Electronic health records and industry vendors took center stage throughout the 4th annual Healthcare Trade Faire & Regional Conference November 19 in downtown Atlanta.
Sponsored by the Georgia chapter of the Healthcare Information and Management Systems Society (HIMSS), the healthcare-wide and impending EHR-focused issues of HITECH stimulus funding, meaningful use and implementation drew a record attendance of 500 healthcare professionals, according to chapter President Don Kinser.
Greenway Medical Technologies Vice President of Marketing, Corporate Development and Government Affairs Justin Barnes debuted the conference as keynote speaker. In his capacity as chairman of the HIMSS Electronic Health Records Association, Barnes detailed the stimulus incentives of EHR adoption in his presentation “ARRA-HITECH: Understanding & Optimizing the EHR Incentives for Georgia Healthcare Providers – Perspectives for all size Hospitals and Physician Practices.”
“The goal of the HITECH Act is a systemic interoperability across the country, reaching three hundred to three hundred and fifty thousand providers nationwide. It’s about managing the heartbeat of your practice,” said Barnes. While he diagrammed the high-profile Medicaid and Medicare EHR adoption incentives offered during coming years, Barnes also revealed less well known but sizable incentives also available for Health Information Exchanges, Regional Extension Centers, Federal Qualified Health Centers and the undertaking of broadband capabilities, all while noting, for example, the $1.5 billion alone that is available from the Health Resources and Services Administration
When practices review EHR vendors for stimulus implementation, he advised attendees to cross reference a system’s certification, KLAS scores and HIMSS Davies Awards among other criteria. And incentives don’t stop with implementation. “Only five percent of practices undertake clinical trials,” he noted. “Trials and research are a source of ROI and income per patient. Think of the clinical trials and research you could do.”
Barnes’ keynote dovetailed into conference sessions such as EHR rollout, eMAR in 90 days, the medical home and “liberating data.” At an overflow CIO roundtable session, panelists grappled with the conflicting objectives of data security and the exchange of patient records. Attendees agreed that systems need sustainable IT funding like that found in other industries, and pointed to the adoption of mobile banking models, both in technical terms and as an analogous strategy, to assure stakeholders of the stability of healthcare technology.
“This is a good time to have a good relationship with your vendor,” recommended panelist Ron Strachan, CIO of Wellstar Health Systems. “Should you make diagnostics from the view of an iPhone? No, that’s not meaningful use. Just because you can doesn’t mean you should.”
A discussion of meaningful use capped the conference, as attendees were given a preview of the critical components of CPOE, e-prescribing, standardized information exchange, quality reporting and other tenets of EHR adoption to procure incentive funds. But, like in the other major sessions, attendees were urged to consider the idealistic and attainable goals of the HITECH Act.
“Meaningful use is understanding what an EHR is and should do,” said presenter Donna Schmidt, chief nursing officer of CSC Healthcare Group. “Meaningful use takes the ambiguity away and allows for prioritizing.”
Echoed presenter David Stewart, GAHIMSS board member, “Meaningful use is the enabler to define quality care and to survive and achieve under any healthcare reform scenario.”
Sunday, November 22, 2009
Thursday, November 19, 2009
Greenway sponsors Vision 2020 HIT symposium
Greenway Medical Technologies’ areas of expertise were on full display November 10 at the Woodruff Arts Center in downtown Atlanta during a special symposium on healthcare technology.
Health data exchange, EHR capabilities, meaningful use, sustainability and regional extension centers were just some of the topics that dominated panel discussions during “Vision 2020.” Hosted by the Technology Association of Georgia, panelists from academic, governmental and private industry healthcare pursuits led an audience of approximately 300 through the critical challenges the year 2020 foreshadows.
As a gold sponsor of the event, Greenway’s presence was also on display in program materials and through a sponsor’s reception the night of November 9. Greenway business partner Intel Health was also a sponsor of the event.
Moderated by CNN Senior Medical Correspondent Elizabeth Cohen and Wayne Oliver, vice president of the Center for Health Transformation, itself a strategic legislative partner of Greenway Medical, panelists ranged from the Georgia Department of Community Health and the Grady Health System to the Health Services Research Institute at Georgia State University, to Cisco Systems, Verizon Wireless and the National Health Museum, recently located to Atlanta from its origins in Washington, D.C.
One theme during the day was linking as divergent a state as Georgia, with its mix of rural and urban health systems and infrastructure matched by socioeconomic challenges. David Hartnett, vice president of technology industry expansion for the Metro Atlanta Chamber, advocated a shared service model toward implementation costs for small or rural practices outside of major infrastructure, while panelists agreed there are resources available to expand it.
Recently in Georgia, for example, only 20 of 150 available broadband grants have been funded, meaning untapped means of HIT expansion are available, but to indefinitely sustain a national network “levels of one to three percent of all healthcare spending devoted to IT is not enough,” said Hal Scott, vice president of Information Systems and CIO of MCG Health System, “especially in the face of uncertain declines in reimbursement. There are going to be enormous demands put on the systems through the collection of data. Right now we’re very euphoric about available resources, but what happens when we get what we ask for?”
By 2020, panelists agreed, what will happen is the realization of a shared vision of a healthcare system that knows few boundaries.
Health data exchange, EHR capabilities, meaningful use, sustainability and regional extension centers were just some of the topics that dominated panel discussions during “Vision 2020.” Hosted by the Technology Association of Georgia, panelists from academic, governmental and private industry healthcare pursuits led an audience of approximately 300 through the critical challenges the year 2020 foreshadows.
As a gold sponsor of the event, Greenway’s presence was also on display in program materials and through a sponsor’s reception the night of November 9. Greenway business partner Intel Health was also a sponsor of the event.
Moderated by CNN Senior Medical Correspondent Elizabeth Cohen and Wayne Oliver, vice president of the Center for Health Transformation, itself a strategic legislative partner of Greenway Medical, panelists ranged from the Georgia Department of Community Health and the Grady Health System to the Health Services Research Institute at Georgia State University, to Cisco Systems, Verizon Wireless and the National Health Museum, recently located to Atlanta from its origins in Washington, D.C.
One theme during the day was linking as divergent a state as Georgia, with its mix of rural and urban health systems and infrastructure matched by socioeconomic challenges. David Hartnett, vice president of technology industry expansion for the Metro Atlanta Chamber, advocated a shared service model toward implementation costs for small or rural practices outside of major infrastructure, while panelists agreed there are resources available to expand it.
Recently in Georgia, for example, only 20 of 150 available broadband grants have been funded, meaning untapped means of HIT expansion are available, but to indefinitely sustain a national network “levels of one to three percent of all healthcare spending devoted to IT is not enough,” said Hal Scott, vice president of Information Systems and CIO of MCG Health System, “especially in the face of uncertain declines in reimbursement. There are going to be enormous demands put on the systems through the collection of data. Right now we’re very euphoric about available resources, but what happens when we get what we ask for?”
By 2020, panelists agreed, what will happen is the realization of a shared vision of a healthcare system that knows few boundaries.
Wednesday, August 19, 2009
Thursday, July 23, 2009
Monday, July 6, 2009
Meaningful Use Criteria Comments for Review
Greenway Medical Technologies HITPC Meaningful Use Comments Regarding Inpatient, Ambulatory and Interoperability.
Priority 1: Improve quality, safety, efficiency, and reduce health disparities
Greenway Medical Technologies (Greenway) supports the use of comprehensive EHRs to attain meaningful use (MU) starting in 2011. Initial MU criteria should promote achievable objectives to promote as much adoption as possible.
· 2011 objectives should be based on software and standards that are currently deployed and implemented. Advancement towards 2013 and 2015 objectives will evolve naturally once adoption occurs.
· We support MU criteria based on CCHIT inpatient 2007 functionality including CPOE, clinical decision support and closed-loop medication administration. This approach meets the majority of the 2011 objectives including adoption of CPOE (measured as a percent of all physicians) and electronic medication administration (EMAR) with bar-coding in later years.
Functional objectives beyond this scope should not be considered for implementation in 2011. In order for the appropriate measures to be supported, there must be correlation between objectives, measures and underlying technology to make this possible.
· CPOE use will be aided by EMAR and evidence–based order sets. Selecting a few evidence-based order sets for chronic diseases (e.g., diabetes and cardiovascular disease) for CPOE implementation will support desired outcomes for overall improvement in healthcare delivery.
· Measures as described may require extensive manual data collection from electronic and paper sources to determine percentages. Reporting quality measures must initially be simple, neutral and based on accepted and readily usable standards. Quality reporting will expand with the addition of clinical documentation, incorporation of data sets or applicable standards. Reporting should allow submission of either patient-level data or population-level computed measures so long as the process for such computation is sufficiently specified and validated, and the underlying data comes from EHRs.
· Consideration should be given to the volume of information that will be reported once mandatory programs exist and organizations are able to receive this information. Quality reporting should be tied to MU objectives and outcomes while remaining independent of healthcare reform mandates for pay-for-performance programs.
· In addition to quality reporting, starting in 2011, there should be objective measures to evaluate the use of quality measures for patient care management.
· We support the inclusion in 2011 criteria of the forthcoming HITSP C/106 guidance on the ability for EHRs to consume quality measures in electronic format. This is an important keystone to the required decision support and quality reporting infrastructure.
· The HITSP-recommended Quality Reporting standards support for 2011 is extremely aggressive for the EHR community. The RHQDAPU program is well-established for hospital baseline comparative data with extensive measure definition from reputable clinical groups. Any quality reporting components should be considered relative to established baselines for hospitals and clinical outcome benefits for patients with consideration for ability to electronically gather the data.
Challenges to physician practices in achieving this priority include capturing codified clinical data, reporting quality measures and using data to track clinical conditions and chronic diseases. Greenway recommends reconsideration of requiring competence in all three areas for 2011.
In studying EHR adoption, many have reported low EHR usage among small practices (less than 25%, according to an April 2009 article in The Wall Street Journal, with use of comprehensive ambulatory EHRs is reported between 4% and 13% as cited in a 2008 New England Journal of Medicine article. We believe that the most successful approach to achieving MU, especially for the majority of physicians who practice in small groups, is through deployment of a comprehensive EHR certified to meet all aspects of MU.
· Consideration must be given to specialists vs. family or general practitioners in developing MU criteria relative to this priority.
Another strategy that addresses implementation challenges for practices of all sizes, yet achieves improved healthcare outcomes and system performance through HIT adoption, is to limit the type of reporting required in 2011.
· There is precedent in the existing CMS PQRI program, as well as in the NCQA Medical Home recognition program, to allow practices to select three measures that are “important” to their patient population.
· Based on comments to NeHC by the ACP (June 2, 2009), we support the concept that HIT adoption and MU will be more easily achieved if practices focus initially on the goals of data collection and use of data to care for patients and families rather than broader population health management.
· We further recommend that criteria for reporting be scoped to demonstrated ability to report rather than reaching any particular measurement threshold. Moreover, as part of the foundation-building for quality reporting based on clinical data, we recommend that data from EHRs be used for this reporting rather than billing and claims data.
Two 2011 objectives require clarification in order to avoid ambiguity in terms of interoperability:
· “Send reminders to patients per patient preference for preventive /follow up care [OP, IP]”. Patient preference should not be open-ended regarding technological methods used, but within the technologies available to providers (e.g., phone, mail). If reminders are to be generated from an EHR and if security is required, HITSP-recommended specifications should be used
· “Incorporate lab test results into EHR [OP, IP]”. Is this about results (1) from a lab system in response to orders, or (2) about accessing shared historical lab tests (either in a separate report, or included in a CCD summary)? We suggest the use of option (1) and encourage access of lab results in a CCD for consistency with the sharing results with patients.
For 2011 and 2013, on the interoperability associated with NQF quality measures we suggest alignment on the single set of standards harmonized by HITSP
Priority 2: Engage patients and families
Careful consideration of the differences between patient engagement in ambulatory and inpatient settings is important. Patient preferences for access to personal health information via portals or other electronic means, as well as personal health record (PHR) preferences, may not be generally available in inpatient systems to meet 2011 objectives. Educational resources such as drug information monographs and clinical summaries are available and could be a significant starting point to engage patients.
Patient-centered care delivery requires engagement not only of patients and families, but also of designated caregivers. This can be facilitated through access to patients’ healthcare data as well as educational tools to help manage health status.
· Many ambulatory EHRs today provide patient education materials at the point of care. The “stretch goal” of providing remote electronic access to such resources adds another layer of complexity to physicians’ practices that may not have access to adequate IT resources.
· Our experience with customers is that implementation of patient-centered connectivity is just beginning to be adopted among small and solo practices because of the amount of setup and maintenance required. This should be later in the MU timeline.
Two 2011 objectives require clarification in order to avoid ambiguity in term of interoperability:
· “Provide patients with electronic copy of/or electronic access to clinical information (including lab results, problem list, medication lists, allergies) per patient preference (e.g., through PHR) [OP, IP]”. The information “transport” method or medium requires clarification. Likewise the need to provide “access to clinical information” may be interpreted as a tethered PHR or as a network interfacing to a PHR. Furthermore the statement “per patient preference” implies that every provider would have to support all of the above. It is strongly recommended that sharing with PHRs uses the same transport, standards and terminologies as sharing among disparate EHRs.
· “Provide clinical summaries for patients for each encounter [OP, IP]”. Additional clarity is needed. Is this on paper, in electronic form? Clarity is also needed re content. Is it providing discharge instructions such as for IP, or a visit summary for OP?
Priority 3: Improve care coordination
The medication reconciliation process is still largely manual with many independent workflows often determined by hospital policies and procedures. The availability of an automated, electronic process for medication reconciliation in the inpatient setting will be best accomplished beyond 2011.
· Alignment with the electronic prescribing process, including medication history query, will further automate the process. Exchange of clinical summary information should be evaluated and hospitals should be encouraged to use standards-based data exchange from the outset.
· Interoperability standards for document exchange with a health information exchange (HIE) are best accomplished with a certified HIE using HITSP-recommended standards. There are also opportunities for standards-based exchange among hospitals and their community physicians.
It is also essential to balance the need for accelerated adoption of interoperable, comprehensive EHRs with the need for clinicians and hospitals to implement these in a careful and non-disruptive fashion.
· The requirement to provide patients with access to clinical information via PHRs should draw on both ambulatory and inpatient commercial systems’ abilities to utilize the same protocols for data sharing among disparate EHRs. This would support faster adoption and deployment of either tethered or non-tethered PHRs.
Greenway emphasizes existing HITSP-recommended standards for exchange of information. The underlying best practices reflected in these standards are supported and tested by our industry and adherence to these as national standards is, we believe, critical for all systems.
· Our companies currently participate in several regional HIEs so we can attest to the variety of interfacing standards we must support to meet each HIEs requirements. This is a costly and inefficient way to exchange healthcare information. We ask the Committee to support continued use of HITSP-recommended standards.
Two 2011 objectives require clarification in order to avoid ambiguity in term of interoperability:
· “Exchange key clinical information among providers of care (e.g., problems, medications, allergies, test results) [OP, IP]”. This should be HITSP standards-based information to ensure effective re-use.
· For the measure “% of transitions in care for which summary care record is shared”, we would like to see a baseline percentage (low, 5-10%) with an associated threshold. To account for the ramp-up of connected peers.
When combining the 2013 objective: “Produce and share an electronic summary care record for every transition in care [OP, IP]” and the objective for medication reconciliation for each transition of care, this would imply discrete data import for medications.
Priority 4: Improve population and public health
The process for reporting public health surveillance and receiving alerts will require standards development in order to meet the defined objectives.
· Communication with registries requires consideration of standards and processes involving the exchange of data.
· Reportable lab results are a requirement of laboratories and should not be a MU requirement for inpatient EHRs.
Greenway supports the CDC standard to report immunizations to public health registries; however, we remain concerned about the ability of these registries to accept a dramatic increase in data feeds should this requirement be retained for 2011.
· Issues of volume in reporting already exist. We have already seen how registries were not able to accept the volume of EHR-based PQRI reporting and CMS is still working through these issues with several ambulatory EHR vendors.
· Immunization reporting is another process like quality reporting that requires workflow analyses for successful implementation. Our experience is that such quality-enabling activities can only take place once a practice is comfortable with the new electronic workflow. We recommend that this criterion be tiered for practices that are current EHR users.
Greenway suggests that submitting electronic data to immunization registries be ambulatory-only for 2011 with limited reporting for inpatient systems (e.g., tetanus, hepatitis B on all babies). To achieve this consistently, the HITSP-recommended standards (including HL7V2 transport) should be used.
The objective to receive immunization histories and recommendations from immunization registries should be qualified by “where required and accepted” since not all states may support immunization registries by 2013.
Priority 5- Ensure adequate privacy and security protections for personal health information
Whether any entity is under investigation for HIPAA or security violations should not be considered when evaluating their compliance with MU criteria.
Greenway recommends compliance with privacy requirements that are understandable by consumers and effective. Privacy standards harmonized by HITSP should be leveraged.
Priority 1: Improve quality, safety, efficiency, and reduce health disparities
Greenway Medical Technologies (Greenway) supports the use of comprehensive EHRs to attain meaningful use (MU) starting in 2011. Initial MU criteria should promote achievable objectives to promote as much adoption as possible.
· 2011 objectives should be based on software and standards that are currently deployed and implemented. Advancement towards 2013 and 2015 objectives will evolve naturally once adoption occurs.
· We support MU criteria based on CCHIT inpatient 2007 functionality including CPOE, clinical decision support and closed-loop medication administration. This approach meets the majority of the 2011 objectives including adoption of CPOE (measured as a percent of all physicians) and electronic medication administration (EMAR) with bar-coding in later years.
Functional objectives beyond this scope should not be considered for implementation in 2011. In order for the appropriate measures to be supported, there must be correlation between objectives, measures and underlying technology to make this possible.
· CPOE use will be aided by EMAR and evidence–based order sets. Selecting a few evidence-based order sets for chronic diseases (e.g., diabetes and cardiovascular disease) for CPOE implementation will support desired outcomes for overall improvement in healthcare delivery.
· Measures as described may require extensive manual data collection from electronic and paper sources to determine percentages. Reporting quality measures must initially be simple, neutral and based on accepted and readily usable standards. Quality reporting will expand with the addition of clinical documentation, incorporation of data sets or applicable standards. Reporting should allow submission of either patient-level data or population-level computed measures so long as the process for such computation is sufficiently specified and validated, and the underlying data comes from EHRs.
· Consideration should be given to the volume of information that will be reported once mandatory programs exist and organizations are able to receive this information. Quality reporting should be tied to MU objectives and outcomes while remaining independent of healthcare reform mandates for pay-for-performance programs.
· In addition to quality reporting, starting in 2011, there should be objective measures to evaluate the use of quality measures for patient care management.
· We support the inclusion in 2011 criteria of the forthcoming HITSP C/106 guidance on the ability for EHRs to consume quality measures in electronic format. This is an important keystone to the required decision support and quality reporting infrastructure.
· The HITSP-recommended Quality Reporting standards support for 2011 is extremely aggressive for the EHR community. The RHQDAPU program is well-established for hospital baseline comparative data with extensive measure definition from reputable clinical groups. Any quality reporting components should be considered relative to established baselines for hospitals and clinical outcome benefits for patients with consideration for ability to electronically gather the data.
Challenges to physician practices in achieving this priority include capturing codified clinical data, reporting quality measures and using data to track clinical conditions and chronic diseases. Greenway recommends reconsideration of requiring competence in all three areas for 2011.
In studying EHR adoption, many have reported low EHR usage among small practices (less than 25%, according to an April 2009 article in The Wall Street Journal, with use of comprehensive ambulatory EHRs is reported between 4% and 13% as cited in a 2008 New England Journal of Medicine article. We believe that the most successful approach to achieving MU, especially for the majority of physicians who practice in small groups, is through deployment of a comprehensive EHR certified to meet all aspects of MU.
· Consideration must be given to specialists vs. family or general practitioners in developing MU criteria relative to this priority.
Another strategy that addresses implementation challenges for practices of all sizes, yet achieves improved healthcare outcomes and system performance through HIT adoption, is to limit the type of reporting required in 2011.
· There is precedent in the existing CMS PQRI program, as well as in the NCQA Medical Home recognition program, to allow practices to select three measures that are “important” to their patient population.
· Based on comments to NeHC by the ACP (June 2, 2009), we support the concept that HIT adoption and MU will be more easily achieved if practices focus initially on the goals of data collection and use of data to care for patients and families rather than broader population health management.
· We further recommend that criteria for reporting be scoped to demonstrated ability to report rather than reaching any particular measurement threshold. Moreover, as part of the foundation-building for quality reporting based on clinical data, we recommend that data from EHRs be used for this reporting rather than billing and claims data.
Two 2011 objectives require clarification in order to avoid ambiguity in terms of interoperability:
· “Send reminders to patients per patient preference for preventive /follow up care [OP, IP]”. Patient preference should not be open-ended regarding technological methods used, but within the technologies available to providers (e.g., phone, mail). If reminders are to be generated from an EHR and if security is required, HITSP-recommended specifications should be used
· “Incorporate lab test results into EHR [OP, IP]”. Is this about results (1) from a lab system in response to orders, or (2) about accessing shared historical lab tests (either in a separate report, or included in a CCD summary)? We suggest the use of option (1) and encourage access of lab results in a CCD for consistency with the sharing results with patients.
For 2011 and 2013, on the interoperability associated with NQF quality measures we suggest alignment on the single set of standards harmonized by HITSP
Priority 2: Engage patients and families
Careful consideration of the differences between patient engagement in ambulatory and inpatient settings is important. Patient preferences for access to personal health information via portals or other electronic means, as well as personal health record (PHR) preferences, may not be generally available in inpatient systems to meet 2011 objectives. Educational resources such as drug information monographs and clinical summaries are available and could be a significant starting point to engage patients.
Patient-centered care delivery requires engagement not only of patients and families, but also of designated caregivers. This can be facilitated through access to patients’ healthcare data as well as educational tools to help manage health status.
· Many ambulatory EHRs today provide patient education materials at the point of care. The “stretch goal” of providing remote electronic access to such resources adds another layer of complexity to physicians’ practices that may not have access to adequate IT resources.
· Our experience with customers is that implementation of patient-centered connectivity is just beginning to be adopted among small and solo practices because of the amount of setup and maintenance required. This should be later in the MU timeline.
Two 2011 objectives require clarification in order to avoid ambiguity in term of interoperability:
· “Provide patients with electronic copy of/or electronic access to clinical information (including lab results, problem list, medication lists, allergies) per patient preference (e.g., through PHR) [OP, IP]”. The information “transport” method or medium requires clarification. Likewise the need to provide “access to clinical information” may be interpreted as a tethered PHR or as a network interfacing to a PHR. Furthermore the statement “per patient preference” implies that every provider would have to support all of the above. It is strongly recommended that sharing with PHRs uses the same transport, standards and terminologies as sharing among disparate EHRs.
· “Provide clinical summaries for patients for each encounter [OP, IP]”. Additional clarity is needed. Is this on paper, in electronic form? Clarity is also needed re content. Is it providing discharge instructions such as for IP, or a visit summary for OP?
Priority 3: Improve care coordination
The medication reconciliation process is still largely manual with many independent workflows often determined by hospital policies and procedures. The availability of an automated, electronic process for medication reconciliation in the inpatient setting will be best accomplished beyond 2011.
· Alignment with the electronic prescribing process, including medication history query, will further automate the process. Exchange of clinical summary information should be evaluated and hospitals should be encouraged to use standards-based data exchange from the outset.
· Interoperability standards for document exchange with a health information exchange (HIE) are best accomplished with a certified HIE using HITSP-recommended standards. There are also opportunities for standards-based exchange among hospitals and their community physicians.
It is also essential to balance the need for accelerated adoption of interoperable, comprehensive EHRs with the need for clinicians and hospitals to implement these in a careful and non-disruptive fashion.
· The requirement to provide patients with access to clinical information via PHRs should draw on both ambulatory and inpatient commercial systems’ abilities to utilize the same protocols for data sharing among disparate EHRs. This would support faster adoption and deployment of either tethered or non-tethered PHRs.
Greenway emphasizes existing HITSP-recommended standards for exchange of information. The underlying best practices reflected in these standards are supported and tested by our industry and adherence to these as national standards is, we believe, critical for all systems.
· Our companies currently participate in several regional HIEs so we can attest to the variety of interfacing standards we must support to meet each HIEs requirements. This is a costly and inefficient way to exchange healthcare information. We ask the Committee to support continued use of HITSP-recommended standards.
Two 2011 objectives require clarification in order to avoid ambiguity in term of interoperability:
· “Exchange key clinical information among providers of care (e.g., problems, medications, allergies, test results) [OP, IP]”. This should be HITSP standards-based information to ensure effective re-use.
· For the measure “% of transitions in care for which summary care record is shared”, we would like to see a baseline percentage (low, 5-10%) with an associated threshold. To account for the ramp-up of connected peers.
When combining the 2013 objective: “Produce and share an electronic summary care record for every transition in care [OP, IP]” and the objective for medication reconciliation for each transition of care, this would imply discrete data import for medications.
Priority 4: Improve population and public health
The process for reporting public health surveillance and receiving alerts will require standards development in order to meet the defined objectives.
· Communication with registries requires consideration of standards and processes involving the exchange of data.
· Reportable lab results are a requirement of laboratories and should not be a MU requirement for inpatient EHRs.
Greenway supports the CDC standard to report immunizations to public health registries; however, we remain concerned about the ability of these registries to accept a dramatic increase in data feeds should this requirement be retained for 2011.
· Issues of volume in reporting already exist. We have already seen how registries were not able to accept the volume of EHR-based PQRI reporting and CMS is still working through these issues with several ambulatory EHR vendors.
· Immunization reporting is another process like quality reporting that requires workflow analyses for successful implementation. Our experience is that such quality-enabling activities can only take place once a practice is comfortable with the new electronic workflow. We recommend that this criterion be tiered for practices that are current EHR users.
Greenway suggests that submitting electronic data to immunization registries be ambulatory-only for 2011 with limited reporting for inpatient systems (e.g., tetanus, hepatitis B on all babies). To achieve this consistently, the HITSP-recommended standards (including HL7V2 transport) should be used.
The objective to receive immunization histories and recommendations from immunization registries should be qualified by “where required and accepted” since not all states may support immunization registries by 2013.
Priority 5- Ensure adequate privacy and security protections for personal health information
Whether any entity is under investigation for HIPAA or security violations should not be considered when evaluating their compliance with MU criteria.
Greenway recommends compliance with privacy requirements that are understandable by consumers and effective. Privacy standards harmonized by HITSP should be leveraged.
Monday, June 1, 2009
HIMSS Electronic Health Record Association on “Meaningful Use” of Certified EHRs
The Electronic Health Records Association (EHR Association) seeks broad stakeholder consensus on the American Recovery and Reinvestment Act of 2009 (ARRA) as well as specific recommendations for the definition of “meaningful use” of certified EHRs, which will be used to determine eligibility for the over $36B in healthcare IT stimulus incentives for physicians and hospitals.
“I’ve been pleased to have the opportunities to speak and collaborate on behalf of the Association with healthcare executives and clinicians around the country on the ARRA term “meaningful use” of certified EHRs,” said Justin Barnes, EHR Association Chairman. “I believe that our unique, collective experience as developers, implementers and providers of EHRs is being recognized as we strive to strike the right balance between practical application of these comprehensive EHR solutions and real results that support more effective, efficient care delivery.”
http://www.himssehra.org/docs/20090520_EHRA_meaningfulUsePR.pdf
“I’ve been pleased to have the opportunities to speak and collaborate on behalf of the Association with healthcare executives and clinicians around the country on the ARRA term “meaningful use” of certified EHRs,” said Justin Barnes, EHR Association Chairman. “I believe that our unique, collective experience as developers, implementers and providers of EHRs is being recognized as we strive to strike the right balance between practical application of these comprehensive EHR solutions and real results that support more effective, efficient care delivery.”
http://www.himssehra.org/docs/20090520_EHRA_meaningfulUsePR.pdf
Thursday, May 14, 2009
Great selections and additions. These leaders should prove to be great choices for the health IT and specifically, the EHR industry.
HHS Announces Members of Committees That Will Advise on Implementation of Health IT
FOR IMMEDIATE RELEASE
Contact: HHS Press Office
Friday, May 8, 2009
(202) 690-6343
HHS Announces Members of Committees That Will Advise on Implementation
of Health IT
Policy and Standards Committees Will Meet Next Week
The Department of Health and Human Services today announced the
appointment of three members to the Health Information Technology (HIT)
Policy Committee as well as members of the HIT Standards Committee. The
two new federal advisory committees were established by the American
Recovery & Reinvestment Act of 2009. The first meeting of the Health IT
Policy Committee will be held on Monday, May 11 in Washington, D. C.
"The Policy and Standards committees bring together a wide diversity of
key stakeholders to help guide the advancement of health IT as an
integral part of health reform," stated Dr. David Blumenthal, National
Coordinator for Health Information Technology at HHS and Chairman of the
Policy Committee. "It is an honor to lead one of these committees, and
I am confident that these committees will provide valuable insight to
help develop important health IT policy in the next few years."
The HIT Policy Committee will make recommendations to the National
Coordinator for Health Information Technology on a policy framework for
the development and adoption of a nationwide interoperable health
information infrastructure, including standards for the secure and
private exchange of patient medical information.
The HHS appointees to the Policy Committee are:
David Blumenthal, MD, MPP,
National Coordinator for Health Information Technology, U.S. Department
of Health and Human Services.
Michael J. Klag, MD, MPH
Dean, Johns Hopkins Bloomberg School of Public Health.
Deven C. McGraw, JD, MPH, Director
Health Privacy Project, Center for Democracy & Technology.
An additional 13 members were appointed by the Acting Comptroller
General of the United States, and four members appointed by the Majority
and Minority Leaders of the Senate and the Speaker and Minority Leader
of the House of Representatives. A complete list of the Policy Committee
members and information about the May 11th meeting can be found at
http://healthit.hhs.gov/. The Presidential appointments from relevant
federal agencies are expected to be announced prior to the HIT Policy
Committee's second meeting in June.
In addition, appointments were made to the HIT Standards Committee, also
a federal advisory body, which is charged with making recommendations to
the National Coordinator on standards, implementation specifications,
and certification criteria for the electronic exchange and use of health
information. The first meeting of this committee is scheduled for
Friday, May 15, 2009.
Members appointed by HHS are:
Jonathan Perlin, MD, Chair
Healthcare Corporation of America
John Halamka, MD. Co-Chair
Harvard Medical School
Dixie Baker, PhD
Science Applications International Corporation
Anne Castro
BlueCross BlueShield of South Carolina
Christopher Chute, MD
Mayo Clinic College of Medicine
Janet Corrigan, PhD
National Quality Forum
John Derr, R.Ph.
Golden Living, LLC
Linda Dillman
Wal-Mart Stores, Inc.
James Ferguson
Kaiser Permanente
Steven Findlay, MPH
Consumers Union
Douglas Fridsma, MD, PhD
Arizona Biomedical Collaborataive 1
C. Martin Harris, MD, MBA
Cleveland Clinic Foundation
Stanley M. Huff, MD
Intermountain Healthcare
Kevin Hutchinson
Prematics, Inc.
Elizabeth O. Johnson, RN
Tenet Health
John Klimek, R.Ph.
National Council for Prescription Drug Programs
David McCallie, Jr., MD
Cerner Corporation
Judy Murphy, RN
Aurora Health Care
J. Marc Overhage, MD, PhD
Regenstrief Institute
Gina Perez, MPA
Delaware Health Information Network
Wes Rishel
Gartner, Inc.
Sharon Terry, MA
Genetic Alliance
James Walker, MD
Geisinger Health System
Representatives from relevant federal agencies will be named separately.
For more information about these committees, meeting dates andpreliminary agendas please visit http://healthit.hhs.gov
FOR IMMEDIATE RELEASE
Contact: HHS Press Office
Friday, May 8, 2009
(202) 690-6343
HHS Announces Members of Committees That Will Advise on Implementation
of Health IT
Policy and Standards Committees Will Meet Next Week
The Department of Health and Human Services today announced the
appointment of three members to the Health Information Technology (HIT)
Policy Committee as well as members of the HIT Standards Committee. The
two new federal advisory committees were established by the American
Recovery & Reinvestment Act of 2009. The first meeting of the Health IT
Policy Committee will be held on Monday, May 11 in Washington, D. C.
"The Policy and Standards committees bring together a wide diversity of
key stakeholders to help guide the advancement of health IT as an
integral part of health reform," stated Dr. David Blumenthal, National
Coordinator for Health Information Technology at HHS and Chairman of the
Policy Committee. "It is an honor to lead one of these committees, and
I am confident that these committees will provide valuable insight to
help develop important health IT policy in the next few years."
The HIT Policy Committee will make recommendations to the National
Coordinator for Health Information Technology on a policy framework for
the development and adoption of a nationwide interoperable health
information infrastructure, including standards for the secure and
private exchange of patient medical information.
The HHS appointees to the Policy Committee are:
David Blumenthal, MD, MPP,
National Coordinator for Health Information Technology, U.S. Department
of Health and Human Services.
Michael J. Klag, MD, MPH
Dean, Johns Hopkins Bloomberg School of Public Health.
Deven C. McGraw, JD, MPH, Director
Health Privacy Project, Center for Democracy & Technology.
An additional 13 members were appointed by the Acting Comptroller
General of the United States, and four members appointed by the Majority
and Minority Leaders of the Senate and the Speaker and Minority Leader
of the House of Representatives. A complete list of the Policy Committee
members and information about the May 11th meeting can be found at
http://healthit.hhs.gov/. The Presidential appointments from relevant
federal agencies are expected to be announced prior to the HIT Policy
Committee's second meeting in June.
In addition, appointments were made to the HIT Standards Committee, also
a federal advisory body, which is charged with making recommendations to
the National Coordinator on standards, implementation specifications,
and certification criteria for the electronic exchange and use of health
information. The first meeting of this committee is scheduled for
Friday, May 15, 2009.
Members appointed by HHS are:
Jonathan Perlin, MD, Chair
Healthcare Corporation of America
John Halamka, MD. Co-Chair
Harvard Medical School
Dixie Baker, PhD
Science Applications International Corporation
Anne Castro
BlueCross BlueShield of South Carolina
Christopher Chute, MD
Mayo Clinic College of Medicine
Janet Corrigan, PhD
National Quality Forum
John Derr, R.Ph.
Golden Living, LLC
Linda Dillman
Wal-Mart Stores, Inc.
James Ferguson
Kaiser Permanente
Steven Findlay, MPH
Consumers Union
Douglas Fridsma, MD, PhD
Arizona Biomedical Collaborataive 1
C. Martin Harris, MD, MBA
Cleveland Clinic Foundation
Stanley M. Huff, MD
Intermountain Healthcare
Kevin Hutchinson
Prematics, Inc.
Elizabeth O. Johnson, RN
Tenet Health
John Klimek, R.Ph.
National Council for Prescription Drug Programs
David McCallie, Jr., MD
Cerner Corporation
Judy Murphy, RN
Aurora Health Care
J. Marc Overhage, MD, PhD
Regenstrief Institute
Gina Perez, MPA
Delaware Health Information Network
Wes Rishel
Gartner, Inc.
Sharon Terry, MA
Genetic Alliance
James Walker, MD
Geisinger Health System
Representatives from relevant federal agencies will be named separately.
For more information about these committees, meeting dates andpreliminary agendas please visit http://healthit.hhs.gov
Tuesday, April 28, 2009
Monday, April 13, 2009
CERTIFICATION COMMISSION EXPERIENCES SURGE IN APPLICATIONS
Recently announced on the CCHIT website:
CERTIFICATION COMMISSION EXPERIENCES SURGE IN APPLICATIONS;
Solid interest from EHR vendors parallel new federal incentives. An unprecedented rush of applications to meet a deadline for applying for the '08 cycle of certification testing brought to 64 the number of ambulatory electronic health record (EHR) products seeking to become CCHIT Certified® under the most rigorous criteria to date for functionality, security and, especially, interoperability. To date, 25 ambulatory EHR products have been 08 certified, including Greenway Medical Technologies, NextGen and Allscripts.
~This may reflect the impetus from the HITECH Act of the ARRA requiring "meaningful use" of “certified” solutions.
CERTIFICATION COMMISSION EXPERIENCES SURGE IN APPLICATIONS;
Solid interest from EHR vendors parallel new federal incentives. An unprecedented rush of applications to meet a deadline for applying for the '08 cycle of certification testing brought to 64 the number of ambulatory electronic health record (EHR) products seeking to become CCHIT Certified® under the most rigorous criteria to date for functionality, security and, especially, interoperability. To date, 25 ambulatory EHR products have been 08 certified, including Greenway Medical Technologies, NextGen and Allscripts.
~This may reflect the impetus from the HITECH Act of the ARRA requiring "meaningful use" of “certified” solutions.
Monday, March 30, 2009
Congressional Health Hearings on Capitol Hill This Week (Mar-30)
1. The Senate Health, Education, Labor and Pensions Committee chaired by Senator Ted Kennedy (D-MA) will host a nomination hearing on Tuesday for Kansas Governor Kathleen Sebelius to be the next Secretary of the Department of Health and Human Services (HHS) Secretary, followed by a nomination hearing by the Senate Finance Committee on Thursday. While both Senate committees have jurisdiction over federal healthcare issues, the Senate Finance Committee has ultimate jurisdiction over approving the HHS Secretary nomination and following the Thursday hearing will vote to send the nomination to the full Senate for a vote. Once passed by the full Senate, the nominee is then considered confirmed by the Senate. It is anticipated that Governor Sebelius will assume the office of Secretary of HHS following Senate confirmation as soon as President Obama returns home from overseas and swears Governor Sebelius into office.
2. The U.S. House has two committees with jurisdiction over healthcare issues. Subcommittees of the House Energy and Commerce Committee chaired by Rep. Henry Waxman (D-CA) will hold three healthcare hearings this week. On Tuesday, the Health Subcommittee of the House Energy and Commerce Committee will examine public health in the context of overhauling the nation's healthcare system, and the Commerce, Trade and Consumer Protection Subcommittee of the House Energy and Commerce Committee will examine legislation that would prohibit brand-name pharmaceutical companies from paying generic drug makers to delay selling their low-cost versions. The Health Subcommittee of the House Energy and Commerce Committee will hold another hearing this Thursday on a healthcare overhaul that examines ways to save money in the system and improve safety.
3. Finally, the House Ways and Means Committee chaired by Rep. Charles Rangel (D-NY) will hold a hearing this Wednesday on modernizing the healthcare delivery system, with a focus on care coordination and improving quality of care.
2. The U.S. House has two committees with jurisdiction over healthcare issues. Subcommittees of the House Energy and Commerce Committee chaired by Rep. Henry Waxman (D-CA) will hold three healthcare hearings this week. On Tuesday, the Health Subcommittee of the House Energy and Commerce Committee will examine public health in the context of overhauling the nation's healthcare system, and the Commerce, Trade and Consumer Protection Subcommittee of the House Energy and Commerce Committee will examine legislation that would prohibit brand-name pharmaceutical companies from paying generic drug makers to delay selling their low-cost versions. The Health Subcommittee of the House Energy and Commerce Committee will hold another hearing this Thursday on a healthcare overhaul that examines ways to save money in the system and improve safety.
3. Finally, the House Ways and Means Committee chaired by Rep. Charles Rangel (D-NY) will hold a hearing this Wednesday on modernizing the healthcare delivery system, with a focus on care coordination and improving quality of care.
Immediate HITECH Timeline
Within 45 days of enactment (April 3, 2009):
• Appointment of HIT Policy Committee members - Section 3002(b)
After 45 days from date of enactment (April 3, 2009), but prior to 90 days (May 18, 2009):
• HIT Policy Committee makes recommendations to ONC on areas in which standards, implementation specifications, and certification criteria are needed including those to protect privacy, ensure security, account for disclosures, encrypt information and use EHRs for quality improvement (Section 3002)
Within 90 days of enactment (May 18, 2009):
• HIT Standards Committee will develop a schedule for assessment of the policy recommendations developed by the HIT Policy Committee (Section 3003)
• NIST to conduct pilot testing of standards and implementation (Section 3003 and Section 13201)
• Draft description of program for establishing regional centers for HIT Implementation Assistance (Section 3012)Not later than 45 days after the HIT Standards Committee delivers recommendations to ONC
• ONC makes a determination whether to endorse each standard, implementation specification, and certification criterion for the electronic exchange and use of health information that is recommended by the HIT Standards Committee and delivers recommendations to HHS Secretary (Section 3001)
By December 31, 2009:
• HHS Secretary (in consultation with other Federal Agencies) will determine what standards should be adopted from those endorsed by ONC, and adopt them through rulemaking processes (Section 3004)
• Secretary will adopt an initial set of standards, implementation specifications and certification criteria through release of Interim Final Regulations (Section 3004)
• Appointment of HIT Policy Committee members - Section 3002(b)
After 45 days from date of enactment (April 3, 2009), but prior to 90 days (May 18, 2009):
• HIT Policy Committee makes recommendations to ONC on areas in which standards, implementation specifications, and certification criteria are needed including those to protect privacy, ensure security, account for disclosures, encrypt information and use EHRs for quality improvement (Section 3002)
Within 90 days of enactment (May 18, 2009):
• HIT Standards Committee will develop a schedule for assessment of the policy recommendations developed by the HIT Policy Committee (Section 3003)
• NIST to conduct pilot testing of standards and implementation (Section 3003 and Section 13201)
• Draft description of program for establishing regional centers for HIT Implementation Assistance (Section 3012)Not later than 45 days after the HIT Standards Committee delivers recommendations to ONC
• ONC makes a determination whether to endorse each standard, implementation specification, and certification criterion for the electronic exchange and use of health information that is recommended by the HIT Standards Committee and delivers recommendations to HHS Secretary (Section 3001)
By December 31, 2009:
• HHS Secretary (in consultation with other Federal Agencies) will determine what standards should be adopted from those endorsed by ONC, and adopt them through rulemaking processes (Section 3004)
• Secretary will adopt an initial set of standards, implementation specifications and certification criteria through release of Interim Final Regulations (Section 3004)
Monday, March 23, 2009
ROI
A few great case studies:
There are numerous studies showing that EHR has a significant ROI: http://content.healthaffairs.org/cgi/content/full/hlthaff.w5.10/DC1 http://content.healthaffairs.org/cgi/content/full/24/5/1103
http://www.ncbi.nlm.nih.gov/pubmed/12714130
http://www.jamia.org/cgi/content/full/13/3/261
http://www.ncbi.nlm.nih.gov/sites/entrez
http://www.greenwaymedical.com/dynamic/pdf/roi/roi_nine_doctor_obgyn.pdf
http://www.greenwaymedical.com/dynamic/pdf/casestudies/testimonial_oswego_greenway_sept2004.pdf http://www.greenwaymedical.com/dynamic/pdf/roi/post%20deployment%20roi%20-%20oswego%20obgyn.pdf.
For example, a detailed case study of the cost and quality benefits of EHR at Family Care of Concord, NH found net benefits per clinician per year of $30,324 https://www.acponline.org/atpro/timssnet/products/tnt_products.cfm?action=long&primary_id=330371070.
Another study of hospital-based provider order entry identified net savings of $1.7 million per year from drug dosing guidance, nursing time utilization, and error prevention http://www.jamia.org/cgi/content/full/13/3/261.
Studies show that there is benefit for health conditions like diabetes and heart disease from EHR http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=15802479, http://www.ncbi.nlm.nih.gov/pubmed/18373141, and http://www.bmj.com/cgi/content/abstract/330/7494/765.
EHRs increase overall patient safety. Children's Hospital of Seattle, following best practices for implementation, have experienced a trend toward a lower mortality rate http://pediatrics.aappublications.org/cgi/content/abstract/118/1/290.
The level of medication error reduction with computerization of prescribing seen in multiple studies is over 80%
http://www.jamia.org/cgi/content/full/6/4/313; http://archinte.ama-assn.org/cgi/content/full/163/12/1409.
There are numerous studies showing that EHR has a significant ROI: http://content.healthaffairs.org/cgi/content/full/hlthaff.w5.10/DC1 http://content.healthaffairs.org/cgi/content/full/24/5/1103
http://www.ncbi.nlm.nih.gov/pubmed/12714130
http://www.jamia.org/cgi/content/full/13/3/261
http://www.ncbi.nlm.nih.gov/sites/entrez
http://www.greenwaymedical.com/dynamic/pdf/roi/roi_nine_doctor_obgyn.pdf
http://www.greenwaymedical.com/dynamic/pdf/casestudies/testimonial_oswego_greenway_sept2004.pdf http://www.greenwaymedical.com/dynamic/pdf/roi/post%20deployment%20roi%20-%20oswego%20obgyn.pdf.
For example, a detailed case study of the cost and quality benefits of EHR at Family Care of Concord, NH found net benefits per clinician per year of $30,324 https://www.acponline.org/atpro/timssnet/products/tnt_products.cfm?action=long&primary_id=330371070.
Another study of hospital-based provider order entry identified net savings of $1.7 million per year from drug dosing guidance, nursing time utilization, and error prevention http://www.jamia.org/cgi/content/full/13/3/261.
Studies show that there is benefit for health conditions like diabetes and heart disease from EHR http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=15802479, http://www.ncbi.nlm.nih.gov/pubmed/18373141, and http://www.bmj.com/cgi/content/abstract/330/7494/765.
EHRs increase overall patient safety. Children's Hospital of Seattle, following best practices for implementation, have experienced a trend toward a lower mortality rate http://pediatrics.aappublications.org/cgi/content/abstract/118/1/290.
The level of medication error reduction with computerization of prescribing seen in multiple studies is over 80%
http://www.jamia.org/cgi/content/full/6/4/313; http://archinte.ama-assn.org/cgi/content/full/163/12/1409.
Friday, March 20, 2009
NEW ONC DIRECTOR ~ David Blumenthal, M.D., M.P.P.
David Blumenthal, M.D., M.P.P., is director of the Institute for Health Policy at Massachusetts General Hospital and Samuel O. Their Professor of Medicine at Harvard Medical School. Previously, he held posts as senior vice president at Boston's Brigham and Women's Hospital and executive director of the Center for Health Policy and Management at Harvard's John F. Kennedy School of Government. During the late 1970s, he was a professional staff member on Senator Edward Kennedy's Senate Subcommittee on Health and Scientific Research. Dr. Blumenthal is the founding chairman of AcademyHealth, the national organization of health services researchers; national correspondent for the New England Journal of Medicine; and a trustee of the University of Pennsylvania Health System
Interesting Stimulus Factoid - CMS Website posts Eligible Stimulus Recipients, including Hospitals
`(B) POSTING ON WEBSITE- The Secretary shall post on the Internet website of the Centers
for Medicare &Medicaid Services, in an easily understandable format, a list of the names of
the eligible hospitals that are meaningful EHR users under this subsection or subsection (b)(3)(B)
(ix) (and a list of the names of critical access hospitals to which paragraph (3) or (4) of section
1814(l) applies), and other relevant data as determined appropriate by the Secretary. The
Secretary shall ensure that an eligible hospital (or critical access hospital) has the opportunity
to review the other relevant data that are to be made public with respect to the hospital (or
critical access hospital) prior to such data being made public.
This can be found on page 447 of the Stimulus Package (HR1).
for Medicare &Medicaid Services, in an easily understandable format, a list of the names of
the eligible hospitals that are meaningful EHR users under this subsection or subsection (b)(3)(B)
(ix) (and a list of the names of critical access hospitals to which paragraph (3) or (4) of section
1814(l) applies), and other relevant data as determined appropriate by the Secretary. The
Secretary shall ensure that an eligible hospital (or critical access hospital) has the opportunity
to review the other relevant data that are to be made public with respect to the hospital (or
critical access hospital) prior to such data being made public.
This can be found on page 447 of the Stimulus Package (HR1).
Interesting Stimulus Factoid - CMS Website posts Eligible Stimulus Recipients
All Medicare & Medicaid recipients of Stimulus incentive funds will be posted on a CMS website. It obviously will show the care providers and eligible professionals who adopt and successfully use 21st Century health IT such as EHRs to provide high-quality care to their patients.
"POSTING ON WEBSITE- The Secretary shall post on the Internet website of the Centers
for Medicare &Medicaid Services, in an easily understandable format, a list of the names,
business addresses, and business phone numbers of the eligible professionals who are
meaningful EHR users and, as determined appropriate by the Secretary, of group practices
receiving incentive payments."
This can be found on page 436 of the Stimulus Package.
"POSTING ON WEBSITE- The Secretary shall post on the Internet website of the Centers
for Medicare &Medicaid Services, in an easily understandable format, a list of the names,
business addresses, and business phone numbers of the eligible professionals who are
meaningful EHR users and, as determined appropriate by the Secretary, of group practices
receiving incentive payments."
This can be found on page 436 of the Stimulus Package.
Thursday, March 19, 2009
EHR Association Chair Supports Stimulus Package as Key to Healthcare Transformation
Please click on the image to see an enlarged version/read the text.
Wednesday, March 18, 2009
Budget update to HITECH:
Incentives through Medicare for the Meaningful Use of Certified EHR Technology -
Establishment of incentive payments through Medicare for the meaningful use of certified EHR technology by “eligible professionals and hospitals”. The CBO estimates the total cost of Medicare and Medicaid incentives for eligible professionals and hospitals that demonstrate a meaningful use of certified EHR technology to be $20.819. $20.819 is derived from the sum of the total costs of the incentives in fiscal year 2009 – fiscal year 2015 ($36.368 billion) and the total savings that are achieved in fiscal year 2016 – fiscal year 2019 through the incentives ($15.549 billion).
Establishment of incentive payments through Medicare for the meaningful use of certified EHR technology by “eligible professionals and hospitals”. The CBO estimates the total cost of Medicare and Medicaid incentives for eligible professionals and hospitals that demonstrate a meaningful use of certified EHR technology to be $20.819. $20.819 is derived from the sum of the total costs of the incentives in fiscal year 2009 – fiscal year 2015 ($36.368 billion) and the total savings that are achieved in fiscal year 2016 – fiscal year 2019 through the incentives ($15.549 billion).
Wednesday, March 11, 2009
Optimizing the Opportunities in Economic Stimulus for the Physician Practice
HIMSS09 will include 10 education sessions focused on the impact of the health IT provisions in the American Recovery & Reinvestment Act of 2009. $19 billion is being invested by the federal government in the healthcare industry, primarily to achieve widespread adoption and use of EHR technologies within hospitals, physician practices, community health organizations, public health settings, and others - and to make electronic exchange of health information a reality throughout the United States. Make sure to mark your calendars so you do not miss these highly informative educational sessions!
Conference Highlight:
Optimizing the Opportunities in Economic Stimulus for the Physician Practice
Monday, April 6, 2:15 PM - 3:15 PM
HIMSS Annual Conference, McCormick Place, Chicago, IL
Register here.
This session will provide the attendee with an overview of the incentives related to the Economic Stimulus Package as well as prepare practices for what they must do to adopt an electronic health record (EHR). You will hear from industry, legal, vendor and consulting experts on this topic, including Justin Barnes, VP of Government Affairs and Marketing at Greenway Medical Technologies and Chairman of the EHR Association.
Conference Highlight:
Optimizing the Opportunities in Economic Stimulus for the Physician Practice
Monday, April 6, 2:15 PM - 3:15 PM
HIMSS Annual Conference, McCormick Place, Chicago, IL
Register here.
This session will provide the attendee with an overview of the incentives related to the Economic Stimulus Package as well as prepare practices for what they must do to adopt an electronic health record (EHR). You will hear from industry, legal, vendor and consulting experts on this topic, including Justin Barnes, VP of Government Affairs and Marketing at Greenway Medical Technologies and Chairman of the EHR Association.
HIMSS on EHR Adoption
Interesting piece addressing the urgency of needing to adopt EHRs sooner rather than later to maximize incentives and avoid penalties. This article seems to indicate that only 08 CCHIT Certified EHR solutions could qualify for the functionality requirements in the Stimulus legislation.
Thursday, February 19, 2009
Healthcare Information and Management Systems Society President and CEO H. Stephen Lieber said that although many of the details of the health IT provisions included in the stimulus packaged still need to be worked out, health care providers should start planning the rollout of electronic health record systems now to gain the maximum financial incentives, Health Data Management reports.
…he said that software vendors and health care providers cannot afford to delay health IT projects because health care providers must have qualifying EHR systems in place by 2011 to maximize incentive payments.
Qualifying Systems
Under the stimulus package, qualifying EHR systems must include:
The ability to support the exchange of clinical data with other organizations (interoperability).
Upfront Costs
Lieber said that while the stimulus package does include some funding for health IT grants and loans, "most providers will have to make their own upfront investments in technology."
…Lieber stressed that if health care providers fail to invest in health IT, they could face substantial long-term cuts in Medicare funding (Anderson, Health Data Management, 2/18).
Thursday, February 19, 2009
Healthcare Information and Management Systems Society President and CEO H. Stephen Lieber said that although many of the details of the health IT provisions included in the stimulus packaged still need to be worked out, health care providers should start planning the rollout of electronic health record systems now to gain the maximum financial incentives, Health Data Management reports.
…he said that software vendors and health care providers cannot afford to delay health IT projects because health care providers must have qualifying EHR systems in place by 2011 to maximize incentive payments.
Qualifying Systems
Under the stimulus package, qualifying EHR systems must include:
The ability to support the exchange of clinical data with other organizations (interoperability).
Upfront Costs
Lieber said that while the stimulus package does include some funding for health IT grants and loans, "most providers will have to make their own upfront investments in technology."
…Lieber stressed that if health care providers fail to invest in health IT, they could face substantial long-term cuts in Medicare funding (Anderson, Health Data Management, 2/18).
Monday, March 2, 2009
On Feb 13th, in the 111th CONGRESS, 1st Session, H. R. 1087 was introduced to amend the Internal Revenue Code of 1986 to increase the deduction under Section 179 for the purchase of qualified health care information technology by medical care providers, and for other purposes. This is a very important tax deduction utilized in 2008 to incentivize investment in EHR – we will keep you posted if it is implemented for perpetuity.
111th CONGRESS
1st Session
H. R. 1087
To amend the Internal Revenue Code of 1986 to increase the deduction under section 179 for the purchase of qualified health care information
technology by medical care providers, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 13, 2009
Mr. Gingrey of Georgia (for himself, Mr. Sessions, Mr. Sam Johnson of Texas, Mr. Brown of South Carolina, Mr. Akin, Mr. Smith of Texas, Mr.
Bishop of Utah, Mr. Hensarling, Mrs. Schmidt, Mr. Bartlett, Mr. Pitts, Ms. Fallin, Mr. Burton of Indiana, Mr. Fleming, Mr. Cole, Mr. King of Iowa, Mr. Price of Georgia, and Mr. Lamborn) introduced the following
bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To amend the Internal Revenue Code of 1986 to increase the deduction under section 179 for the purchase of qualified health care information
technology by medical care providers, and for other purposes.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Assisting Doctors to Obtain Proficient and Transmissible Health Information Technology Act of 2009'' or the ``ADOPT HIT Act of 2009''.
SEC. 2. PURCHASE OF QUALIFIED HEALTH CARE INFORMATION TECHNOLOGY.
(a) In General.--Section 179 of the Internal Revenue Code of 1986 (relating to election to expense certain depreciable assets) is amended by adding at the end the following new subsection:
``(f) Health Care Information Technology.--
``(1) In general.--In the case of qualified health care
information technology purchased by a medical care provider and
placed in service during a taxable year--
``(A) subsection (b)(1) shall be applied by
substituting `$250,000' for `$125,000',
``(B) subsection (b)(2) shall be applied by
substituting `$600,000' for `$500,000', and
``(C) subsection (b)(5)(A) shall be applied by
substituting `$250,000 and $600,000' for `$125,000 and
$500,000'.
``(2) Definitions.--For purposes of this subsection--
``(A) Qualified health care information
technology.--The term `qualified health care
information technology' means section 179 property
which--
``(i) has been certified by the Secretary
of Health and Human Services pursuant to
section 3 of the ADOPT HIT Act of 2009, and
``(ii) is used primarily for the electronic
creation, maintenance, and exchange of medical
care information to improve the quality or
efficiency of medical care.
``(B) Medical care provider.--The term `medical
care provider' means any person engaged in the trade or
business of providing medical care.
``(C) Medical care.--The term `medical care' has
the meaning given such term by section 213(d).''.
(b) Effective Date.--The amendment made by this section shall apply to property placed in service after December 31, 2008.
SEC. 3. CERTIFICATION OF HEALTH CARE INFORMATION TECHNOLOGY.
(a) In General.--The Secretary of Health and Human Services shall develop criteria to ensure and certify that hardware, software, and support services for the electronic exchange of health information meet certain standards, as determined by the Secretary.
(b) Certification Assistance.--The Secretary of Health and Human Services may recognize a private entity or entities to assist in the certification described under paragraph (1) using the criteria developed by the Secretary under this section.
111th CONGRESS
1st Session
H. R. 1087
To amend the Internal Revenue Code of 1986 to increase the deduction under section 179 for the purchase of qualified health care information
technology by medical care providers, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 13, 2009
Mr. Gingrey of Georgia (for himself, Mr. Sessions, Mr. Sam Johnson of Texas, Mr. Brown of South Carolina, Mr. Akin, Mr. Smith of Texas, Mr.
Bishop of Utah, Mr. Hensarling, Mrs. Schmidt, Mr. Bartlett, Mr. Pitts, Ms. Fallin, Mr. Burton of Indiana, Mr. Fleming, Mr. Cole, Mr. King of Iowa, Mr. Price of Georgia, and Mr. Lamborn) introduced the following
bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To amend the Internal Revenue Code of 1986 to increase the deduction under section 179 for the purchase of qualified health care information
technology by medical care providers, and for other purposes.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Assisting Doctors to Obtain Proficient and Transmissible Health Information Technology Act of 2009'' or the ``ADOPT HIT Act of 2009''.
SEC. 2. PURCHASE OF QUALIFIED HEALTH CARE INFORMATION TECHNOLOGY.
(a) In General.--Section 179 of the Internal Revenue Code of 1986 (relating to election to expense certain depreciable assets) is amended by adding at the end the following new subsection:
``(f) Health Care Information Technology.--
``(1) In general.--In the case of qualified health care
information technology purchased by a medical care provider and
placed in service during a taxable year--
``(A) subsection (b)(1) shall be applied by
substituting `$250,000' for `$125,000',
``(B) subsection (b)(2) shall be applied by
substituting `$600,000' for `$500,000', and
``(C) subsection (b)(5)(A) shall be applied by
substituting `$250,000 and $600,000' for `$125,000 and
$500,000'.
``(2) Definitions.--For purposes of this subsection--
``(A) Qualified health care information
technology.--The term `qualified health care
information technology' means section 179 property
which--
``(i) has been certified by the Secretary
of Health and Human Services pursuant to
section 3 of the ADOPT HIT Act of 2009, and
``(ii) is used primarily for the electronic
creation, maintenance, and exchange of medical
care information to improve the quality or
efficiency of medical care.
``(B) Medical care provider.--The term `medical
care provider' means any person engaged in the trade or
business of providing medical care.
``(C) Medical care.--The term `medical care' has
the meaning given such term by section 213(d).''.
(b) Effective Date.--The amendment made by this section shall apply to property placed in service after December 31, 2008.
SEC. 3. CERTIFICATION OF HEALTH CARE INFORMATION TECHNOLOGY.
(a) In General.--The Secretary of Health and Human Services shall develop criteria to ensure and certify that hardware, software, and support services for the electronic exchange of health information meet certain standards, as determined by the Secretary.
(b) Certification Assistance.--The Secretary of Health and Human Services may recognize a private entity or entities to assist in the certification described under paragraph (1) using the criteria developed by the Secretary under this section.
Monday, February 16, 2009
HEALTH PROVISIONS IN THE AMERICAN RECOVERY AND REINVESTMENT ACT OF 2009: FREQUENTLY ASKED QUESTIONS
The American Recovery and Reinvestment Act of 2009 includes important investments in health information technology and in research on the comparative effectiveness of various health care tests and treatments. These investments will quickly grow jobs in the health care sector and eventually improve the quality of health care for every American. Unfortunately, incorrect rumors about these provisions and their likely effects threaten to undermine these good policies. Following are the most Frequently Asked Questions – and accurate answers – about how health information technology provisions in the American Recovery and Reinvestment Act will work:
Health Information Technology
Q: What will the “National Coordinator of Health Information Technology” do?
A: Under this bill, the National Coordinator of Health Information Technology will set minimum standards for the technology systems your doctor may choose to store and maintain your medical records – making sure, for instance, that the systems are configured to keep your information from getting loose to the public, but still allowing your various doctors to share the information easily and confidentially. The coordinator will also work to support doctors and hospitals as they transition to electronic records. Actually, the Office of the National Coordinator of Health Information Technology is not even new. President George W. Bush created the office by Executive Order a number of years ago. The bill simply codifies the office and gives it a specific job.
Q: Will the health IT director have any influence on the decisions doctors and patients can make together about tests and treatment?
A: Absolutely not. This position’s function is to make sure that doctors and other health care providers use good, secure technologies as they change their record-keeping systems from paper to computers.
Q: Will the government have access to my electronic medical record?
A: No. Federal law makes your medical records – whether they’re on paper or in a computer – confidential to you and your health provider.
Q: What‟s the “meaningful use” of health IT? Does this bill say that my doctor has to use health information technology and provide only certain treatments to me, or risk a penalty from the government?
A: To improve the quality of American health care, it’s important for doctors and providers to move to an electronic system of records. This will reduce medical errors, improve efficiency, and help doctors for a single patient work together better to keep that patient healthy. The bill requires health providers to be “meaningful users” of health IT by 2015 – meaning, they have to have a system of electronic records to achieve these goals. This bill does not, however, require physicians to follow any particular treatment guidelines, protocols, or other research in order to meet the “meaningful use” standard. They just have to have electronic records by 2015.
Comparative Effective Research
Q: What is comparative effectiveness research?
A: Comparative effectiveness research compares clinical outcomes, or the “clinical effectiveness,” of alternative therapies for the same condition. More evidence on what works and doesn’t work can help patients and doctors make better health care decisions together, thus improving the quality of patients’ care, improving efficiency by focusing on what works, and ultimately saving money throughout the health system.
Q: Why should the government be doing this research?
A: Right now, much of health care research is funded by companies trying to sell a drug or treatment. The comparative effectiveness research provisions in the Senate economic recovery legislation are designed to allow unbiased research that simply gets the facts – and the provision will create jobs in the research sector as well.
Q: Can the government use the results of this research to tell me, or my doctor, what tests and treatments I can or cannot have?
A: Absolutely not. In fact, the Senate bill specifically prohibits the government from making any coverage decisions based on this research, or even from issuing guidelines that would suggest how to interpret the research results. The sole aim is to disseminate the results of the research to the public, so that patients and their doctors can make the best decisions for their specific situations, together.
Q: Will this bill allow the government to apply the results of comparative effectiveness research to deny me end-of-life care or medicines that I choose?
A: Absolutely not. In fact, the Senate bill specifically prohibits the government from making any coverage decisions based on this research, or even from issuing guidelines that would suggest how to interpret the research results. The sole aim is to disseminate the results of the research to the public, so that patients and their doctors can make the best decisions for their specific situations, together.
Q: Is there some kind of health care „czar‟ in this bill with access to this comparative effectiveness research and my electronic medical records, who might make decisions about what my doctor or insurance company can do about my medical treatment?
A: No. Comparative effectiveness and health IT are separate in this bill. There’s no crossover in the administration of these provisions, research, or technology.
Health Information Technology
Q: What will the “National Coordinator of Health Information Technology” do?
A: Under this bill, the National Coordinator of Health Information Technology will set minimum standards for the technology systems your doctor may choose to store and maintain your medical records – making sure, for instance, that the systems are configured to keep your information from getting loose to the public, but still allowing your various doctors to share the information easily and confidentially. The coordinator will also work to support doctors and hospitals as they transition to electronic records. Actually, the Office of the National Coordinator of Health Information Technology is not even new. President George W. Bush created the office by Executive Order a number of years ago. The bill simply codifies the office and gives it a specific job.
Q: Will the health IT director have any influence on the decisions doctors and patients can make together about tests and treatment?
A: Absolutely not. This position’s function is to make sure that doctors and other health care providers use good, secure technologies as they change their record-keeping systems from paper to computers.
Q: Will the government have access to my electronic medical record?
A: No. Federal law makes your medical records – whether they’re on paper or in a computer – confidential to you and your health provider.
Q: What‟s the “meaningful use” of health IT? Does this bill say that my doctor has to use health information technology and provide only certain treatments to me, or risk a penalty from the government?
A: To improve the quality of American health care, it’s important for doctors and providers to move to an electronic system of records. This will reduce medical errors, improve efficiency, and help doctors for a single patient work together better to keep that patient healthy. The bill requires health providers to be “meaningful users” of health IT by 2015 – meaning, they have to have a system of electronic records to achieve these goals. This bill does not, however, require physicians to follow any particular treatment guidelines, protocols, or other research in order to meet the “meaningful use” standard. They just have to have electronic records by 2015.
Comparative Effective Research
Q: What is comparative effectiveness research?
A: Comparative effectiveness research compares clinical outcomes, or the “clinical effectiveness,” of alternative therapies for the same condition. More evidence on what works and doesn’t work can help patients and doctors make better health care decisions together, thus improving the quality of patients’ care, improving efficiency by focusing on what works, and ultimately saving money throughout the health system.
Q: Why should the government be doing this research?
A: Right now, much of health care research is funded by companies trying to sell a drug or treatment. The comparative effectiveness research provisions in the Senate economic recovery legislation are designed to allow unbiased research that simply gets the facts – and the provision will create jobs in the research sector as well.
Q: Can the government use the results of this research to tell me, or my doctor, what tests and treatments I can or cannot have?
A: Absolutely not. In fact, the Senate bill specifically prohibits the government from making any coverage decisions based on this research, or even from issuing guidelines that would suggest how to interpret the research results. The sole aim is to disseminate the results of the research to the public, so that patients and their doctors can make the best decisions for their specific situations, together.
Q: Will this bill allow the government to apply the results of comparative effectiveness research to deny me end-of-life care or medicines that I choose?
A: Absolutely not. In fact, the Senate bill specifically prohibits the government from making any coverage decisions based on this research, or even from issuing guidelines that would suggest how to interpret the research results. The sole aim is to disseminate the results of the research to the public, so that patients and their doctors can make the best decisions for their specific situations, together.
Q: Is there some kind of health care „czar‟ in this bill with access to this comparative effectiveness research and my electronic medical records, who might make decisions about what my doctor or insurance company can do about my medical treatment?
A: No. Comparative effectiveness and health IT are separate in this bill. There’s no crossover in the administration of these provisions, research, or technology.
Health Information Technology for Economic and Clinical Health Act (HITECH Act of Economic Stimulus Package) Update
*Please click on image to see enlarged version of the Stimulus Physician Medicare Incentives Graph.
(High-level details shared by the Committee on Energy and Commerce, Ways and Means, and Science and Technology in the House and Committee on Finance and Health, Education, Labor and Pensions in the Senate - subject to interpretation).
Funding and Incentives for a Certified Electronic Health Record:
Over $30B in Direct Health IT Adoption and Infrastructure Incentives. $17.7B for Medicare and $12.4B for Medicaid, $300M for Health Information Exchanges and $85M for Indian Health Services.
Medicare Incentives to Physicians. Incentives for eligible professionals under Medicare are increased to a maximum amount of $44,000 between 2011-2015. 1% annual reductions begin in 2015.
Medicaid Incentives to Pediatricians as well as Underserved and Rural Communities. Eligible professionals with these designations can receive incentive payments up to $63,750 between 2010-2015.
Health Professional Shortage Area Bonus. The conference agreement would provide a 10% increase in Medicare incentive payments for eligible professionals practicing in areas designated as having shortages of health professionals.
Clinical Research Funding. $1.1 billion for comparative effectiveness research within the Agency for Healthcare Research and Quality (AHRQ), National Institutes of Health (NIH), and the Department of Health and Human Services (HHS).
Regional Health Information Exchanges. $300 million in grants to support regional health information exchanges was retained but moved to the corresponding funding sections in the Act.
Funding and Incentives for a Certified Electronic Health Record:
Over $30B in Direct Health IT Adoption and Infrastructure Incentives. $17.7B for Medicare and $12.4B for Medicaid, $300M for Health Information Exchanges and $85M for Indian Health Services.
Medicare Incentives to Physicians. Incentives for eligible professionals under Medicare are increased to a maximum amount of $44,000 between 2011-2015. 1% annual reductions begin in 2015.
Medicaid Incentives to Pediatricians as well as Underserved and Rural Communities. Eligible professionals with these designations can receive incentive payments up to $63,750 between 2010-2015.
Health Professional Shortage Area Bonus. The conference agreement would provide a 10% increase in Medicare incentive payments for eligible professionals practicing in areas designated as having shortages of health professionals.
Clinical Research Funding. $1.1 billion for comparative effectiveness research within the Agency for Healthcare Research and Quality (AHRQ), National Institutes of Health (NIH), and the Department of Health and Human Services (HHS).
Regional Health Information Exchanges. $300 million in grants to support regional health information exchanges was retained but moved to the corresponding funding sections in the Act.
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