Health IT for the 21st Century

ONC plans certification well beyond electronic health records

2010-04-02T08:26:00.000-07:00

While the majority of the ONC’s rulemaking proposal for the certification of meaningful use EHRs concerns the process of becoming a certifying entity, the 184-page document originally published March 2 is also a compelling look into the future.

Healthcare providers and health information technology leaders take note: according to the proposal, future plans for the specific certification of personal health records is repeatedly stated. Other passages speak to the existing proposal as a framework to certify “other networks designed for the electronic exchange of health information,” and in another passage, “other types of HIT.”

If that sounds overly ambitious given all that must occur for meaningful use stimulus funds to begin flowing next year (or even potentially this year for some state Medicaid incentives plans), the proposal’s foundations in transparency, competitiveness and a maturing of certification and accreditation should – and is meant to – instill faith in providers of ONC’s serious intent in the long-term establishment of a mutually beneficial health information network with population health squarely in mind.

Some assurance of a master plan, so to speak, can be found in the more detailed timelines of the new EHR certification plan as it corresponds to the stages of meaningful use detailed in the December 30 proposals of EHR standards by ONC, and of eligible professional capabilities by the Centers for Medicare and Medicaid Services (CMS).

The March 2 Notice of Proposed Rulemaking (NPRM) establishes a well-publicized temporary and then permanent certification structure, done to meet 2011 stimulus incentives and coincide with Stage 1 (and then Stage 2) meaningful use criteria.

The NPRM predicts that temporary certification largely overseen by ONC can begin this May or June, and be replaced by permanent certification led by the private sector by the first quarter of 2012. May or June could coincide with the final issuance of Stage 1 eligible professional and EHR meaningful use criteria, now that public comment ended March 15, while Stage 2 can begin when permanent certification takes over. That way private sector entities like the Certification Commission for Health Information Technology (CCHIT), the current gold standard in HIT certification, can know just what they are certifying for. And the proposal’s language concerning recertification following the temporary designation is not a repeat process, but an expansion in accordance with meaningful use stages.

And if all goes well, there’s reason to trust that the future certification of personal health records, “other types” and “other networks” can take hold.

To get there, permanent certification entities will be accredited, according to the new proposal, with oversight provided by the National Institute of Standards and Technology (NIST) and the National Voluntary Laboratory Accreditation Program (NVLAP). Likewise, the overall approach to the certification plans has been built by the International Organization for Standardization (ISO) and the International Electrotechnical Commission (IEC). I know that sounds like a lot of layers of bureaucracy, but that is the world we are currently in. Speaking of CCHIT, the proposal notes that upon its publishing, only CCHIT has applied for and received “recognized certification body” status as outlined by the guidelines establishing the overall certification program, though the proposal clearly states ONC is seeking a competitive environment of varying temporary and permanent certification entities. (Public comment on the March 2 proposal allows 30 days for the temporary program, and 60 days for the permanent certification language.)

The proposal also estimates that meaningful use certification will remain with the current pricing range of $30,000 to $50,000, and also promises to disclose all eventual certification bodies – and the HIT systems ultimately certified – on HHS websites in another nod to transparency.

Finally, the proposal projects that even within 2010, 45 percent of the estimated 93 complete EHR systems currently available will be certified, followed by 40 percent in 2011 and the remaining 15 percent in 2012.

That is a framework we all hope can be met, all toward comprehensive EHR adoption the meaningful use program is meant to facilitate. At the same time, and while the plan for private sector certification is to be applauded, ongoing vigilance is necessary to ensure that the progress and innovation inherent in our industry does not become subject to over-regulation and truly embraces the private sector during future oversights this document also proposes.

By Justin T. Barnes

Justin Barnes is chairman of the Electronic Health Record Association and vice president of marketing, corporate development and government affairs at Greenway Medical Technologies, Inc.

U.S. House Passes Healthcare Reform Legislation ~ Health IT Well-Represented

2010-03-22T11:43:00.000-07:00

Last night, the U.S. House of Representatives passed healthcare reform legislation with significant investment in more health IT - H.R. 3590, the Patient Protection and Affordable Health Care Act - on a vote 219-212. The Senate passed H.R. 3590 on December 24, 2009. President Obama is expected to sign this legislation into law (as early as this Tuesday).

Also last night, the House passed the Reconciliation Act of 2010, H.R. 4872, which makes changes to H.R. 3590. The Senate is expected to consider H.R. 4872 during the week of March 22nd. Senate Democrats will need a simple majority, 51 votes, to pass the legislation.

Below is an brief overview that should suffice most with health IT provisions bolded at the bottom.

Healthcare Reform Legislation, H.R. 3590 and H.R. 4872:

• Costs $938 billion over a decade
• Cuts the deficit by $143 billion in the first ten years (2010- 2019)
• Cuts the deficit by $1.2 trillion in the second ten years
• Estimated to reduce annual growth in Medicare expenditures by 1.4 percentage points per year
• Aims to expand health insurance coverage to 32 million Americans
• Aims to provide healthcare coverage to 94 percent of Americans
• Prohibits insurance companies from denying coverage to individuals with preexisting conditions (effective immediately for children and applies to all individuals beginning in 2014)
• Expands Medicaid to cover individuals with income less than133 percent of the federal poverty level, or $29, 327 for a family of four
• Closes the gap in prescription drug coverage
• Prohibits insurance companies from placing lifetime caps on coverage
• Requires health plans to allow young adults, up to age 26, to remain on their parents’ insurance policy
• Increases funding for Community Health Centers
• Provides financial assistance to states to aid in the establishment of offices of health insurance consumer assistance
• Establishes 50 health insurance exchanges, administered by states, through which, small businesses and individuals without employer sponsored insurance coverage could buy coverage
• Offers tax credits to small businesses to make employee coverage more affordable
• Eliminates co-payments for preventive services and exempts preventive services from deductibles under the Medicare program

• Leverages health IT to improve the quality, cost, and access to healthcare. For example, the legislation:
o Supports programs to foster the reporting of quality measures through the use of health IT
o Directs the establishment of standards to facilitate the enrollment of individuals in health plans, as well as standards to enable the determination of an individual’s eligibility and financial responsibility for specific services prior to or at the point of care
o Establishes new programs that apply, among many things, health IT to test new, more effective healthcare delivery models
o Aims to increase the use of health IT in long-term care settings through financial assistance
o Directs the use of health IT in health risk assessments for Medicare beneficiaries
o Establishes incentive payments for health plans and providers that apply health IT in improving healthcare outcomes
o Supports the education and training of health IT among medical students

Public Policy Update for March

2010-03-22T11:22:00.001-07:00

Congressional Affairs

Congress Votes on Healthcare Reform

Nothing finalized as I put this update together but Health Reform is expected to pass with 216 or 217 votes.

On Thursday afternoon, the reconciliation bill, HR 4872, was released by the House of Representatives. Because Congressional leaders promised 72 hours for review, a vote on the final package—that includes the Senate-passed bill, HR 3590, the Patient Protection and Affordable Care Act— was now scheduled for Sunday afternoon, March 21. The House needs 216 votes for passage. If approved by the House, the package would be considered in the Senate as early as next week, under a process that would require 51 votes for passage rather than the 60-vote threshold to break a filibuster. The reconciliation bill was released after the Congressional Budget Office released its preliminary analysis of the legislation, which puts a $940 billion price tag on the bill over 10 years, with a $138 billion deficit reduction over the same time period.

Groups both pro- and con- have been campaigning hard in Washington, DC this week. President Obama has been meeting one on one with undecided Democrats to urge them to vote yes. Several hundred Tea Party activists protested healthcare reform efforts outside Democratic Congressional offices on Tuesday. And more than 200 advocacy and healthcare organizations placed ads in Capitol Hill newspapers on Wednesday calling for lawmakers to pass the bill. The Washington Post has a graphic showing which way Members of Congress are leaning, and which Members are still undecided.

Governors are frustrated that they have not been able to contribute more to the healthcare reform process. “Polls have shown consistently that the American people are not happy with process,” said Governor Jim Douglas (R) of Vermont. “They want Republicans and Democrats to work together. There’s a clear difference between the level of cooperation in Congress and [among the] nation’s governors, who work with each other and steal good ideas and implement them, who have to balance budgets and get the job done in time.”

Clarification of Eligible Providers in a Hospital Setting Closer to Final Passage
HR 4213, the Tax Extenders Act, amends ARRA to exclude “outpatient” from the definition of hospital based eligible professionals and insert “emergency room setting.” This legislation removes the exclusion of hospital based outpatient physicians from receiving incentive payments. After passage in the Senate last week by a vote of 62-36, House and Senate leaders will work to iron out the differences between the Senate version and similar legislation that passed the House in late 2009.

The EHR language reads:
SEC. 219. EHR CLARIFICATION.

(a) QUALIFICATION FOR CLINIC-BASED PHYSICIANS.—

(1) MEDICARE.—Section 1848(o)(1)(C)(ii) of the
Social Security Act (42 U.S.C. 1395w–4(o)(1)(C)(ii)) is amended by striking ‘‘setting (whether inpatient or outpatient)’’ and inserting ‘‘inpatient or emergency room setting’’.

(2) MEDICAID.—Section 1903(t)(3)(D) of the Social Security Act (42 U.S.C. 1396b(t)(3)(D)) is amended by striking ‘‘setting (whether inpatient or outpatient)’’ and inserting ‘‘inpatient or emergency room setting’’.

(b) EFFECTIVE DATE.—The amendments made by subsection (a) shall be effective as if included in the enactment of the HITECH Act (included in the American Recovery and Reinvestment Act of 2009 (Public Law 111–5)).

(c) IMPLEMENTATION.—Notwithstanding any other provision of law, the Secretary may implement the amendments made by this section by program instruction or otherwise.

Public Policy Events:

National Health IT Week 2010 will take place June 14-18, 2010.

The Government Health IT Conference, “Innovation 2010, On the Threshold of Meaningful Use,” is scheduled for June 15-16, 2010, in Washington DC. Registration is now open. The deadline for Calls for Proposals is March 22, 2010.

The HIMSS 9th Annual Policy Summit will be held June 16-17, 2010, in Washington, DC. Registration is now open.
HHS Releases Additional HIE Funds to States
This week, HHS Secretary Kathleen Sebelius and National Coordinator for Health IT Dr. David Blumenthal announced that an additional $162 million in ARRA funds would be awarded to 16 states to assist them in facilitating “non-proprietary health information exchange that adheres to national standards.” Said Dr. Blumenthal, “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.” According to HHS, every state and eligible territory has now been awarded funds under this program.

HIT Policy Committee Meets
The HIT Policy Committee met on Wednesday, March 17. The agenda included updates from the Workgroups and discussion with the HIT Standards Committee on continued efforts to synchronize policy and standards harmonization efforts. Of particular note was an update on the progress made by the Strategic Plan Workgroup on the Health IT Strategic Framework, which is on track to be delivered to ONC by Spring 2010 for publication in October 2010. In addition, the Certification/Adoption Workgroup provided a summary of their February 25 hearing on patient safety. The Workgroup is working through a series of recommendations for the HIT Policy Committee that will include an emphasis on patient engagement in identifying errors; provider training on reporting patient safety issues; the development of a national health IT reporting system to capture incidents and potential hazards with health IT, to include specific recommendations on certification criteria and software requirements for Stage 2 of meaningful use; and the creation of a toolkit for best safety practices. Audio of the meeting is available on the ONC website.

FCC Releases National Broadband Plan
The Federal Communications Commission has released the National Broadband Plan to ensure every American has “access to broadband capability.” On the Healthcare chapter, the Plan’s Executive Summary notes that “Broadband can help improve the quality and lower the cost of health care through health IT and improved data capture and use, which will enable clearer understanding of the most effective treatments and processes. To achieve these objectives, the plan has recommendations that will: help ensure health care providers have access to affordable broadband by transforming the FCC’s Rural Health Care Program; create incentives for adoption by expanding reimbursement for e-care; remove barriers to e-care by modernizing regulations like device approval, credentialing, privileging and licensing; and drive innovative applications and advanced analytics by ensuring patients have control over their health data and ensuring interoperability of data.”

ONC Launches NHIN Direct
The NHIN Direct project was recently launched by the Office of the National Coordinator for Health IT as the result of a recommendation made by the NHIN Workgroup of the HIT Policy Committee, to enable a secure health information exchange at a more local and less complex level than the Nationwide Health Information Network. “NHIN Direct is the set of standards, policies and services that enable simple, secure transport of health information between authorized care providers. NHIN Direct enables standards-based health information exchange in support of core Stage 1 Meaningful Use measures.” For example, NHIN Direct can be used by a primary care provider to send a referral or care summary to a local specialist. As part of the project, Arien Malec, Coordinator for the NHIN Direct project, is running an NHIN Direct blog and discussion board to engage stakeholders. For more information, please see NHIN Direct FAQ.

Upcoming Federal Events:

The HIT Standards Committee’s Vocabulary Task Force is holding a public meeting on March 23, 2010 in Washington, DC. The subject will be vocabulary subsets and value sets, particularly in the public sector.

The HIT Standards Committee is scheduled to meet on March 24, 2010, from 9:00 am – 3:00 pm.

On March 25, 2010 from 4:00 – 5:00 pm EDT, ONC and NIST will present an informational webinar on the recently released Certification Programs for HIT NPRM. The public comment period ends April 9 on the temporary certification program and May 10 on the permanent certification program.

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State Government Affairs

NCSL Tracks State HIT Legislation
The National Conference of State Legislatures has released the March issue of its Project HITCh newsletter (Health Information Technology Champions). In addition to stories about Federal Certification Processes and Grants, the newsletter notes that several states are considering “legislation to establish state coordinators for HIT, responding to the requirements in the HITECH Act. Some examples include Connecticut (HB 5354), Mississippi (HB 941), Pennsylvania (SB 8), and Wisconsin (HB 779). Some states are also creating their own funding initiatives. In Maine, the legislature is considering SB 675, which would create a $10 million bond issue to purchase software and equipment for providers in the state so they could utilize HIE. New Jersey is considering AB 1986, which would establish the Electronic Health Information Technology Fund, or e-HIT fund. The fund would provide revenue to carry out the state’s HIT plan by levying a 0.199% tax on all health insurance claims in the state.”

ARRA and Beyond: How to Select a Stimulus-ready EHR for the Life of Your Practice and Your Patients

2010-03-11T06:21:00.000-08:00

By Justin T. Barnes

Stated goals of the HITECH (Health Information Technology for Economic and Clinical Health) Act within ARRA (The American Recovery and Reinvestment Act of 2009) mirror those of physician practices: early detection, prevention, and management of chronic diseases, for example.

Additional goals seek to improve the coordination of care and information among hospitals, laboratories, and physician offices; improve healthcare quality, reduce medical errors, reduce health disparities, and advance the delivery of patient-centered medical care.

Getting there, specifically in terms of qualifying for Medicare or Medicaid, Regional Extension Center (REC), Health Information Exchange (HIE), broadband, and the many related programs together offering approximately $45 billion in incentive funds and grants combines the art of traditional medicine and the science of today’s healthcare delivery capabilities, as well as innovation.

Now that the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) have released meaningful use criteria—with the CMS proposed rule defining criteria for eligible professional providers, and the ONC interim final rule setting functionality standards for EHRs—the documents can provide a checklist for selecting the right EHR.

With the public comment phase of the original proposals coming to a close March 15, expect final regulations due later this spring or in early summer to subtract or limit some of the functionality criteria, and expand the definition of providers in hospital settings eligible for funding, all based on public comment to date. By regulatory definition, and again based on public comment, do not expect any expansion of the CMS or ONC list of functionality requirements. The more recent ONC issuance of meaningful use certification the first week of March - proposing a temporary and then final certification process - will help streamline an EHRs current certification status.

And overall there’s still time to qualify. For both the Medicare and Medicaid incentive pathways, the initial meaningful use year for non hospital-based eligible providers remains 2011, with respective funding continuing for 5- and 6-year cycles. And within the Medicare pathway, for example, the proposals state that eligible professionals must only achieve meaningful use reporting for 90 continuous days to qualify, meaning meaningful use reporting can begin as late as October, 2011. (Medicaid incentives can be subject to individual state plans in regards to timetables and is well worth checking.)

The major financial tenets of achieving incentive funds through the use of a certified EHR offering meaningful use functionality are well chronicled and unchanged: up to $44,000 through Medicare and up to $63,750 through Medicaid pathways, paid per eligible professional within a practice of any size.

Whether your practice is seeking a fully integrated, interoperable, and certified EHR/practice management (PM) solution or just searching for a companion certified EHR for an existing PM system, many independent evaluation and analysis tools focus on ARRA-driven meaningful use functionality standards, as well as a wealth of ROI calculators and case studies to draw from.

Throughout the closing months of 2009 and early 2010, tangible ARRA-supporting funding announcements and new legislation brought multiple reasons for confidence in the incentive package. For example, The Small Business Health Information Technology Financing Act (HR 3014) guarantees loans through SBA of up to $350,000 for small practices and $2 million for group practices to bridge EHR implementation costs until ARRA reimbursement kicks in (http://tinyurl.com/yle7x9l). HR 3014 has already passed the House of Representatives, and a companion bill has been introduced in the Senate.

Looking deeper into incentives pathways reveals additional opportunities. Practices within health professional shortage areas can qualify for an additional 10% of incentive funds (www.gao.gov/new.items/d0784.pdf). A total of $2.5 billion is available for the aforementioned utilization of broadband and telemedicine capabilities, and the REC program’s $598 million in funding targets practices of 1-10 providers (http://tinyurl.com/my736w).

Demystifying Meaningful Use
The proposed meaningful use criteria for the main ARRA incentive funds for certified EHR adoption is a two-part consideration. On one hand, your certified EHR must have the necessary functionality to support meaningful use. On the other, practices must show they are using the functionality in a meaningful way within proposed criteria to qualify for the appropriate incentives.

The overall meaningful use criteria is proposed in three phases over time, with only phase one required in the first meaningful use year. Phase one includes the ability of providers to collect data in electronic form, share key information with other providers and patients, and the ability to report quality measures.

For EHR software providers, functionality must allow integration or interoperability via standard exchange language (CCD or CCR) to share data. Electronic prescribing and computerized physician order entry (CPOE) are examples of the basic interoperable and meaningful functionalities to secure.

And of course, it’s smart to look ahead. Phases two and three of meaningful use coming after 2011 expand functionality to include disease management criteria and information exchange with government and public health agencies, when formulary checks, encounter progress notes, and automated lab results come into play. For example, an interoperable EHR should link clinical devices such as ECG or spirometry, or merge automated lab results into flow sheets on a system that maintains the values and integrity of the data for later retrieval.

The demystification comes into play when practices selecting an EHR find that 1) EHR software providers have been developing functionality and interoperability that adheres to previously known meaningful use criteria, and 2) that current certification has also been shaped to meaningful use standards.

Throughout your selection process, keep in mind that the CMS and ONC proposals do state that meaningful use is, “based on currently available technological capabilities and providers’ practice experience,” and that, “the standards adopted in the rules are consistent with current industry standards.”

Selecting an EHR
It is important for practices to select an internal search committee that is well represented by physician, nurse, administrative, and IT personnel. Next, spend time evaluating the goals and workflows of the practice. Are you adopting a certified EHR for just ARRA incentive reasons? Are you looking for improved efficiency within your practice? Are you seeking to improve quality or improve patient satisfaction? Maybe you would like to participate in clinical research? Community leadership? All of the above?

Other areas to think about and discuss with companies that offer certified EHRs (and hopefully ones you have heard great things about) include:
• Your specific requirements in accordance with your practice’s workflow, growth, and revenue targets, as well as future meaningful use requirements
• Your infrastructure. Does your existing PM system have the ability to interoperate with a separate certified her, or should you invest in just a combined EHR/PM system?
• Your practice size and scope. Do they call for implementing a client-server EHR, or an offsite (Internet-dependent), SaaS (Software as a Service) EHR
• EHR product demonstrations, site visits, and references from similar practices of your size and specialty.

Other independent evaluations that speak more to usability should be considered. Two large studies by the AAFP and Medscape were recently released and represent the feeling of thousands of EHR users on the actual usability of their system (http://tinyurl.com/y8rntb6). Another good reference of EHR solutions is found at www.klasresearch.com, where products are listed by practice size. KLAS ratings are based on a set of 25 key questions in the areas of sales and contracting, implementation and training, functionality and upgrades, service and support, and general scoring.

Other national organizations such as the Medical Group Management Association (www.mgma.com) and the HIMSS EHR Association (www.himssehra.org) offer EHR implementation tips, as do such compatible websites as www.ehrdecisions.com. When it comes to cost, don’t be afraid to negotiate with EHR software providers; discuss monthly payment and lease options, as well as IRS Code section 179 tax incentives, with them.

Finding Confidence in ARRA
It’s important to realize that the stimulus EHR adoption incentives are grounded in law, and not just regulation. ARRA funding and other recent developments, such as HR 3014, that support and fund EHR adoption beyond ARRA have inherent flexibility meant to ensure that practices do not fall outside of the guidelines. For example, Medicare reimbursement is not a fixed appropriation, but a fluid formula that keeps pace with the number of practices that are adopting EHRs and achieving meaningful use.

In late 2009, CMS notified all state Medicaid directors that CMS will reimburse at a 100% level the incentive payments that providers who achieve EHR meaningful use are due by state. Also, on December 9, CMS notified its first group of states (TX, GA, NY, ID, CA, and MT) that funds were also being deployed for statewide analysis and infrastructure needs for the planning of activities to administer incentive funds. Texas, for example, received $3.86 million toward that effort.

And earlier, on November 24, ONC announced an $80 million grants program to train a healthcare IT workforce in community colleges and other realms, with all of these steps pointing to concrete support of the ARRA program.

Practices can keep up with the details of ARRA and ongoing events through HHS websites (www.recovery.gov, www.hhs.gov/recovery) and via a new ONC blog titled Health IT Buzz (http://healthit.hhs.gov/blog/onc).

Many components of the HITECH Act were directly supported by the current presidential administration’s transition team when ARRA was created. That support is further encouragement that the legislation is being successfully implemented, and in a bit of serendipity, the incentive funding in its current language will begin arriving at practices the year of this administration’s re-election campaign, meaning national healthcare organizations invested in ARRA will be letting themselves be heard.

The certified EHR adoption and implementation process for your practice should be as time-consuming as it needs to be for you and your practice to achieve meaningful EHR use, but not intimidating. On your side is a wealth of EHR adoption precedent, evaluation and certification resources, ROI examinations, and growing oversight by federal institutions. Making the right selection can provide ROI far beyond the ARRA incentives and can include your practice in the blueprint for a national health information network (NHIN).

Justin T. Barnes is chairman of the Electronic Health Records Association, and is vice president of Marketing, Corporate Development and Government Affairs at Greenway Medical Technologies, Inc.

How Public Comment will Change Meaningful Use

2010-02-26T14:21:00.001-08:00

How Public Comment will Change Meaningful Use

Posted using ShareThis

Millions Awarded in Grants Tied to EHR Functionality

2010-02-15T12:27:00.000-08:00

The following are helpful resources regarding the over $750 million investment in HHS grant awards for meaningful use of health IT, of which $386 million will go to 40 states and qualified State Designated Entities (SDEs) to facilitate health information exchange (HIE) at the state level, while $375 million will go to an initial 32 non-profit organizations to support the development of regional extension centers (RECs).

Additional information about the state HIE and RECs may be found at http://HealthIT.HHS.gov/statehie and http://healthit.hhs.govextensionprogram

Information about other health IT programs funded through the American Recovery and Reinvestment Act of 2009 can be found here: http://HealthIT.HHS.gov

Information about Healthcare/High Growth Grants, and other DOL training programs is available at http://www.doleta.gov/.

For more information about the Recovery Act, please visit: www.hhs.gov/recovery , www.dol.gov/recovery and www.recovery.gov.

Finding Focus at HIMSS

2010-02-08T12:38:00.000-08:00

Conferences like HIMSS can seem overwhelming with information overload. Certainly the opportunities and excitement surrounding the ARRA funding is center stage, and there are many outgrowths from it. One that I believe is involved but even supersedes it in importance and history is the issue of patient privacy and security. It’s on the minds of patients and providers, and we’ve seen it’s a concern when providers consider adapting to electronic health records. Going back to the establishment of HIPPA and looking where we are now with increasing online patient portals and the relationships with Microsoft HealthVault and other patient empowering tools is important. The HIMSS conference has privacy and security workshops in place, and over the years ONC’s Policy and Standards committees have created workgroups just on privacy and security. And we know ONC’s Interim Final Rule on meaningful use has asked the EHR community to offer guidance on privacy and security in public comment to the IFR. If we are truly going to have a national health information network and truly interoperable delivery, the privacy and security of patient records is an area where there must be proven best practices, and this year’s conference is a watershed opportunity for that.

HHS Announces Meaningful Use Proposals Toward Final Regulation

2010-01-05T09:15:00.000-08:00

The much-anticipated proposals of meaningful use criteria by the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) covering EHR technology capabilities and how providers must utilize it to qualify for ARRA incentives were jointly released late Wednesday afternoon.

It’s clear from their reading that the two dominate themes and goals of the proposed rules are standardization and interoperability, all toward the eventuality of a National Health Information Network.

Meaningful use is “based on currently available technological capabilities and providers’ practice experience,” according to the documents, which also state that “the standards adopted in the rule are consistent with current industry standards.”

That means that basic incentive funding for Medicare and Medicaid pathways - along with the majority of the specific clinical meaningful use functionality EHRs must provide - has not changed from preliminary requirements published earlier in 2009.

What’s new is that the proposals outline a manageable 3-step phasing in of criteria goals beginning in 2011. The first phase focuses on the tracking and exchange of clinical summaries and prescriptions, lab tests and medication information using standard exchange language

Phase 2 expands the standard functionality to include disease management, quality reporting and information exchange with public health agencies, and Phase 3 moves those functions to high priority national healthcare issues.

Also new in the proposals is the announcement that EHRs will be certified specific to meaningful use functionality in 2010, the same year that CMS and ONC expect these proposals to become a final regulation.

The broad goals in front of eligible professional (EP) providers are to improve quality, safety and efficiency, reduce outcome disparities, engage patients, improve coordination of care and ensure privacy.

For EHRs, the proposals focus on securely exchanging information using standard data language for clinical summaries, medical descriptions and test results, for example.

The proposals state that the criteria largely drew on recommendations already compiled from the National Committee on Vital and Health Statistics, which Greenway testified before last April, the Health IT Policy Committee and the Health IT Standards Committee.

Similarly, the provider incentive payment schedule and amounts remain largely the same as earlier recommended. For example within the Medicare incentive pathway, EPs can qualify for the first-year maximum $18,000 incentive whether their first year of meaningful use is 2011 or 2012. A new provision that should further motivate EPs to adopt EHRs is that to qualify for meaningful use incentives, reporting only has to take place for 90 continuous days that first year. Then in following years the reporting period would be the entire year.

These proposals offer a 60-day period for public comment, and Greenway is currently formulating its response. Below are links to the proposals as outlined in Wednesday’s announcement, and to a recent article by ONC Director Blumenthal that appeared in the New England Journal of Medicine.

Medicare Incentive Fact Sheet

Medicaid Incentive Fact Sheet

EHR Meaningful Use Fact Sheet

Launching HITECH by David Blumenthal, M.D., M.P.P.

The high road of HITECH

2009-11-22T14:13:00.000-08:00

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.”

Greenway sponsors Vision 2020 HIT symposium

2009-11-19T07:01:00.000-08:00

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.

Optimizing the Economic Stimulus Opportunity Presentation

2009-08-19T11:41:00.000-07:00

http://www.theultramind.com/greenway/Healthnovation_Justin_2009.html

National and Notional HITSP 2009 Draft Timeline

2009-07-23T07:52:00.000-07:00

Meaningful Use Criteria Comments for Review

2009-07-06T05:55:00.000-07:00

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.

HIMSS Electronic Health Record Association on “Meaningful Use” of Certified EHRs

2009-06-01T06:50:00.000-07:00

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

Great selections and additions. These leaders should prove to be great choices for the health IT and specifically, the EHR industry.

2009-05-14T08:14:00.000-07:00

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

Key ARRA Milestones

2009-04-28T07:31:00.000-07:00

Please click on image to see full-size.

CERTIFICATION COMMISSION EXPERIENCES SURGE IN APPLICATIONS

2009-04-13T13:07:00.000-07:00

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.

Congressional Health Hearings on Capitol Hill This Week (Mar-30)

2009-03-30T12:54:00.000-07:00

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.

Immediate HITECH Timeline

2009-03-30T12:17:00.000-07:00

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)

ROI

2009-03-23T10:46:00.001-07:00

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.

NEW ONC DIRECTOR ~ David Blumenthal, M.D., M.P.P.

2009-03-20T11:35:00.000-07:00

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

2009-03-20T11:31:00.002-07:00

`(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).

Interesting Stimulus Factoid - CMS Website posts Eligible Stimulus Recipients

2009-03-20T11:24:00.000-07:00

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.

EHR Association Chair Supports Stimulus Package as Key to Healthcare Transformation

2009-03-19T13:50:00.000-07:00

Please click on the image to see an enlarged version/read the text.

Budget update to HITECH:

2009-03-18T17:29:00.000-07:00

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).

Optimizing the Opportunities in Economic Stimulus for the Physician Practice

2009-03-11T11:58:00.000-07:00

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.

HIMSS on EHR Adoption

2009-03-11T11:54:00.001-07:00

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).

2009-03-02T05:21:00.000-08:00

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.

HEALTH PROVISIONS IN THE AMERICAN RECOVERY AND REINVESTMENT ACT OF 2009: FREQUENTLY ASKED QUESTIONS

2009-02-16T14:57:00.000-08:00

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 for Economic and Clinical Health Act (HITECH Act of Economic Stimulus Package) Update

2009-02-16T12:17:00.000-08:00

*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.