications and allergies; and standards for the secure transportation of this information using the Internet.

CMS provides a 60-day comment period on the proposed rule. “The definition and requirements for demonstrating meaningful use of EHR technology are proposals. CMS welcomes and will give serious consideration to comments that improve our proposal while achieving the goals Congress established for the EHR incentive programs,” Frizzera said.

The CMS proposed rule and fact sheets, may be viewed at http://www.cms.hhs.gov/Recovery/11_HealthIT.asp

ONC’s interim final rule may be viewed at http://healthit.hhs.gov/standardsandcertification. In early 2010 ONC intends to issue a notice of proposed rulemaking related to the certification of health information technology.

Above article publish on http://www.hhs.gov/news/press/2009pres/12/20091230a.html