The Politics of Health Care : EHR/EMR/PHR

Public Comment Period on Federal Health IT Plan Open Through April 22

Frank Irving — Mon, 28 Mar 2011 12:58:00 GMT

ONC's plan initiates "the era of meaningful use."

On March 25, the Office of the National Coordinator for Health Information Technology (ONC) announced an open public comment period on the Federal Health IT Strategic Plan: 2011-2015 ("the Plan"). ONC said the Plan reflects its strategy, developed in collaboration with other federal partners, over the next five years for realizing Congress and the administration's health IT agenda.

Despite evidence of the benefits of the use of health IT, today only 25-percent of physician offices and 15-percent of hospitals take advantage of electronic health records (EHRs), ONC noted. Two major pieces of legislation enacted over the past two years -- the Health Information Technology for Economic and Clinical Health (HITECH) Act and the Affordable Care Act -- provide opportunities to modernize the way care is delivered and improve the health of all Americans. ONC explained that the Plan, originally published in 2008, was updated to reflect the impact of these two pieces of legislation.

The Plan begins in 2011, when eligible professionals and hospitals can demonstrate "meaningful use" of certified electronic health record (EHR) technology to receive incentive payments under the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs as authorized by the HITECH Act.

"We've entered a new era in health care, the era of meaningful use," said David Blumenthal, MD, MPP, national coordinator for health information technology. "Meaningful use provides an opportunity to bring electronic health information to life in the care of patients and power an information-driven health care system that is capable of never-before-imagined levels of performance."

The Plan describes how ONC will work with federal partners and the private sector to bring information to bear in new ways to improve care and transform the health care system.

The Plan also addresses how ONC and its federal partners will increase protections to ensure that electronic health information is kept private and secure, empower individuals with access to their electronic health information, and enhance the ability to study care delivery and payment systems.

Over the past year, ONC has worked closely with its federal partners and the private sector (through the HIT Policy Committee, a Federal Advisory Committee) to update the Plan. Public comments on the Plan may be submitted through April 22, 2011.

Direct Project Pilots Drive Toward Exchange of Electronic Health Information

Frank Irving — Thu, 03 Feb 2011 15:48:00 GMT

Programs underway in Minnesota and Rhode Island; six other states will launch soon.

On Feb. 2, the Office of the National Coordinator for Health IT (ONC) announced that providers and public health agencies in Minnesota and Rhode Island have begun exchanging health information using specifications developed by a government initiative. The Direct Project initiative calls for cooperative efforts by organizations in the health care and information technology (IT) sectors.

ONC said other Direct Project pilot programs will also be launched soon in six other states to demonstrate the effectiveness of the Direct Project approach.

The Direct Project was launched in March 2010 as a part of the Nationwide Health Information Network, to specify a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet in support of Stage 1 Meaningful Use requirements. Participants include electronic health record (EHR) and personal health record (PHR) vendors, medical organizations, systems integrators, integrated delivery networks, federal organizations, state and regional health information organizations, organizations that provide health information exchange capabilities, and health IT consultants.

Information transfers supported by Direct Project specifications address core needs, including standardized exchange of laboratory results; physician-to-physician transfers of summary patient records; transmission of data from physicians to hospitals for patient admission; transmission of hospital discharge data back to physicians; and transmission of information to public health agencies, according to ONC. In addition to representing most-needed information transfers for clinicians and hospitals, these information exchange capabilities will also support providers in meeting meaningful-use objectives established last year by the U.S. Department of Health & Human Services, and will thus support providers in qualifying for Medicare and Medicaid incentive payments in their use of EHRs.

ONC said the project is on track to give U.S. health care providers "early access to an easy-to-use, Internet-based tool that can replace mail and fax transmissions of patient data with secure and efficient electronic health information exchange."

David Blumenthal, MD, national coordinator for health information technology, commented: "Other efforts are also going forward at full-throttle to build a comprehensive structure of health information exchange. But by bringing together health care and IT companies, including competitors, to rapidly produce a system that supports basic clinical delivery and public health needs, we will be able to more quickly start building electronic information exchange into our health care system."

Here's what's happening in the two pilot programs that have already begun using Direct Project-based information exchange:

Since mid-January, Hennepin County Medical Center, a Level 1 Adult and Pediatric Trauma Center, has been successfully sending immunization records to the Minnesota Department of Health.
The Rhode Island Quality Institute (RIQI) is improving patient care when patients are referred to specialists by demonstrating simple, direct provider-to-provider data. Also, RIQI is leveraging Direct Project messaging as a means to securely feed clinical information, with patient consent, from practice-based EHRs to the state-wide health information exchange to improve quality by detecting gaps in care and making sure the full record is available to all care providers.

Other pilot projects to be launched this year include:

a Tennessee effort with the Veteran's Administration, local hospitals and CareSpark to provide care to veterans and their families;
a New York effort including clinicians in hospital and ambulatory care settings with MedAllies and EHR vendors;
a Connecticut effort involving patients, hospitals, ambulatory care settings and a Federally Qualified Health Center with Medical Professional Services, a PHR, and a major reference laboratory;
an expansion of the VisionShare immunization data pilot to Oklahoma;
a California rural care effort involving patients, hospitals and ambulatory care settings with Redwood MedNet; and
an effort in South Texas with a collaboration of hospitals, ambulatory care settings, public health and community health organizations to improve care to mothers with gestational diabetes and their newborns.

Click here for more information on the Direct Project.

ONC Adds Funding for RECs, HIEs and Community Colleges

Frank Irving — Tue, 01 Feb 2011 18:09:00 GMT

National coordinator outlines $80 million allocated to accelerate meaningful use of HIT.

On Jan. 27, David Blumenthal, MD, MPP, who heads the Office of the National Coordinator for Health Information Technology (ONC), issued a public letter announcing new funding for programs that support meaningful use of health information technology (HIT).

Dr. Blumenthal pointed out that in 2011 providers can begin qualifying for "significant payments" through Medicare and Medicaid, as they achieve meaningful use of electronic health records (EHRs).

But equally important, according to Dr. Blumenthal, are "[supporting] programs created under the HITECH Act to help providers adopt and achieve meaningful use of EHRs through technical assistance, through information exchange, and through development of a new workforce of HIT specialists."

ONC supplied the following update on the supporting programs:

ONC funded 62 Regional Extension Centers (RECs) across the nation to provide technical assistance, especially for smaller practice primary care providers, rural hospitals and other settings in underserved areas. "We want the RECs to assist at least 100,000 primary care providers. And already, some 38,000 primary care providers have enrolled for REC assistance," Dr. Blumenthal noted.
ONC created a state grant program to support health information exchange (HIE) and facilitate the potential uses and benefits of secure information sharing. Approved HIE implementation plans are in place in 25 states.
ONC funded 84 community colleges to train HIT specialists that will help to meet the anticipated national shortage of 50,000 for such specialists. The first 3,400 students will graduate by May, 2011 - "with excellent job prospects," according to Dr. Blumenthal.

ONC is providing new funding for each of those three initiatives.

For the RECs, ONC has added funding of $32 million. "This especially reflects our plan to accelerate outreach to health care providers to encourage registration for the [Medicare and Medicaid EHR] Incentive Programs and to provide more support in the field as providers adopt health information technology in their practices," said Dr. Blumenthal. "We recognize that the early transition to HIT can be challenging and we want to make sure that our RECs are fully operational to help make this transition as smooth as possible. We are committed to offer substantial ongoing support to achieve meaningful use through the RECs."

For HIE, ONC has added $16 million in new Challenge Grants to encourage innovations that can be leveraged to support nationwide health information exchange and interoperability. The HIE Challenge Grant Program will provide 10 awards of between $1 and $2 million to State HIE Cooperative Agreement Program grantees, to develop scalable solutions in five key areas: achieving specific health goals, improving care transitions, consumer-mediated information exchange, enhanced querying for patient care, and fostering distributed population-level analytics.

For community colleges, ONC has added $32 million in second-year funding to continue academic HIT programs training for the specialists needed to make rapid adoption and meaningful use possible. "We remain on track to ramp up and graduate an estimated 10,500 students a year through our community college programs," Dr. Blumenthal reported.

Four of Five Hospitals Plan to Take Advantage of EHR Incentive Payments

Frank Irving — Fri, 14 Jan 2011 14:18:00 GMT

ONC releases survey data showing reversal of low interest in EHR adoption in previous years.

More than eighty percent of U.S. hospitals, and 41 percent of office-based physicians, intend to take advantage of federal incentive payments for adoption and meaningful use of certified electronic health records (EHR) technology, according to survey data released Jan. 13 by the Office of the National Coordinator for Health Information Technology (ONC). ONC released the survey information as the registration period opened for the Medicare and Medicaid EHR Incentive Programs.

David Blumenthal, MD, MPP, the National Coordinator for Health Information Technology, said the survey numbers represent a reversal of the low interest in EHR adoption in previous years. He credited leadership from the medical community and the federal government for the improved prospects for adoption and use of health information technology (health IT).

"For years we have known that electronic health records would improve care for patients and bring about greater cost effectiveness in our health sector, yet adoption rates by health care providers remained low," Dr. Blumenthal said. "In 2009, Congress and the president authorized major new federal support for EHR adoption and use, and in combination with medical professional and hospital leadership. I believe we are seeing the tide turn toward widespread and accelerating adoption and use of health IT."

The data released Jan. 13 comes from surveys commissioned by ONC and carried out in the course of regular annual surveillance by the American Hospital Association (AHA) and the National Center for Health Statistics (NCHS), an agency of the Centers for Disease Control and Prevention (CDC).

The AHA survey found that 81 percent of hospitals plan to achieve meaningful use of EHRs and take advantage of incentive payments. About two-thirds of hospitals (65 percent) responded that they will enroll during Stage 1 of the Incentive Programs, in 2011-2012.

The NCHS survey found that 41 percent of office-based physicians are planning to achieve meaningful use of certified EHR technology and take advantage of the incentive payments. Four-fifths of these, or about a third of all office-based physicians (32.4 percent), responded that they will enroll during Stage 1 of the programs. Only 14 percent of respondents said they were not planning to apply for meaningful use incentives.

Additional survey data from NCHS show that significantly increasing numbers of primary care physicians have already adopted a basic EHR, rising by 50 percent from 19.8 percent of primary care physicians in 2008 to 29.6 percent in 2010. Basic EHRs provide a beginning point for use of electronic health records in physician offices, but most physicians would need to further upgrade their EHR systems or their use of the systems in order to qualify for meaningful use incentive payments, according to ONC.

Incentive payments for the adoption and meaningful use of certified EHR technology were authorized in the Health Information Technology Economic and Clinical Health Act (HITECH) in 2009. Incentive payments will be made through the Medicare and Medicaid programs. Non-hospital-based physicians and other eligible professionals can obtain incentive payments of as much as $44,000 under Medicare or $63,750 under Medicaid. Under both Medicare and Medicaid, eligible hospitals may receive millions of dollars for implementing and meaningfully using certified EHR technology, ONC reported.

Provider registration for the Medicare EHR Incentive Program and some Medicaid EHR Incentive Programs opened Jan. 3, 2011. Most states will allow provider registration to begin for their Medicaid EHR Incentive Programs during the spring and summer of 2010.

"We are pleased to see this evidence of an enthusiastic early response, and we believe participation will continue to grow, especially as the nation's physicians become more familiar with this one-time opportunity to improve care while helping to offset the costs of adopting EHR systems," said Donald Berwick, MD, administrator of the Centers for Medicare & Medicaid Services (CMS).

To qualify for incentive payments, under the Medicare EHR Incentive Program, providers must achieve meaningful use of certified EHR technology, under regulations issued by CMS and ONC. Medicaid providers can receive their first year's incentive payment for adopting, implementing and upgrading certified EHR technology but must demonstrate meaningful use in subsequent years in order to qualify for additional payments.

Dr. Blumenthal also noted that technical support programs created under the HITECH Act are now operating under ONC. In particular, 62 Regional Extension Centers across the nation will offer "on-the-ground assistance," according to ONC, especially for small-practice primary care providers and for small hospitals and clinics.

Click here for more information about the incentive payments program.

Click here for more information about RECs and technical assistance.

ONC Final Rule Establishes Permanent Certification Program for HIT

Frank Irving — Tue, 04 Jan 2011 15:54:00 GMT

NIST will develop a program for organizations to be accredited to test health information technology for purposes of permanent certification.

On Jan. 3, the Office of the National Coordinator for Health Information Technology (ONC) issued a final rule to establish the permanent certification program for health information technology. "The permanent certification program provides new features that will enhance the certification of health information technology, including increasing the comprehensiveness, transparency, reliability and efficiency of the current processes used for the certification of electronic health record [EHR] technology," according to an ONC statement.

Meaningful use of certified EHR technology is a core requirement for eligible health care providers who seek to qualify to receive incentive payments under the Medicare and Medicaid EHR Incentive Programs as authorized by the Health Information Technology for Economic and Clinical Health (HITECH) Act.

"This final rule completes the two-phased approach ONC began with the proposed rule issued in Spring 2010 and includes several important improvements to our certification processes," said David Blumenthal, MD, MPP, national coordinator for health information technology. "Our goal is to make the transition to the permanent certification program as seamless as possible."

The temporary certification program, established through a final rule published on June 24, 2010, will continue to be in effect until it sunsets on Dec. 31, 2011, or at a later date -- upon completion of the processes necessary for operation of the permanent certification program. ONC said it expects to implement the programmatic activities necessary to implement the permanent certification program throughout 2011.

ONC summarized features of the permanent certification program as follows:

Organizations must first be accredited in order to test and/or certify health information technology;
Certification bodies authorized by the national coordinator (ONC-Authorized Certification Bodies or ONC-ACBs) are required to conduct post-certification surveillance; and
ONC-ACBs are permitted to perform "gap certification."

As proposed, ONC will request that the National Institute of Standards and Technology (NIST) through its National Voluntary Laboratory Accreditation Program (NVLAP) develop a laboratory accreditation program for organizations to be accredited to test health information technology for purposes of the permanent certification program.

"Based on NIST's technical expertise and the strong relationship formed between ONC and NIST during the successful implementation of the temporary certification program, the use of NVLAP is expected to enhance testing under the permanent certification program and its objectivity overall," ONC stated.

Click here for more information about the permanent certification program and the final rule.

EHR Incentives Registration Starts January 3

Frank Irving — Thu, 23 Dec 2010 13:46:00 GMT

Professionals eligible for Medicare and Medicaid programs must select which program they wish to participate in when they register.

On Dec. 22, the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) announced the availability of registration for the Medicare and Medicaid electronic health record (EHR) incentive programs.

Beginning Jan. 3, 2011, registration will be available for eligible health care professionals and hospitals who wish to participate in the Medicare EHR incentive program.

On Jan. 3, registration in the Medicaid EHR Incentive Program will also be available in Alaska, Iowa, Kentucky, Louisiana, Oklahoma, Michigan, Mississippi, North Carolina, South Carolina, Tennessee and Texas. In February, registration will open in California, Missouri and North Dakota. CMS said other states likely will launch their Medicaid EHR Incentive Programs during the spring and summer of 2011.

Under the Health Information Technology for Economic and Clinical Health Act (HITECH), part of the American Recovery and Reinvestment Act of 2009, Medicare and Medicaid incentive payments will be available to eligible professionals, eligible hospitals and critical access hospitals (CAHs) when they adopt certified EHR technology and successfully demonstrate "meaningful use" of the technology in ways that improve quality, safety and effectiveness of patient-centered care.

Under the EHR incentive programs, eligible professionals can receive as much as $44,000 over a five-year period through Medicare. For Medicaid, eligible professionals can receive as much as $63,750 over six years. Under both Medicare and Medicaid, eligible hospitals may receive millions of dollars for implementing and meaningfully using certified EHR technology.

Professionals who meet the eligibility requirements for both the Medicare and Medicaid EHR incentive programs must select which program they wish to participate in when they register. They cannot participate in both programs; however, after receiving payment, they may change their program selection once before 2015.

Hospitals that are eligible for both programs can receive payments from both Medicare and Medicaid, CMS said.

Eligible providers seeking to participate in the Medicaid programs must initiate registration at CMS' registration site but must complete the process through an eligibility verification site maintained by their state Medicaid agency. Eligible providers with questions about their state's launch date should contact their state Medicaid agency.

CMS said interested providers should prepare for registration by visiting the agency's official Web site for the Medicare and Medicaid EHR Incentive Programs. The site provides general and detailed information on the programs, including tabs on the path to payment, eligibility, meaningful use, certified EHR technology and frequently asked questions.

CMS also announced the following key dates for the Medicare and Medicaid incentive programs' first year:

Jan. 3, 2011 - Registration for the Medicare EHR incentive program begins.
Jan. 3, 2011 -States that are ready may launch their incentive programs for Medicaid providers.
January 2011 - Some state agencies begin issuing Medicaid EHR incentive payments.
April 2011 - Attestation for the Medicare EHR incentive program begins.
May 2011 - Issuance of Medicare EHR incentive payments expected to begin.
July 3, 2011 - Last day for eligible hospitals to begin their 90-day reporting period to demonstrate meaningful use for the Medicare EHR incentive program for federal fiscal year (FY) 2011.
Sept. 30, 2011 - Federal FY 2011 payment year ends at midnight for eligible hospitals and CAHs.
Oct. 3, 2011 - Last day for eligible professionals to begin their 90-day reporting period for calendar year 2011 to demonstrate meaningful use for the Medicare EHR incentive program.
Nov. 30, 2011 - Last day for eligible hospitals and CAHs to register and attest to receive an incentive payment for federal fiscal year 2011.
Dec. 31, 2011 - Calendar 2011 payment year ends for eligible professionals.

IT Investments Will Follow ARRA Incentive Awards, According to Study

Frank Irving — Mon, 29 Nov 2010 16:13:00 GMT

Beacon Partners reports on preparedness for meaningful use incentive payments.

A study released Nov. 19 by management consulting firm Beacon Partners examines health care organizations' preparations to obtain incentive funding from the American Recovery and Reinvestment Act (ARRA). Beginning in 2011, hospitals and physicians can qualify for Medicare or Medicaid reimbursements under ARRA if they demonstrate "meaningful use" of certified electronic health records.

Beacon Partners reported that of the 200 respondents to its "ARRA Preparedness and Sustainability" survey, 85 percent were C-level executives, with 62 percent from community hospitals and 27 percent having net patient service revenue greater than $150 million.

"Right now there is a lot of emphasis on getting as much ARRA incentive money as possible. Health care organizations are under a lot of pressure as such, but what about down the road when that money is no longer a factor?" asked Ralph P. Fargnoli, Jr., president and CEO of Beacon Partners. "The results of this study provide a good glimpse as to how well health care organizations are preparing for the long-term sustainability of their investments after the ARRA incentive dollars are gone."

Among the study findings:

45 percent of respondents have not applied for any federal or local grants, "which is a viable way to ignite the process of initiating health information exchanges (HIEs) to attain meaningful use," according to Beacon Partners.
In a step toward sustaining their overall IT investment, the majority of health care organizations have built IT expenditures into their financial plans for the coming years to help support patient care, clinical quality and safety as part of their annual spending, tactical planning and strategic multi-year plans.
More than 80 percent of health care organizations will either maintain or increase their IT investments if they are awarded the meaningful use incentive payments.
Only 15 percent of respondents have operational HIEs. Nearly 60 percent of the respondents have HIE plans in development and another 20+ percent are in the pre-planning stages.
More than 40 percent of respondents have plans to enhance their physician and patient portals, "which are crucial to the development of a sound and secure infrastructure at any health care organization," Beacon Partners commented.
In their efforts to achieve meaningful use, quality reporting is the biggest concern amongst 73 percent of respondents.

Click here to view the full report.

ICD-10-Compatible vs. ICD-10-Ready: There Is a Difference

Frank Irving — Tue, 02 Nov 2010 12:36:00 GMT

Guest commentary from Ken Lacy, chief information officer, Precyse Solutions

The ICD-10 compliance deadline is drawing closer; as of this month it's only three years away. As the health care industry scrambles to prepare for ICD-10, one thing is very clear: The process will be way too complex to manage without automation, namely Computer Assisted Coding (CAC). Already we've seen CAC tools being changed and developed in preparation, and the closer the deadline gets, the more valuable this software becomes. What can you do to ensure that your health care organization is ready for the most challenging transition in the history of coding? How will you upgrade? Which CAC solution should you choose? How will you go about training your staff on the new software? And have you thought about the new implications that ICD-10 has for RAC audits?

Just about every health information management (HIM) company out there says they have a CAC solution for the transition to ICD-10, and every day it seems a new CAC software is being released that promises improved coder productivity, more streamlined processes, shortened turnarounds and reduced costs. Let the buyer beware -- there is a big difference between CAC applications that are ICD-10-compatible and CAC applications that are ICD-10-ready, and it can mean the difference between simply dealing with the obstacles posed by the ICD-10 transition and having the power to virtually overcome them.

Most of the solutions out there are just ICD-10-compatible, meaning the vendor has taken an existing CAC product that was built for ICD-9 and updated or re-engineered it to be ICD-10 compatible. While these CAC solutions can work with ICD-10, they were not built for it, so they will inevitably go through some growing pains and have some kinks to iron out. It's kind of like wearing a suit that was custom-made for someone else. It may fit, but it's not going to fit as well as it fits the person it was made for.

On the other hand, a CAC solution that is ICD-10-ready is one that has been built from the ground up to work with ICD-10, as opposed to merely being updated or re-engineered to meet ICD-10 requirements. Such a solution never even heard of ICD-9. To stretch my metaphor a bit further, the ICD-10-ready solution is the custom-made suit, and ICD-10 is the person it was made for. These are the most advanced CAC platforms available, and they can break through the clutter of outdated processes to streamline and modernize the information management workflow. One of the major benefits of ICD-10-ready systems involves meeting the challenge of integrating electronic health records (EHRs) into the coding process. The CAC engine inherent in a system built specifically for ICD-10 can provide a bridge between EHR documentation, the transcription system and the health care provider's financial systems.

ICD-10-ready CAC solutions can also make a difference in Recovery Audit Contractor (RAC) audits. For the most part, ICD-10-ready means RAC-ready too. That's because the areas of risk associated with RAC audits will become more complicated once ICD-10 is in place. Furthermore, RACs themselves are implementing the latest CAC solutions to identify those not in compliance with ICD-10. ICD-10-ready solutions have NLP (natural language processing) and speech understanding technology driving the automated code assignment. The type of CAC software that will help you proactively attack RAC is the kind that incorporates automation for coding workflow and process.

Additionally, CAC solutions that provide the ability to set up coding work pools specific to RAC-target case types coupled with an automated pre-bill quality assurance (QA) rules and routing process is a tremendous benefit. These pre-bill QA rules can be based on a number of variables; from a RAC perspective, a rule can be established for each targeted case. And since ICD-10-ready systems help meet the challenge of integrating EHR records into the coding process, it follows that organizations that adopt ICD-10-ready solutions will have the power to get through RAC audits more smoothly and to improve the accuracy of claims management.

A great example of how an ICD-10-ready CAC solution can revolutionize coding workflow is the Baptist Health System (BHS) in Birmingham, Ala. Before implementing an ICD-10-ready solution a few years ago, the BHS team was frustrated by a number of issues, including recruiting and retaining quality coders, optimizing the coders' proficiency, capturing revenue that human error may have missed, retaining a coding audit trail and meeting changing compliance rules and regulations.

Since implementing an ICD-10-ready solution, BHS has been able to increase productivity, accuracy and quality, while significantly reducing costs and providing valuable management reporting tools. BHS has experienced a 20 percent increase in coding efficiency; a 5 percent increase in DRG-based revenue through more accurate coding and improved Case Mix Index (CMI); a 10 percent reduction in voluntary auditing; coder productivity improvement; reduced audit costs; and a revenue increase of 0.25 percent, due to better information and more accurate coding.

The bottom line is this: There is an absolute difference between CAC solutions that are ICD-compatible and those that are ICD-10-ready. Hospitals and health systems that choose ICD-10-ready solutions will be better prepared to optimize coding operations, accelerate ICD-10 transition and manage RAC and other governmental auditing bodies. When assessing which solutions will best help manage the transition to ICD-10 and proactively attack RAC audits, providers mustn't be distracted by the urgency and complexity of the evaluation and decision-making process. Don't scramble. Carefully shape your vendor technology evaluation criteria, create an evaluation matrix so you are confidently comparing apples to apples, and be sure the solution you are selecting addresses your facility's specific priorities and circumstances. After all, scrambling to the ICD-10 deadline without careful assessment and selection of the right tools for your organization could leave you struggling to keep your ill-fitted pants amid a compliance quagmire.

Mr. Lacy is chief information officer at Precyse Solutions, where he is responsible for setting the technology direction for the company's product offerings and internal systems, overseeing the development, implementation, and customer support teams. He has led the development of PrecyseCode, an advanced health information management platform. Mr. Lacy has over 15 years of experience in the health care information services industry. He holds a B.S. degree in electrical engineering and an M.S. degree in Business and Health Care Administration from Georgia Institute of Technology.

IOM to Study How to Maximize Patient Safety Through Use of HIT

Frank Irving — Thu, 30 Sep 2010 14:00:00 GMT

ONC authorizes $989,000 contract for one-year study of best policies and practices.

The Institute of Medicine (IOM) will conduct a one-year study aimed at ensuring that health information technology (HIT) will achieve its full potential for improving patient safety in health care. The study will be carried out under a $989,000 contract announced Sept. 29 by the Office of the National Coordinator for Health Information Technology (ONC), which is charged with coordinating federal efforts regarding HIT adoption and meaningful use.

The study will examine a range of patient safety-related issues, including prevention of HIT-related errors and rapid reporting of any HIT-related patient safety issues. It will make recommendations concerning the potential effects of government policies and private-sector actions in maximizing patient safety and avoiding medical errors through HIT. According to IOM, the study will:

summarize existing knowledge of the effects of HIT on patient safety;
identify approaches to promote the safety-enhancing features of HIT while protecting patients from any safety problems associated with HIT;
identify approaches for preventing HIT-related patient safety problems before they occur;
identify approaches for surveillance and reporting activities to bring about rapid detection and correction of patient safety problems;
address the potential roles of private-sector entities such as accrediting and certification bodies, as well as patient safety organizations and professional and trade associations; and
discuss existing authorities and potential roles for key federal agencies, including the Food and Drug Administration, the Agency for Healthcare Research and Quality, and the Centers for Medicare & Medicaid Services (CMS).

Donald Berwick, MD, CMS administrator, commented, "Improving patient safety in health care depends on thoroughness in planning and execution, to find problems systematically and correct them decisively. We have high expectations for patient safety improvement through HIT, but achieving those goals will require the same careful and vigorous approach that is needed to improve safety in any enterprise. The IOM can help us identify a productive path to better patient safety with the help of HIT."

In July, CMS announced regulations outlining the initial requirements that eligible health care providers must meet to demonstrate meaningful use of certified electronic health record (EHR) technology for the Medicare and Medicaid incentive payments program, which CMS will administer. Also in July, ONC announced regulations completing the adoption of an initial set of standards, implementation specifications and certification criteria to enable the testing and certification of EHR technology for meaningful use Stage 1. Earlier this month, ONC named initial testing and certifying bodies.

Final Awardees Named in System to Help Practices and Hospitals Move to EHRs

Frank Irving — Wed, 29 Sep 2010 12:47:00 GMT

National HIT coordinator says Regional Extension Centers now in place in every region of the country.

On Sept. 28, David Blumenthal, MD, national coordinator for health information technology, announced selection of the final Regional Extension Centers (RECs), completing a national system of 62 organizations that will help physicians, clinics and hospitals to move from paper-based medical records to electronic health records (EHRs).

Two new awardees were named to cover Orange County, Calif., and the state of New Hampshire. In addition, service areas were expanded for two already-named Florida RECs.

"The selection of these final awardees means that Regional Extension Centers are now in place in every region of our country to help health providers make the switch from paper-based medical practice to electronic health records," said Dr. Blumenthal. "For primary care physicians and smaller hospitals in particular, the RECs will be an important resource to help meet the challenges of adopting EHRs and using them to deliver better care."

RECs were created last year under the Health Information Technology Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act of 2009. HITECH provided approximately $2 billion in new programs to provide training and technical assistance and to demonstrate the effectiveness of health information technology in supporting improvement in care. Under the HITECH Act, $677 million is allocated for the next two years to support a nationwide system of RECs.

Additionally, the HITECH Act also created the Medicare and Medicaid EHR incentive programs, which will provide incentive payments to eligible professionals and hospitals that adopt and demonstrate meaningful use of certified EHR technology. Incentives totaling as much as $27.4 billion over 10 years could be expended under the program, which is administered by the Centers for Medicare & Medicaid Services.

The new awardees and award amounts (covering two years) are:

CalOptima Foundation, covering Orange County, Calif. ($4,662,426)
Massachusetts eHealth Collaborative, covering the state of New Hampshire ($5,105,495).

In addition, two Florida REC organizations will expand their coverage areas: Community Health Centers Alliances will cover additional areas in Glades and Hendry counties, and Health Choice Network of Florida will cover additional areas in Indian River, Palm Beach, St. Lucie, Martin and Okeechobee counties.

RECs will target their assistance to eligible primary care providers in smaller practices as well as small and rural hospitals and public health clinics. However, the RECs will also serve as a resource for all providers in an area, giving assistance, as feasible, to any doctor, hospital or clinic making the request. Each REC organization has identified a target number of primary care physicians, based on population needs to be assisted in the first two years of the program.

For awardees announced Sept. 29, the targets are: Orange County, 1,000 primary care physicians (PCPs); New Hampshire,1,000 PCPs; Glades and Hendry, Fla., 21 PCPs; and Indian River, Palm Beach, St. Lucie, Martin and Okeechobee, Fla., 1,000 PCPs.

"Conversion from paper to electronic health records is a challenging task for any provider, and we believe that help from the RECs will make an important difference, especially in assisting doctors in smaller practices and the smaller and rural hospitals," said Dr. Blumenthal. "The RECs can also be important in helping providers make full use of the potential of EHRs for improving care and making medical practices work more effectively and efficiently."

Click here for a complete listing of REC grant recipients.

Four States Qualify for ARRA Matching Funds for EHR Incentives Program

Frank Irving — Wed, 15 Sep 2010 15:10:00 GMT

Hawaii, Massachusetts, North Dakota and Ohio will receive 90 percent federal match for planning activities.

The Centers for Medicare & Medicaid Services (CMS) announced on Sept. 13 that the Medicaid program in four states -- Hawaii, Massachusetts, North Dakota and Ohio -- will receive federal matching funds for state planning activities necessary to implement the electronic health record (EHR) incentive program established by the American Recovery and Reinvestment Act of 2009 (ARRA).

Hawaii will receive approximately $836,000 in federal matching funds.

Massachusetts will receive approximately $3.56 million in federal matching funds.

North Dakota will receive approximately $226,000 in federal matching funds.

Ohio will receive approximately $2.29 million in federal matching funds.

According to CMS, ARRA provides a 90 percent federal match for state planning activities to administer the incentive payments to Medicaid providers to ensure their proper payments through audits and to participate in statewide efforts to promote interoperability and meaningful use of EHR technology statewide and, eventually, across the nation.

The four states will use their federal matching funds for planning activities that include conducting analyses to determine the current status of health information technology (HIT) activities. As part of that process, they will gather information on issues such as existing barriers to use of EHRs, provider eligibility for EHR incentive payments, and the creation of a state Medicaid HIT Plan, which will define each respective state's vision for its long-term HIT use.

Click here for additional information on implementation of the Medicaid-related provisions of the ARRA's EHR incentive payment program.

HHS Awards New Round of Funding to Support Rural Hospitals’ Switch to EHRs

Frank Irving — Mon, 13 Sep 2010 14:45:00 GMT

Nearly $20 million will go to 1,655 critical access and rural facilities.

On Sept. 10, U.S. Department of Health & Human Services (HHS) Secretary Kathleen Sebelius announced nearly $20 million in new technical support assistance to help critical access and rural hospital facilities convert from paper-based medical records to certified electronic health record (EHR) technology. HHS reported that 1,655 critical access and rural hospitals in 41 states and the nationwide Indian Country, headquartered in the District of Columbia, stand to benefit from this assistance, which can help each of them qualify for substantial EHR incentive payments from Medicare and Medicaid.

"The benefits of health information technology can be especially important for patients and clinicians in small and rural health care facilities, yet these facilities face high hurdles as they look toward joining in the transition to electronic information," Secretary Sebelius said. "The funding we are announcing...is a new category of support, aimed specifically at assisting critical access and rural hospitals with their particular needs and challenges. This new funding is added to the substantial base we have already built to provide assistance to health care providers throughout the country as they transition to EHRs."

The new funding is provided under the Health Information Technology Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act of 2009. The HITECH Act created the Medicare and Medicaid EHR incentive programs, which will provide incentive payments to eligible professionals and hospitals that adopt and demonstrate meaningful use of certified EHR technology. Incentives totaling as much as $27.4 billion over 10 years could be expended under the program, which is administered by the Centers for Medicare & Medicaid Services. In addition, the HITECH Act provided $2 billion through the Office of the National Coordinator for Health Information Technology (ONC) to support technical assistance, training and demonstration projects to assist in the nation's transition to EHRs.

The funding announced Sept. 10 comes through one of the ONC programs, the Regional Extension Centers (RECs). RECs offer technical assistance, guidance and information on best practices to support and accelerate health care providers' efforts to become meaningful users of certified EHRs under the Medicare and Medicaid incentives programs. A total of 60 RECs are located throughout the country.

The funding announced Sept. 10 is part of the Critical Access Hospitals and Rural Hospitals Project, a priority for the REC program. The intent of the project is to provide additional technical support to critical access and rural hospitals with fewer than 50 beds in selecting and implementing EHR systems primarily within the outpatient setting.

"Regional Extension Centers are poised to provide the hands-on, field support needed by health care providers to advance the rapid adoption and use of health IT," said David Blumenthal, MD, National Coordinator for Health Information Technology. "The added level of support we are announcing...will enable the RECs to offer greater field support to these communities as they deal with the financial and workforce constraints, and work to achieve access to broadband connectivity and to overcome other barriers that critical access hospitals and other rural hospitals may confront."

HHS noted that the Sept. 10 round of awards builds on the funding that RECs are already receiving under the HITECH Act, bringing the total amount of funding awarded to date to support the efforts of RECs to over $663 million.

Click here for a complete listing of REC grant recipients and additional information about the Health Information Technology Regional Extension Centers.

ONC Names CCHIT and Drummond Group as Initial EHR Certification Bodies

Frank Irving — Wed, 01 Sep 2010 14:32:00 GMT

EHR vendors can begin to have their products certified as meeting criteria to support meaningful use.

On Aug. 30, the Office of the National Coordinator for Health Information Technology (ONC) named the first technology review bodies that have been authorized to test and certify electronic health record (EHR) systems for compliance with the standards and certification criteria that were issued by the U.S. Department of Health & Human Services (HHS) earlier this year. ONC announced The Certification Commission for Health Information Technology (CCHIT), Chicago, and the Drummond Group Inc. (DGI), Austin, Texas, as the first EHR certification bodies.

According to HHS, announcement of these ONC-Authorized Testing and Certification Bodies (ONC-ATCBs) means that EHR vendors can now begin to have their products certified as meeting criteria to support meaningful use, a key step in the national initiative to encourage adoption and effective use of EHRs by America's health care providers.

"Less than two months following the issuance of final meaningful use rules, we have approved our initial ONC-ATCB certifiers. EHR vendors can begin immediately to get their products certified." said David Blumenthal, MD, national coordinator for Health Information Technology. This is a crucial step because it ensures that certified EHR products will be available to support the achievement of the required meaningful use objectives, that these products will be aligned with one another on key standards, and that doctors and hospitals can invest with confidence in these certified systems."

Applications for additional ONC-ATCBs are also under review.

Certification of EHRs is part of a broad initiative undertaken by Congress and President Obama under the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was part of the American Recovery and Reinvestment Act (ARRA) of 2009. HITECH created new incentive payment programs to help health providers as they transition from paper-based medical records to EHRs. Incentive payments totaling as much as $27 billion may be made under the program, according to HHS. Individual physicians and other eligible professionals can receive up to $44,000 through Medicare and almost $64,000 through Medicaid. Hospitals can receive millions, the agency reported.

To qualify for the incentive payments, providers must not only adopt, but also demonstrate meaningful use of, certified EHR systems. The law envisions that defined meaningful use requirements will help ensure that the patient and provider benefits of EHRs are realized. Initial meaningful use criteria were defined in a final rule issued by the Centers for Medicare & Medicaid Services (CMS) on July 28.

In addition to the CMS rule, ONC also issued standards and certification criteria for EHRs on July 28, aimed at ensuring that EHR systems will support the specific tasks required under meaningful use. Also, through regulations issued on June 24, ONC created a system by which technology review organizations could also qualify as ONC- ATCBs that will certify EHR products as meeting the requirements necessary for meaningful use.

"Multiple steps are underway to carry out the intent of Congress in supporting rapid and effective adoption of EHRs throughout our health care system, Dr. Blumenthal said. "The naming of initial ONC-ATCBs is one important step. Actual certification of multiple vendors' systems by the ONC-ATCBs is an important next step. CMS is also working to create an online system for providers to register and attest for the EHR incentive programs. The first incentive payments are targeted to be made in May 2011. Meanwhile, ONC is also carrying out new programs of technical assistance and training, especially for smaller hospitals and physician practices."

Dr. Blumenthal said the Health IT initiative "is on an aggressive schedule to meet the urgent targets set by Congress and the president toward realizing the quality and safety improvements that we can achieve through health information technology."

Click here for more information about the ONC certification programs.

Six States and DC Receive Federal Matching Funds Under EHR Incentive Program

Frank Irving — Thu, 05 Aug 2010 14:27:00 GMT

Money awarded for planning activities including analysis of current HIT activities.

The Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act of 2009, established programs under Medicare and Medicaid to provide incentive payments for the "meaningful use" of certified electronic health record (EHR) technology. The Medicare and Medicaid EHR incentive programs provide incentive payments to eligible professionals and eligible hospitals as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology.

On Aug. 2, the Centers for Medicare & Medicaid Services (CMS) announced that six states and the District of Columbia will receive federal matching funds for planning activities necessary to implement the EHR incentive program:

Connecticut will receive approximately $695,000 in federal matching funds.
Delaware will receive approximately $247,000.
The District of Columbia will receive approximately $817,000.
Indiana will receive approximately $2.31 million.
New Hampshire will receive approximately $335,000.
Rhode Island will receive approximately $401,000.
West Virginia will receive approximately $945,000.

According to CMS, the states and district will use the federal matching funds for planning activities that include conducting comprehensive analyses to determine their current status of HIT activities. As part of that process, they will gather information on issues such as existing barriers to its use of EHRs, provider eligibility for EHR incentive payments, and the creation of a Medicaid HIT Plan, which will define the state/district's vision for long-term HIT use.

You can access additional information on provisions of the EHR incentive payment program here.

Details on Temporary Certification Program for EHR Technology

Frank Irving — Fri, 16 Jul 2010 14:09:00 GMT

Programs and requirements are important both to technology vendors and to eligible providers.

Guest commentary from Stephen W. Bernstein, Bernadette M. Broccolo, Daniel F. Gottlieb and Sarah S. Nelson, attorneys in the Health Industry Advisory Practice Group of the law firm of McDermott, Will & Emery, LLP

On June 24, 2010, the Office of the National Coordinator (ONC) published the temporary electronic health record (EHR) certification program final rule (Final Rule),¹ establishing the process by which the ONC will select organizations to be ONC-Authorized Testing and Certification Bodies (ONC-ATCBs) for the Medicare and Medicaid EHR incentive programs established by the Health Information Technology for Economic and Clinical Health Act (HITECH Act).

The Final Rule also establishes parameters under which the ONC-ATCBs will test and certify that EHR technology (Certified EHR Technology) meets the technological capability, functionality and security requirements (EHR Certification Requirements)² for supporting the achievement of meaningful use³ by eligible hospitals and professionals (collectively, eligible providers). The Final Rule does not permit uncertified EHR technology currently in use to be "grandfathered" -- that is, deemed to be Certified EHR Technology for purposes of the EHR incentive programs.

The temporary certification program became effective immediately on the June 24, 2010, Final Rule publication date. This reflects ONC's recognition of the need to facilitate the ability of eligible providers to meet the HITECH Act deadline for demonstrating the meaningful use of Certified EHR Technology that will be required to earn the 2011 EHR incentive payments.⁴

The Final Rule revises the sunset date for the temporary certification program so that it will end on Dec. 31, 2011, unless the ONC determines that the permanent certification program is not fully constituted at that time and delays the sunset date. In the proposed rule for the certification programs (Proposed Rule),⁵ the ONC proposed that the temporary program would end when at least one ONC-approved accreditor was authorized to certify EHR technology under the permanent program.

The ONC is expected to issue a separate final rule establishing the permanent EHR certification program by fall 2010.⁶ For more information regarding the Proposed Rule, see the authors' article titled "HHS Issues Proposed Rule Establishing Certification Programs for Health Information Technology," published in the BNA Health IT Law & Industry Report. The ONC is also expected to issue a final rule this summer finalizing the EHR Certification Requirements previously established by interim final rule on Jan. 13, 2010.⁷

The temporary certification programs and the EHR Certification Requirements are important both to EHR technology vendors, which must obtain certification of their technology under the temporary or permanent program to serve the eligible provider market, and to eligible providers, which must ensure that the EHR technology they are purchasing will support their qualification for the Medicare and Medicaid incentives.

Selection of ONC-ATCBs
Under the temporary certification program, the ONC will select an organization(s) to become an ONC-ATCB with authority to test and certify Complete EHRs (as defined below) and/or EHR Modules (as defined below) as meeting the Certification Requirements. To become an ONC-ATCB, an organization must request and submit an application to demonstrate its competency and ability to both test and certify Complete EHRs and/or EHR Modules. The ONC is currently accepting applications.

A Complete EHR is EHR technology that has been developed to meet all of the applicable EHR Certification Requirements. The use of the word ‘‘applicable'' reflects the fact that some requirements apply to EHR technology used in the ambulatory setting, and other criteria apply to EHR technology used in the inpatient setting. An EHR Module is any service, component or combination thereof that can meet at least one of the certification criteria included in the EHR Certification Requirements. A vendor may present an EHR Module for testing and certification as part of a pre-coordinated bundle of EHR Modules, which could otherwise constitute a Complete EHR.

As under the Proposed Rule, Part 1 of the application requires documentation to demonstrate testing and certification processes in accordance with the guide published by the International Organization for Standardization (ISO) and the International Electrotechnical Commission (IEC) (ISO/IEC Guide 65), which specifies standards for operating a certification program. Part 2 requires the applicant to complete a proficiency examination and demonstrate that it can competently test and certify Complete EHRs and/or EHR Modules.

Testing and certification of EHR technology
Once certified by the ONC, an ONC-ATCB would be qualified to perform testing and certification of complete EHRs and/or EHR modules. "Testing'' describes the process used to determine the degree to which a Complete EHR or EHR Module can meet specific, predefined, measurable, quantitative requirements. The results would be compared to and evaluated in accordance with predefined measures. ‘‘Certification'' describes the assessment (and subsequent assertion) made by an authorized certifying organization (e.g., an ONC-ATCB in the temporary program), once it has analyzed the quantitative results rendered from testing along with other qualitative factors, that a complete EHR or EHR module has met all the applicable EHR Certification Requirements.

Testing tools and procedures
The Proposed Rule included a Principle of Proper Conduct (Principle) for ONC-ATCBs, requiring ONC-ATCBs to use test tools and procedures that were "published by NIST or functionally equivalent testing tools and procedures published by another entity"⁷ to test an EHR. The Final Rule revises this Principle to require instead the use of "test tools and test procedures approved by the National Coordinator for the purposes of assessing Complete EHRs' and/or EHR Modules' compliance with the certification criteria adopted by the Secretary." While the ONC will still likely require NIST test tools and procedures, it will have the flexibility to adopt other acceptable test tools and procedures in addition to those developed by NIST. ONC-ATCBs and developers of Complete EHRs and EHR Modules will likely benefit from the uniformity of standards and greater ONC control achieved by this approach.

Privacy and security testing of EHR modules
The Proposed Rule required ONC-ATCBs to test and certify an EHR Module in accordance with the privacy and security certification criteria adopted by the Secretary, unless the EHR Module met one of the following proposed exceptions:

The EHR Module(s) are presented for testing and certification as a pre-coordinated, integrated "bundle" of EHR Modules, which could otherwise constitute a Complete EHR, and may be tested and certified in the same manner as a Complete EHR.
It would be technically infeasible for the EHR Module to be tested and certified in accordance with some or all of the privacy and security criteria.
The EHR Module is designed to perform a specific privacy and security capability.

The Final Rule eliminates the third exception for modules that can perform a specific privacy and security capability and expanded the second exception to also include cases where testing to the privacy and security criteria would be "inapplicable."

Effect of new or modified EHR certification requirements
Under the Final Rule, when the ONC adopts new or modified EHR Certification Requirements, EHR technology certified under legacy Certification Requirements would no longer be Certified EHR Technology. Consequently, each time the ONC adopts or modifies EHR Certification Requirements, previously certified EHR technology must be retested and recertified in order for eligible providers to continue to qualify for incentive payments (or avoid downward adjustments in reimbursement) for meaningful use of the technology. Currently, the ONC and the Centers for Medicare & Medicaid Services (CMS) anticipate adopting new EHR Certification Requirements and meaningful use requirements, respectively, no more frequently than every two years.

Additional proprietary certification requirements
In the Final Rule, the ONC clarifies that while it does not preclude an ONC-ATCB from certifying health information technology in accordance with its own requirements that may be unrelated to and potentially exceed the ONC's EHR Certification Requirements, such activities are not within the scope of an ONC-ATCB's authority under the temporary certification program and are not endorsed by the ONC. Therefore, any EHR technology that is certified under the ONC's EHR Certification Requirements as well as an ONC-ATCB's own certification criteria would have to have its status as Certified EHR Technology noted separately from any other proprietary certifications.

Modification of Certified EHR Technology
Commenters to the Proposed Rule noted the necessity for eligible providers to understand the extent to which they may modify Certified EHR Technology without undermining the EHR's certification and causing it to be treated as "self-developed" technology requiring certification. For example, provider comments expressed the concern that extensive modifications may be required to configure EHR technology within the context of the provider's entire information technology environment. In the Proposed Rule, the ONC proposed to define a "self-developed" EHR as an EHR that has been designed, modified or created by, or under contract for, a person or entity that will assume the total costs for its testing and certification and will be a primary user of the Complete EHR or EHR Module.

The Final Rule somewhat clarifies the extent to which modifications can be made without threatening the certification status of Certified EHR. The ONC believes that it is possible for an eligible provider to modify a capability of a Complete EHR or an EHR Module, provided that due diligence is taken to prevent such modification from adversely affecting the certified capability or precluding the proper operation of the Certified EHR. However, the ONC recommends in the Final Rule that if an eligible provider would like further assurance that specific modifications will not impact the certification, the provider should have the Complete EHR or EHR Module(s) retested and recertified after modification.

Stephen W. Bernstein is head of McDermott, Will & Emery's Health Industry Advisory Practice Group, specializing in e-health, deployment of EHR systems, health-related matters impacted by the Internet and HIPAA, as well as mergers, acquisitions, affiliations and joint ventures in the hospital and physician areas. He can be reached at sbernstein@mwe.com.

Ms. Broccolo serves as chair of the Life Sciences Division of the firm's Health Industry Advisory practice and advises clients on health industry relationship formation and realignments; health information technology acquisitions; electronic health information networks; conflict-of-interest compliance and overall corporate compliance programs. She can be reached at bbroccolo@mwe.com.

Mr. Gottlieb represents a wide range of health industry clients, advising them on compliance with federal and state health care laws as well as representing them in mergers, acquisitions, joint ventures and other transactions involving physicians and other health care providers. He can be reached at dgottlieb@mwe.com.

Ms. Nelson is an associate in the firm's Los Angeles office and focuses her practice on a variety of regulatory, transactional and litigation matters for clients such as hospital systems, ambulatory surgical centers, pharmaceutical companies, health insurers and physicians. She can be reached at snelson@mwe.com.

References

1) 75 Fed. Reg. 36157 (June 24, 2010).

2) 75 Fed. Reg. 2013 (January 13, 2010).

3) 75 Fed. Reg. 1843 (January 13, 2010).

4) 75 Fed. Reg. at 36194.

5) 75 Fed. Reg. 11327 (March 10, 2010).

6) See ONC's "Temporary Certification Program Final Rule: Frequently Asked Questions."

7) 75 FR 11366.