Meaningful use program Stage 3 inches nearer to approval

The draft regulatory language of Stage 3 of the meaningful use program, scheduled to start in 2017, has been submitted for review to the Office of Information and Regulatory Affairs in the Office of Management and Budget.  The rules, submitted to the OMB by the Office of the National Coordinator for Health Information Technology, may reflect some of the discussions that have been taking place in the healthcare industry regarding lessons learned from the program’s roll-out so far.

See Modern Healthcare article at "EHR Stage 3 proposals go to OMB, hint at changes" 


Billions at risk as providers face Stage 2 hurdle

An impressive number of healthcare providers met Stage 1 requirements and qualified for EHR payments in 2011 and 2012 – some 170,000.  Of these providers, who are therefore eligible to continue in the EHR incentive program, only about 4% appear to be on track to meet Stage 2 requirements.  With the December 2014 deadline looming, providers are in danger of losing billions according to data recently released by the Centers for Medicare & Medicaid Services (CMS).

See Modern Healthcare article at “Number of providers facing Stage 2 EHR hurdle puts billions at stake”

Stage 2-ready software delays prompt CMS to postpone Stage 2 deadline

While vendors were able to supply the software needed for healthcare providers to comply with Stage 1 of the EHR incentive program, they are experiencing delays in developing the software needed for Stage 2 meaningful use compliance.  In response to feedback from the healthcare community on this subject, the Centers for Medicare and Medicaid Services and the HHS' Office of the National Coordinator for Health Information Technology propose postponing Stage 2 implementation deadlines one year -- to take effect in 2015 instead of in 2014

Via Modern Healthcare:

For the second time this year, the federal government is pushing back a major health information technology initiative, potentially giving early adopters of electronic health records an extra year to meet more stringent meaningful-use requirements.

The CMS and HHS' Office of the National Coordinator for Health Information Technology issued a proposed rule last week that would give hospitals, office-based physicians and other professionals eligible for the EHR incentive program an additional year to use 2011 Edition software for their systems and continue to meet Stage 1 criteria for meaningful use of the technology.

The proposed rule means providers that entered the program in 2011 could have as many as four years using 2011 software at Stage 1 meaningful use.

The rule also would make official a previously announced delay until 2017 for the start date of what is likely to be the even more difficult Stage 3 meaningful-use requirements now under development.

The new rule comes less than two months after Congress, responding to pressure from physicians and other groups, postponed the nationwide switch to the ICD-10 diagnostic and procedural coding system until Oct. 1, 2015.

Going into 2014, ICD-10 and Stage 2 deadlines were ranked as the two biggest HIT headaches for industry leaders, according to Modern Healthcare's annual IT readers' survey. Now, both have been eased.

“There is a thank you here,” said Russell Branzell, president and CEO of the College of Healthcare Information Management Executives, an association of hospital chief information officers. CHIME lobbied hard to give providers more flexibility with Stage 2. “Our general impression is the proposed rule is a good thing.” But, he added, “it is extremely complex.”

The CMS and ONC rule writers cited the slow delivery and implementation of the upgraded 2014 Edition software needed for Stage 2 as the reason for the delay.

Providers told the CMS in letters, forums, listening sessions and public comments that they were facing long backlogs for installations of updated technology, limiting their ability to attest to meeting the Stage 2 criteria for 2014. Those providers scheduled to step up to Stage 2 this year can remain at Stage 1 if they attest they're unable to advance due to software availability issues.

The proposed rule is subject to a 60-day public comment period, which started Friday when the rule was officially published in the Federal Register. The protracted rulemaking process virtually ensures that hospital leaders will make a decision on Stage 2 without a final rule being in place.

“Even if (CMS and ONC) get the final rule and put it out for adoption, that could be four months,” Branzell said. “So, do you roll the dice and collect data on Stage 1 based on this proposed rule, or do you go and try for Stage 2?”

So far, reactions from Medical Group Management Association members have been positive, said Robert Tennant, the MGMA's senior policy adviser. “It's not everything we were looking for, but it was a good start and recognition that the program parameters were proving challenging for vendors and their customers,” he said. “The extra time is going to allow the momentum to continue.”

One concern, he noted, is that the proposed rule says the program reverts “back to normal” in 2015. But given the need for delays thus far, “we're going to be looking hard at 2015 to make sure the vendors are ready for that year. What we don't want is all of the good effort to stop and the program ends at Stage 1. So I think it's a prudent move, and we appreciate the flexibility,” Tennant said.

Tom Leary, vice president of government relations for the Chicago-based Healthcare Information and Management Systems Society, a trade association for the health IT industry, also expressed relief over the proposed changes. But Leary wondered about the timing of a final rule after the 60-day public comment period for the proposed rule ends in July.

If the CMS issues an interim final rule, it could take effect 30 days from publication, he said. “One of the questions we have in to CMS is the timeline on that,” he said.

By Joseph Conn

“CMS proposes Stage 2 delay,” Modern Healthcare (May 24, 2014)

Rural providers cope with HIT staffing deficits

If compliance with ONC regulations is challenging for healthcare providers in urban areas, with high concentrations of IT professionals, it is especially challenging for rural providers where IT resources in the form of human capital are scarce.  The federal government's 2009 healthcare stimulus package, HITECH, provided funding for a national network of regional extension centers (RECs) designed to assist rural healthcare systems.  While the program is considered very effective, its funding will dry up in 2014.  Rural providers have devised a creative array of strategies to overcome their HIT staffing obstacles.

Via Modern Healthcare:

It took St. Claire Regional Medical Center, in the small town of Morehead in northeastern Kentucky, 2½ months to fill an open position on its computer help desk.

“We just don't see that many people who are even close to being qualified willing to work for the amount of money we're able to pay,” said Randy McCleese, vice president of information services and chief information officer of the 159-bed hospital. “That's part of what we have to deal with in the rural environment.”

The need for qualified information technology professionals to work in hospital and clinic settings has increased enormously in recent years, given the expanded use of technology such as electronic health records. But more than two-thirds of the CIOs surveyed in 2012 by the College of Healthcare Information Management Executives reported shortages on their IT staff. That's an especially big problem for providers in small towns and rural areas, who can't necessarily afford to pay nationally competitive salaries and who can't offer big-city attractions to lure candidates.

These IT staffing shortages create daily inefficiencies for small hospitals such as St. Claire Regional. New computers sit idle because there's no one there to set them up. Software fixes don't always get taken care of in a timely manner. “We really get into a backlog of the things that need to be done,” McCleese said.

To address these challenges in filling their IT staffing needs, small-town and rural providers are adopting a variety of strategies. Some are training current employees, such as nurses, in IT skills, some are partnering with other hospitals to share IT staff, and some are outsourcing IT work to consultants. Many worry that the end of federal funding for IT regional extension centers will cut off a valuable source of technology assistance.

While small-town and rural providers also have trouble filling clinical positions, McCleese, CHIME's board chairman, estimates that a typical nurse opening at St. Claire Regional might generate 10 to 15 applicants, compared with the three he received for the recent help-desk position. “Comparatively speaking, we get a much smaller number for the IT positions,” he said.

McCleese faces competition for IT workers from providers based an hour away in the bigger cities of Lexington, Ky., and Huntington, W.Va. He estimates that his hospital pays salaries that are 25% to 30% lower than in those bigger towns.

National data confirm that disparity. The median annual salary for a medical records and health IT technician averaged across non-metro areas is $31,390, compared with $33,566 for metro areas, according to U.S. Bureau of Labor Statistics data.

Across the country, the need for HIT professionals has boomed. The BLS estimated that an additional 41,100 health information technicians will be needed between 2012 and 2022. The bureau also projected that employment for medical-records and health-information technicians will increase 22% by 2022, much higher than the expected 11% increase in overall employment.

The starting gun for the HIT employment boom—and the associated squeeze in smaller towns and rural areas—was the American Recovery and Reinvestment Act of 2009, which pushed many providers to adopt EHR systems by 2014 through $25 billion in payment incentives and grants for training programs.

“The demand (for HIT professionals) just exploded when the electronic record stuff took hold,” said Mark Sonneborn, vice president of information services at the Minnesota Hospital Association. From February 2009 to February 2012, the number of online job postings in the field almost tripled from 4,850 to 14,512, according to a data brief from HHS' Office of the National Coordinator for Health Information Technology. The ONC does not break out urban and rural job listings.

Brock Slabach, senior vice president for member services at the National Rural Health Association, said the looming end of the EHR incentive payments could hurt HIT efforts at rural hospitals and clinics. “The question will be, can these facilities, with these declining reimbursements, and the incentives ending with the American Recovery and Reinvestment Act, continue to operate these information systems efficiently and effectively?” he asked.

In addition to the stimulus program, the Patient Protection and Affordable Care Act drove the need for IT development and staffing through its focus on population-health initiatives, quality-of-care measures, and preventable readmissions. Another factor is the looming implementation of the ICD-10 coding system.

Implementing EHRs is the heavier lift for Milly Prachar's hospital, however. “It's so far-reaching and really touches all users within the organization,” said Prachar, director of health-information management at Roseau LifeCare Medical Center, a 25-bed critical-access hospital in Roseau, Minn., a town of 2,600 near the Canadian border.

Tight deadlines and finances are one side of the problem, and finding qualified IT workers is the other. Prachar's hospital opted to train one of its nurses in clinical IT rather than recruit an IT specialist. That's a strategy a number of other rural-health facilities are using for their IT needs. “Because of our location—we're pretty remote—we didn't think it would be likely that there would be someone with the knowledge of the organization as well as EHR knowledge that could step into that role,” she said.

But that does not solve the problem of how to deal with the increasing number and scope of IT projects on top of the hospital's usual workload. The result for small town and rural providers is a backlog of work and delays in implementing meaningful use of EHR systems and cost-saving quality measures. It also holds them back from participating in alternative payment and delivery models such as accountable care organizations and bundled payment, which require sophisticated data systems.

“They're not keeping up with health reform,” said Joe Wivoda, a health IT consultant based in Hibbing, Minn. “There's no way in the world that you can do health reform without robust health IT capabilities.”

Chantal Worzala, director of policy at the American Hospital Association, said there are two issues for rural providers in hiring IT talent. One is whether the hospital can afford to pay enough to be competitive with urban hospitals, vendors and consulting firms, and the answer is often no. The second issue is convincing IT professionals to live and work in a small town or rural community.

A key for rural providers in recruiting students for HIT jobs is identifying candidates who want to live in a rural community or small town, said Sunny Ainley, associate dean of continuing education and workforce development at the Center for Applied Learning at Normandale Community College in Bloomington, Minn. “You have to enjoy the rural amenities of living in Minnesota,” she said.

Effectively using social media is one way to reach candidates. “People have a very high trust for social media, so we always recommend to our clients to make sure they have a Facebook page and they're very active,” said Ralph Henderson, president of healthcare staffing at AMN Healthcare. “That takes away some of the issues that, 'I don't know that health care system' or 'I don't know that city very well.'”

He also advises conducting on-campus recruiting at colleges and universities to get to know people early in their careers and establish relationships with them. In addition, he recommends having a strong training program. “The healthcare systems that do a good job of hiring new grads and then setting up training programs for them are the ones that tend to win those competitive wars for talent,” Henderson said. These programs breed loyalty to the hospital as well as the local community.

Hire and train
Another approach is to hire and train, bringing on new employees knowing they'll need skills development to do the job effectively. A related strategy is to develop existing employees' IT skill sets through onsite or off-site training, as Roseau LifeCare Medical Center did with the nurse on its staff.

Other small providers are exploring partnerships with larger hospitals, although Slabach worries this could hurt rural providers in the long run. “If the urban partner doesn't have a real keen sensitivity to rural healthcare, preserving access and maintaining traditional patterns of care, you could see patients being transferred to larger facilities,” he said.

A way around this is the IT cooperative approach, which a few small providers have pursued. The not-for-profit Illinois Critical Access Hospital Network offers IT services to its 53 member hospitals on a fee-for-service basis. “(It's at) far less cost to us than if we A, had hired that individual ourselves or B, if we were working through a third-party consulting firm,” said Harry Wolin, CEO of the 20-bed Mason District Hospital in Havana, Ill.

Even so, consulting firms are finding plenty of work with the boom in IT needs. “Small organizations have limited resources (and) limited availability to reach out to talent because everybody wants to work for a larger organization and make more money,” said Carol LeMaster, senior director of career services and professional development at the Healthcare Information and Management Systems Society. “Typically, it's just easier for them to just hire a consulting organization.”

Educators also are working to connect graduates of their HIT training programs to open positions. Normandale Community College was one of about 81 community colleges that received stimulus funding through the ONC for a program aimed at training HIT professionals to help implement EHRs as demand for these positions soared.

But a key source of support for the smallest rural providers as they strive for meaningful use is about to dry up. The HITECH provision of the 2009 stimulus law funded a nationwide network of 62 regional extension centers, run by the ONC to help rural providers implement EHRs. As of January, 3,427 of the 6,700 providers at critical-access and rural hospitals that worked with the RECs had achieved some level of meaningful use.

The RECs will run out of stimulus funding this year. “That is going to be, in certain parts of the country, really, really hard,” said Mat Kendall, who left his position running the REC program at HHS in March. Seventy-one percent of healthcare leaders surveyed by Modern Healthcare between November and January said they think federal funding for these centers should continue.

Kendall worries that the digital divide between urban and rural providers will widen during implementation of Stage 2 meaningful use of EHRs. The ONC is working with providers and vendors to help them with this process, he said. But “there's nothing we can do about the inability to find (IT professionals).”

By Catherine Hollander

“Rural hospitals get creative in staffing for IT needs,” Modern Healthcare (May 17, 2014)

Software to ease ICD-10 transition: providers consider the options

Congress' decision this spring to delay the ICD-10 deadline has given healthcare providers some extra breathing space to make the transition, but many are seeking additional help in the form of new "language-to-code" translation software. 

Via Modern Healthcare:

Despite the recent congressional delay in implementing the ICD-10 coding system, there is growing interest in a high-tech way of helping physicians convert their standard clinical terminology into the complex new payment codes. It's called “language-to-code” translation.

These translation systems are essentially computerized medical dictionaries stuffed with clinician-friendly descriptions in English or Latin of patient complaints, diagnoses and procedures, which are then linked to lists of clinical and billing codes. These words are presented to clinicians during preparation or updating of a problem list, for example, through software built into their electronic health records. Once a clinician selects a word or phrase, the software links it to code sets such as SNOMED CT—now available for free through the National Library of Medicine—the American Medical Association's Current Procedural Terminology, and ICD-9 and ICD-10.

IT experts say these translation systems can remove some but not all of the hassle physicians will experience translating doc-speak into ICD-10 code sets if and when ICD-10 is implemented in the U.S. Such systems could ease physician fears about ICD-10 disrupting their workflows and cash flows.

“Implementation of SNOMED CT will help providers with the transition to ICD-10,” Dr. Amy Helwig, acting chief medical officer of HHS' Office of the National Coordinator for Health Information Technology, wrote on the ONC's blog. That's because computer systems can use SNOMED “to seamlessly generate ICD-10 codes.”

The ONC's 2014 edition criteria for testing and certifying EHRs require them to be able to record clinical information in SNOMED codes. To meet Stage 2 meaningful-use criteria, physicians are required not only to have systems capable of recording in SNOMED, but to actually use SNOMED codes “to document problem lists, procedures and some clinical findings, Helwig said.

Language-to-code translation systems have different names. It's called clinical interface terminology by commercial developer Intelligent Medical Objects and an enterprise clinical terminology management platform by Health Language Inc., and branded as Convergent Medical Terminology by Kaiser Permanente.

The delay in shifting to ICD-10 (See related story, p. 2) gives only the most tech-savvy provider organizations enough time to build translation tools into their EHRs, said Dr. Andrew Wiesenthal, director of healthcare practice at Deloitte Consulting. Wiesenthal helped develop Kaiser's translation system while working there.

Several top EHR vendors have had one or more of these translators installed in their systems for some time. Many EHRs for office-based physicians will at least let them look up SNOMED terms. Many clinicians support using SNOMED codes because they make medical records more amenable to analysis for research and population management, in addition to serving as a federally endorsed aid to the ICD-10 transition.

Kaiser developed its CMT translation system more than a decade ago. Starting first with clinical language mapped to 650 or so of Kaiser's most commonly used SNOMED codes, Kaiser has since expanded CMT to include about 100,000 medical concepts.

The system converts these doc-language terms into SNOMED, ICD-9 and ICD-10. In 2010, Kaiser donated CMT to the International Health Terminology Standards Development Organisation, which allows the National Library of Medicine to distribute the translator, as well as SNOMED codes and cross maps, free of charge in the U.S.

There have been 4,400 free downloads of the CMT system since the library released its first free cross map of SNOMED to ICD-10 in 2012, said Betsy Humphreys, the library's deputy director. She thinks the cross map is being used by federal agencies, including the Veterans Affairs Department and the Indian Health Service; EHR vendors; and large healthcare organizations.

Dr. Lyle Berkowitz, medical director of IT and innovation at Northwestern Memorial Physicians Group, said his group has used a translator from Intelligent Medical Objects for at least five years. While it is useful for physicians in compiling patient problem lists to help formulate treatment plans and create research registries, it's problematic for coding a care episode in ICD-9 or ICD-10 for billing purposes.

“I can put (congestive heart failure) on my problem list, but for billing I need to be more specific,” he said. Spending that extra time on coding for ICD-10 “is where the worry is.”

Robert Tennant, senior policy adviser for the Medical Group Management Association, said few if any smaller physician groups now are using computer-assisted code translators in their EHRs. “I've not come across anybody using it,” he said. “I know Kaiser has been a strong proponent for many years, but they're kind of a unique animal in the industry.”

By Joseph Conn

“IT experts push translator systems to convert doc-speak into ICD-10 codes,” Modern Healthcare (May 3, 2014)

Montana hospital one of first to sue vendor in court over non-compliant EHR system

Healthcare providers face many challenges in trying to keep up with ever more rigorous requirements for EHR software compliance.  EHR software vendors seem to be struggling, too, in many cases causing their clients to fail the federal EHR certification requirements, thereby losing eligibility for incentive payments.  Montana’s Mountainview Medical Center, which failed the October 1, 2013 certification deadline, is one of the first healthcare providers to take this issue to court.

Via Modern Healthcare:

A small Montana hospital may be among the first of many providers to go to court to resolve their frustrations with electronic health record systems developers that are either lagging or failing to update their software to the new, more stringent testing and certification requirements of the federal EHR incentive payment program.

Mountainview Medical Center in White Sulphur Springs is suing NextGen Healthcare Information Systems in federal court for failing to provide a certified EHR system in a timely manner. 


“That's the most important thing in this whole deal, to be federally certified,” said Aaron Rogers, CEO of the 25-bed Mountainview. “This is a huge, huge deal for every hospital, and we're certainly in that group. Ultimately, the reason there is a lawsuit is because certification was not attained, plain and simple. It didn't meet the criteria that we have to have federally.”

The critical-access hospital argues in the lawsuit that it was promised “a certified electronic health record system as defined by federal law” when it licensed software from NextGen in 2012.

Under new federal requirements that went into effect Oct. 1 for hospitals (and on Jan. 1 for office-based physicians) providers are no longer eligible for EHR incentive payments if they are still using 2011 Edition-compliant software. Thus, even for hospitals and physicians seeking to meet Stage 1 meaningful use for the first time, they must use 2014 Edition software to qualify for incentive payment.

A Modern Healthcare review of the Certified Health IT Product List compiled by HHS' Office of the National Coordinator for Health Information Technology showed that in September just 79 companies, providers and other organizations had software tested and certified to 2014 Edition criteria. That's compared with nearly 1,000 IT vendors whose products were tested and certified to the 2011 Edition criteria initially suitable for Stage 1 of the program. The precipitous drop in the number of vendors with certified products suggests many providers could be left in the lurch after investing substantial sums of money on EHR systems they believed would allow them to meet the federal requirements.

Mountainview's agreement with NextGen, according to a complaint filed last month in U.S. District Court in Helena, said the EHR was to be installed no later than June 1, 2013, but when NextGen failed to meet that date, it asked for and was given an extension until Oct. 1, 2013.

In September, however, the hospital “learned that NextGen did not have an (EHR) that was certified pursuant to the 2014 (Edition) standards” required for use by hospitals after Oct. 1, 2013. The complaint is asking for economic and unspecified compensatory damages, attorney fees and other court costs.

The complaint said Mountainview has already spent “in excess of $441,000 to facilitate” the EHR installation. That includes license fees, hardware and other costs.

Rogers said the hospital has been using electronic lab and imaging systems since 2009, but does not have a complete EHR. It is seeking to meet Stage 1 meaningful use in the 2014 fiscal year.

NextGen's Inpatient Clinicals complete EHR for hospital inpatient use was certified by the Chicago-based Certification Commission for Health Information Technology as meeting the 2014 Edition criteria. But that certification didn't come until Nov. 25, according to a copy of the test results from the Office of the National Coordinator for Health Information Technology. NextGen spokeswoman Michelle Rovner said in an email that, “While we cannot comment on pending litigation, other than to say that we firmly believe the allegations made by Mountainview Medical Center regarding our inpatient application are without merit and we will defend against them vigorously, we confidently stand behind the quality and performance of our products and offerings.”

Rovner said the CCHIT certification means hospitals can use the software to meet both Stage 1 and Stage 2 meaningful use requirements.

According to the database created by the CMS and the ONC, 62 of NextGen's hospital customers have met meaningful-use criteria, giving the company a 1.3% share of the hospital inpatient complete EHR niche. NextGen ranks fourth in the database of 455 vendors of complete EHRs for use by physicians and other eligible professionals in ambulatory care with nearly 17,850 meaningful users.

By Joseph Conn

“Montana hospital sues developer over electronic health-record certification,” Modern Healthcare (January 7, 2014)

Mostashari urges HIT vendors to conduct themselves ethically

Farzad Mostashari, National Coordinator for Health Information Technology, believes most HIT vendors operate in good faith.  At a recent meeting, however, Mostashari stated that he will be testing organized peer pressure as a means of bringing more ethically problematic vendors into line, in order to avoid having to develop onerous additional regulations.  He warned that he will impose more regulations if necessary.

See Healthcare IT News article at "Mostashari calls on vendors to play fair".

HHS Inspector General: Medicare EHR incentive program lacks adequate safeguards against error and fraud

The HHS Inspector General this week reported the results of its recent investigation to “verify the accuracy of professionals' and hospitals' self-reported meaningful-use information, as well as eligibility and payment amounts.”   The investigation reviewed payments issued from May through December 2011, a period during which approximately $1.7 billion was distributed to almost  28,000 recipients.  The Inspector General’s office concluded that Medicare needs to improve its review process.

Link to report here.

Via Modern Healthcare:

The CMS and the Office of the National Coordinator for Health Information Technology at HHS need to tighten up their oversight of the Medicare EHR incentive payment program, according to HHS' inspector general's office.
The watchdog office, headed by Inspector General Daniel Levinson, offered a couple of recommendations for the agencies in its report, "Early Assessment Finds That CMS Faces Obstacles in Overseeing the Medicare EHR Incentive Program" (PDF). The report is based on audits of EHR incentive payment attestations, reviews of internal CMS and ONC documents about the program and interviews with CMS personnel. The inspector general's office did not focus this time on the Medicaid portions of the program, although a previous report, issued in July 2011, did, focusing on 13 state-run Medicaid EHR incentive programs. The inspector general's office also is conducting "a series of audits of Medicare and Medicaid EHR incentive payments" to "verify the accuracy of professionals' and hospitals' self-reported meaningful-use information, as well as eligibility and payment amounts. No time frame for those audits was included in the report.

The inspector general's review covered the early stages of the Medicare EHR incentive program, from when payments started flowing in May 2011 through December 2011. During that period, the program paid out about $1.7 billion to nearly 27,000 physicians and other eligible professionals and 668 hospitals, the report said. 
The inspector general said that the CMS validates the presence of some required information and confirms some calculations provided by hospitals and providers. For example, "The validation checks that self-reported numerators and denominators calculate to required percentage thresholds and that all relevant yes/no measures were checked 'yes,' " according to the report. However, the report continued, the CMS "does not verify that numerators and denominators entered for percentage-based measures reflect the actual number of patients for a given measure or that professionals and hospitals possess certified EHR technology."
One "obstacle" the CMS faces in trying to get independent validation that what the providers are attesting to actually happened is that data from other sources—such as Medicare claims or private insurance data—is either incomplete for the task or unavailable.
The inspector general's office notes that although the CMS is not required to perform prepayment verification, "doing so would strengthen its oversight of the anticipated $6.6 billion in incentive payments" the program is expected to shell out over its lifetime, which runs through 2016.
Regarding post-payment oversight, the inspector general noted that, so far, the CMS "has not yet completed any post-payment audits." But the CMS has said it plans to use EHR-generated reports "to verify the accuracy of self-reported information where possible" and obtain supporting documents in instances where the reports don't cover the audit subject matter—and this is where the ONC comes in for criticism.
The ONC oversees the rule writing, and the testing and certification programs to determine whether EHR technology qualifies for use in the Medicare EHR incentive payment program.
The CMS "cannot use EHR reports to verify all self-reported meaningful-use information because ONC does not require certified EHR technology to be capable of producing reports for all meaningful-use measures," the inspector general's report said. The ONC requires an EHR to write reports on the 30 percentage-based measures but not the 19 yes/no measures users also are required to attest to in order to get paid.
"EHR reports also do not contain information necessary for CMS to verify all percentage-based measures," the inspector general's report said, specifically noting that denominators for many of those measures include data from both paper-based and EHR systems.
The inspector general's office recommended that the CMS beef up its prepayment assessment program, including by focusing on "high-risk" professionals and hospitals, asking them to "submit supporting documentation for prepayment review."
It also recommended that ONC "improve the certification process" to ensure that certification bodies "comprehensively test EHR reports for accuracy as part of the certification process" as well as not rely on "vendor-supplied data" during the testing phase.
The CMS, in an Oct. 9 letter from acting Administrator Marilyn Tavenner, said prepayment audits were not necessary at this time, but concurred with another inspector general's office recommendation to issue a guidance on proper provider documentation required for the program.
In a similar letter to the inspector general's office dated Sept. 25, ONC chief Dr. Farzad Mostashari concurred with the inspector general's office's recommendation of testing a "yes/no" reporting functionality. He said he would ask his two advisory committees, the Health IT Policy and Standards committees, to make recommendations "on the appropriate scope and feasibility of a certification criterion focused on 'yes/no' reports."
Mostashari also said the ONC has “already taken steps” to address a separate inspector general's recommendation that it improve its EHR testing and certification program. Specifically, the OIG recommended that the national coordinator supplant vendor-supplied data used in the initial rounds of its certification tests with a standard data set to be used by all vendors.
Last fall, GE warned customers of two of its EHR systems for ambulatory-care providers that errors had been found in reports to support meaningful-use attestations. That incident was specifically mentioned in the OIG report, which added that the ONC's certification process "did not identify these potential inaccuracies because the vendor-supplied test data did not account for the manner in which some professionals use the products." Similar problems may exist with reports from other EHR products, the OIG report said, but it cited no other examples of report-writing failures.
In his letter, Mostashari said the updated 2014 edition testing and certification rules—which were released in February in conjunction with the CMS' Stage 2 meaningful-use rules—contain "more rigorous testing requirements" that became effective Oct. 4, 2012. He said the ONC "will continue to migrate away from the exclusive use of vendor-supplied data."
In a telephone interview, Mostashari said the GE report-writing problem was "old news." Asked whether he was aware of any other incidents of EHR systems failing to produce accurate test reports, Mostashari said, "It's really a CMS question."

By Joseph Conn

HHS inspector general: Medicare EHR program needs better oversight,Modern Healthcare  (November 29, 2012)

ONC: no caps on per-provider EHR incentive payments

National Coordinator for Health IT Farzad Mostashari has announced there is no cap on how much individual providers may receive in meaningful use incentive payouts, as long as they meet the requirements for the EHR incentive payments program.  According to the ONC, almost seven billion of the approximately twenty billion dollars in incentives allocated under the HITECH Act has already been distributed.

Via Healthcare IT News:

WASHINGTON – There are no set appropriations for how much the federal government can spend on rewarding providers who adopt and use electronic health records under the Medicare and Medicaid meaningful use EHR incentive program, according to National Coordinator for Health IT Farzad Mostashari, MD.

"Whoever qualifies, gets paid; there's no hard cap," said Mostashari, who gave a keynote at the Annual Policy Summit for the Health Information Management and Systems Society (HIMSS) on Wednesday.

Mostashari said the federal government estimates it will pay out around $20 billion in incentives before the program shifts to a penalty in 2015, but there is no fixed budget set in the HITECH Act that mandated the program. The government recently announced it has paid out nearly $7 billion since the program began in 2011.

[See also: "Government EHR incentives near $7B."]

The federal health IT czar said he couldn't imagine health IT advancement – which enjoys widespread bipartisan support – losing the backing of Congress after the election, no matter the party in control.

It would be hard to picture Congress cutting or capping the program after doctors and hospitals have made major investments in health IT "on the good word of Congress," he said.

An attendee of the HIMSS Policy Summit – a sort of pep rally for HIMSS members to promote HIT on the Hill – recommended that Congress all be encouraged to use Blue Button to access their personal health data. This would "crystallize quite clearly" where things stand with regard to health IT today. We need more time and support, the attendee said, and Mostashari and other attendees agreed.

Mostashari praised the meaningful use incentive program, noting that "we've made great steps." He predicted that Stage 2, set to begin in 2014, will bring about even more "incredible progress."

The use of electronic health records is "ultimately about population health," Mostashari said. "You have to care more about the people who didn't walk into your door, than those who did." The meaningful use program is intended to go from measuring quality at the start, to accounting for population health. "That's why doctors are doing what they're doing, [and] that's why we're doing what we're doing," he said of federal regulators.

At a visit to the Cleveland Clinic recently, Mostashari said he observed health data exchanged between the clinic and other local facilities, using compatible coding that transferred the data easily. "They do it all day, every day," he said. "So don't tell us that exchange isn't happening."

[See also: "Stage 2 MU released at last."]

Two years ago, the industry wasn't there, he said of health information exchange. The patient information wasn't packaged and ready to code medications and lab reports in the same record. But things have changed, Mostashari added. He praised the industry and the  marketplace for pushing it forward.

The industry came together with a consensus and pilots and working groups, which resulted in the meaningful use Stage 2 rule, Mostashari said. "We're light years ahead of where we could possibly have been in Stage 1," he added, noting that he believes meaningful use Stage 2 will necessitate a push from the industry for health information exchange standards.

It will be important in the near future to tap into "the biggest underused resource – the patient," Mostashari said. Providers will have to "be sticky," and attract patients to their services because patients will no longer be limited to the provider that holds their health information.

Said Mostashari, speaking to doctors as a doctor: "We have to make them want to come to us."

By Diana Manos, Senior Editor

Mostashari: No cap on EHR incentive payouts,” Healthcare IT News (September 13, 2012)

Majority of health care providers have entered electronic age

Over half of U.S. doctors now use electronic medical records, and half of the remainder plan to start in the coming year, a new poll has found.

Via HealthDay:

TUESDAY, July 17 (HealthDay News) -- A majority of U.S. physicians have now adopted an electronic health record system as part of their routine practice, a new national survey reveals.

The finding is based on responses provided by nearly 3,200 doctors across the country who completed a mail-in survey in 2011. The survey was conducted by the U.S. Centers for Disease Control and Prevention's National Center for Health Statistics as part of an ongoing three-year effort (continuing through 2013) designed to assess perceptions and practices regarding electronic health record systems.

Specifically, the poll found that 55 percent of U.S. doctors have embraced some type of electronic health record system. And roughly 75 percent of those who have done so reported that the type of system they took on meets the criteria of playing a "meaningful" role in their practice, according to the terms of 2009 federal legislation (entitled the Health Information Technology for Economic and Clinical Health Act) designed to promote the use of electronic health records.

What's more, 85 percent of those doctors who now have an electronic health record system in place said they are either "somewhat" or "very" satisfied with its day-to-day operations (47 percent and 38 percent, respectively). And three in four said patient care has improved as a result of electronic health record adoption.

The poll also indicated that among those who have yet to embrace an electronic health record system, almost half said they plan to do so in the coming year.

Physician age seems to have played a role in how likely a doctor was to have already brought an electronic health record system into their practice, the findings showed. While 64 percent of those under the age of 50 have done so, the poll revealed that the same was true of only 49 percent among those aged 50 and older.

Office size also seems to matter, with larger physician practices being more likely to have incorporated an electronic health record system into their administrative infrastructure. Specifically, 86 percent of offices with 11 or more physicians on site had taken on such a system, compared with roughly 60 percent to 62 percent of those with two to 10 physicians and just under 30 percent of single-doctor practices.

But although some kinds of specialists (such as surgeons) were somewhat less likely to have implemented an electronic health record system, race, gender and physician location did not seem to play a role in the likelihood that a doctor's office would or would not bring the technology into their workplace.

Eric Jamoom, of the health care statistics division of the U.S. National Center for Health Statistics, and colleagues published their findings July 17 in the NCHS Data Brief.

More information

For more on electronic health records, visit the U.S. National Library of Medicine.

-- Alan Mozes

SOURCE: U.S. Centers for Disease Control and Prevention, news release, July 17, 2012

Copyright © 2012 HealthDay. All rights reserved.

U.S. Doctors Embracing Electronic Health Records: Survey,” HealthDay (July 17, 2012)

Patient-accessible electronic medical records may increase preventive care

Patients increased their preventive care significantly after being given access to their medical records online in a recent study.  These health care consumers’ use of preventive care measures such as cancer screenings, and immunizations, were higher than those of consumers without online access to their EMRs.

Via Reuters:

In a clinical trial at eight primary care practices, researchers found that patients who used such "interactive" health records were more likely to become up-to-date on recommended preventive care.

That included screening tests for breast, colon and cervical cancers, and immunizations like the yearly flu shot.

After 16 months, 25 percent of patients who used the online records were up-to-date on their preventive care - which was double the rate of non-users.

"It's hard to get people to take an active role in their healthcare," said Jesse C. Crosson, an assistant professor at the UMDNJ-Robert Wood Johnson Medical School in Somerset, New Jersey.

So it's "very encouraging" to see some benefits in this study, said Crosson, who was not involved in the work but has studied the impact of electronic health records.

In the U.S., there has been a huge push to get doctors to switch from old-fashioned paper to electronic records. That's because digital records can, among other things, allow doctors, hospitals and other providers to communicate more easily - and hopefully cut down on errors, while getting more patients the tests and treatments they need.

Congress has authorized up to $27 billion in government incentives to get doctors and hospitals to put electronic records to "meaningful use." And by 2015, providers will face penalties if they don't switch.

"Meaningful use" means steps like having up-to-date medication lists for each patient, and electronically prescribing drugs.

But there hasn't been much evidence yet that electronic records are improving Americans' care.

In a recent study of 42 medical practices, Crosson found that switching to digital records did not seem to improve diabetes care. Patients at offices that made the switch were no more likely to be getting recommended tests and treatments than patients whose doctors had stuck with paper records.

But the new study, published in the Annals of Family Medicine, took electronic records a step farther.

Researchers randomly assigned 4,500 primary care patients to either stick with their normal care or have the chance to access personalized health records on a secure Web site,

The system automatically pulled information from patients' electronic records at their doctors' offices, then gave each patient a "tailored list" of preventive services they should get - like cancer screenings and immunizations. It also gave them links to educational materials on those services, and why they're recommended.

"What we tested is a higher level of functionality than exists in current practice," said lead researcher Dr. Alex H. Krist, of Virginia Commonwealth University in Richmond.

And it did seem to make a difference. Overall, patients who used the system were more likely to be up-to-date on their preventive care 16 months later: 25 percent were, which was up from less than 14 percent at the start of the study.

In contrast, there was little change among patients given standard care: Less than 13 percent were up-to-date on preventive care by the study's end, which was up from 11 percent.

The problem, though, was that most people who were offered personalized health records didn't choose to use them.

Of the 2,250 patients offered the chance, only 17 percent had done so 16 months later.

Krist said he thinks that's largely a product of the controlled clinical trial design: People were "invited" by mail to set up online health records, and that may not have cut it.

"We didn't field it in a way that a real medical practice would," Krist said.

If the personal records were actually promoted at the doctor's office, they would probably be more popular, according to Krist.

Crosson agreed that the constraints of the clinical trial were probably an important factor. "Sending something in the mail might not be the best way to get people to go online," he noted.

Right now, the MyPreventiveCare system is in use in 14 U.S. primary care practices. But the researchers are hoping to "field" it in 300 practices over the next couple years. (The system is currently a "non-commercial" product; the research is being funded by the U.S. Agency for Healthcare Research and Quality.)

To work, the personal health records have to be integrated into doctors' existing electronic records systems.

Crosson said he didn't think the logistics of doing that will be the challenging part; instead, he said, the "human factor" might be.

E-records, though, are not going to magically make us healthier.

Krist pointed out that people who used the online records were more likely to get recommended cancer screenings and vaccinations. But they weren't any more motivated to get advice on diet, exercise, smoking or weight loss, if they needed it.

That type of "health behavior change," Krist noted, is more complicated than getting a test or a shot. And people tend to need a lot more help in making those changes.

"Technology alone isn't the fix," he said.

Interactive health records may boost preventive care,” Reuters Health (July 12, 2012)

HHS publishes EHR privacy and security guide

The ONC’s Office of the Chief Privacy Officer (OCPO) has published a "Guide to Privacy and Security of Health Information” intended to help healthcare practitioners and their staffs better understand the roles of privacy and security in the meaningful use of electronic health records.

Via Healthcare IT News:

Earlier this spring Healthcare IT News reported the results of a study from HIMSS Analytics and Kroll that showed security breaches are still widespread in healthcare – despite increased attention paid to patient privacy.

The ‘HIMSS Analytics Report: Security of Patient Data,’ suggested that, despite increasingly stringent regulatory activity with regard to reporting and auditing procedures, most providers were prioritizing compliance with the rules over actually bolstering their own organizations' security protocols.

So the new ONC guide, which seeks to offer a comprehensive, easy-to-understand resource to help providers incorporate robust privacy and security routines into their clinical workflow, comes at a crucial time.

Developed by OCPO in partnership with the American Health Information Management Association (AHIMA) Foundation, the 47-page guide offers detailed guidance on topics such as security risk analyses and management tips, and working with EHR and health IT vendors.

The guide also offers a 10-step plan for reinforcing privacy and security protections before attesting for meaningful use:

1. Confirm your organization is a covered entity. Most healthcare providers are covered entities, and thus, have HIPAA responsibilities for individually identifiable health information. The Department of Health and Human Services offers tools that can help you confirm your organization's status.

2. Provide leadership. Emphasizing the importance of protecting patient information to all your employees is central to ensuring a culture where security is treated with the importance it deserves.

3. Document your process, findings and actions. The Centers for Medicare & Medicaid Services (CMS) advises all providers attesting for meaningful use to retain all relevant records that support attestation. Record all your practice decisions, findings and actions related to safeguarding patient information.

4. Conduct security risk analysis. A security risk analysis – or a reassessment, if you've already done one – compares your current security measures to what is legally and pragmatically required to safeguard personal health information, and identifies high priority threats and vulnerabilities.

5. Develop an action plan. Using your risk analysis results, discuss and develop an action plan to mitigate the identified risks. The plan must have five components, the guide notes: administrative, physical, and technical safeguards; policies and procedures; and organizational standards.

6. Manage and mitigate risks. Begin implementing your action plan. Develop written and up-to-date policies and procedures about how your practice protects personal health information. Do not lose sight of basic security measures, some of which can be low-cost and highly effective.

7. Prevent with education and training. To safeguard patient information, your workforce must know how to implement your policies, procedures, and security audits, according to ONC. HIPAA covered providers must train their workforces (employees, volunteers, trainees, and contractors) on your policies and procedures. Staffs must receive formal training on breach notification.

8. Communicate with patients. Your patients may be concerned about confidentiality and security of their health information in an EHR, the guide points out. Emphasize the benefits of EHRs to them as patients, perhaps using consumer education handouts that others have developed, and reassure them that you have a system to proactively protect their health information.

9. Update business associate agreements. Ensure your business associate agreements require compliance with HIPAA and HITECH breach notification requirements. This will require your business associates to safeguard protected health information they get from your practice, train their workforce, and adhere to breach notification requirements.

10. Attest for the security risk analysis meaningful use objective. Only apply for an EHR incentive program once you'd fulfilled the security risk analysis requirement and have documented your efforts, the ONC guide emphasizes, pointing out that when you attest to meaningful use, it is a legal statement that you have met specific standards, including that you protect electronic health information. Participants in the EHR Incentive Program can be audited.

Beyond HIPAA and HITECH, ‘ensuring privacy and security of health information, including information in electronic health records, is a key component to building the trust required to realize the potential benefits of electronic health information exchange,’ the ONC guide notes. ‘If individuals and other participants in a network lack trust in electronic exchange of information due to perceived or actual risks to electronic health information or the accuracy and completeness of such information, it may affect their willingness to disclose necessary health information and could have life-threatening consequences.




Access the ONC Guide to Privacy and Security of Health Information here.

ONC privacy and security guide offers 10 steps for MU,” Healthcare IT News (May 9, 2012)


HHS advisory panel recommends delaying Stage 2 Meaningful Use until 2014

The HIT Policy Committee, which advises the Office of the National Coordinator for Health IT in the Department of Health and Human Services, voted 12-5 to approve a significant delay in requiring providers to meet Stage 2 Meaningful Use until 2014.  If finalized by CMS, such delay would be a welcome relief to those providers who qualified for Stage 1 Meaningful Use in 2011 (and therefore would have only a few months to commence Stage 2 Meaningful Use under the current rule).

Via Government Health IT:

The delay is among the stage 2 recommendations that the Health IT Policy Committee approved at its meeting June 8 by an overwhelming vote of 12 to 5.

The original 2013 timeframe does not give vendors enough time to design, develop, and test new functionality and providers to deploy it and report measures for one year, said Dr. Paul Tang, vice chair of the Health IT Policy Committee and chair of its meaningful use work group.

“The only group that would be affected is the early entrants who qualify for stage 1 in 2011 who get put into a bit of predicament in an unintended way,” he said. Tang is also chief medical information officer at the Palo Alto Medical Foundation.

As a result, stage 1 demonstration and attestation would continue through 2013; stage 2 would start in 2014 and stage 3 in 2015. With the revised timing, providers will still receive the same payments as originally planned. Instead of 2013, however, early entrants will have to wait to attest and receive payments for stage 2 in 2014.

You can find and download the Meaningful Use workgroup's recommendations by clicking here.

GOP bill proposes repeal of HITECH Act

 Via Healthcare IT News:

The Spending Reduction Act of 2011 (H.R. 408), introduced on January 24 by Rep. Jim Jordan (R-Ohio), seeks to reduce federal spending by $2.5 trillion over the coming decade. As it does so, it singles out many federal programs for elimination.

Section 302 of the bill, titled "REPEAL OF CERTAIN STIMULUS PROVISIONS," states that "effective on the date of the enactment of this Act, subtitles B and C of title II and titles III through VII of division B of the American Recovery and Reinvestment Act of 2009 (Public Law 111-5) are repealed, and the provisions of law amended or repealed by such provisions of division B are restored or revived as if such provisions of division B had not been enacted."

Since the Medicare and Medicaid EHR Incentive Programs set up under the ARRA/HITECH Act of 2009 fall under division B, it would appear that the $27 billion earmarked for disbursement to healthcare providers to spurring EHR adoption would fall on the chopping block were the bill to ever pass.

For good measure, Jordan's Republican Study Committee also decrees that the enacted legislation would "further prohibit any FY 2011 funding from being used to carry out any provision of the Democrat government takeover of health care, or to defend the health care law against any lawsuit challenging any provision of the act.


 Of course, the measure has little chance of succeeding, considering it would have to pass the House of Representatives, the Senate, and avoid an almost-certain veto from President Obama. Still, the GOP-backed proposal does add a bit of uncertainty in the market.  

Dave Roberts, vice president of government relations for HIMSS, is less worried about the bill being signed into law than he is about the climate it creates.

The draft has already been referred to 14 different committees in the House, he says, so it's going to be a while before it sees any floor action.

The problem is that it's already "creating confusion in the industry," says Roberts. "We've heard from some CIOs, asking us, 'What is this? We hear the House is going to rescind our money.' It adds to the confusion in the whole marketplace. And providers and hospitals who want to purchase this [technology] are wondering, 'Do I really want to start down this path?'

"We're trying to tell people," he says, "that this process is going on. This is only one body [of Congress]. Don't let this be a concern."

But, Roberts cautions: "We're leading up to the 2012 elections. The Senate's majority is very reduced right now. And if this is a new way of thinking, that could be concerning. So I think that while this particular bill may not pass, it's something that has to be watched closely.

HIMSS has issued a Legislative Action Alert on January 25, 2011. As a strong proponent of the EHR incentives program included in the HITECH Act, there is little doubt that HIMSS will be quite engaged in defending this portion of the stimulus bill.

"GOP-sponsored bill threatens MU funding," Healthcare IT News (January 28, 2011).


Registration for CMS EHR Incentive program is now open

Center for Medicare and Medicaid Services (CMS) opened the registration process for eligible hospitals and professionals hoping to capitalize on the incentive payments provided under the HITECH Act.  Each such hospital or professional needs to register with CMS in order to receive such payments, and CMS encourages all eligible healthcare providers to register as soon as possible.

You can find the EHR Incentives Program registration page by clicking here.

According to Government Health IT, over 4,000 providers have already registered with CMS. Several states have also launched registrations for their Medicaid incentive programs.  Moreover, hospitals in Oklahoma and Kentucky have already begun receiving incentive payments:

Kentucky processed payment to the University of Kentucky Healthcare, the university’s teaching hospital, for $2.86 million. The first payment amounts to one- third of the hospital’s overall expected amount for participating in the program, according to CMS. Oklahoma issued payments to two physicians at the Gastorf Family Clinic of Durant, Okla., for $21,250 each for having adopted certified EHRs.

Besides Kentucky and Oklahoma, registration is available for the Medicaid EHR incentive program in Alaska, Iowa, Louisiana, Michigan, Mississippi, North Carolina, South Carolina, Tennessee and Texas.

In February, registration will open in California, Missouri, and North Dakota. Other states will likely launch their Medicaid EHR incentive programs during the spring and summer of 2011.

You can learn more about registration for Medicare incentives for eligible professionals by clicking here; and for Medicaid incentives for eligible professionals by clicking here. A similar CMS guide for both Medicare and Medicaid incentives for eligible hospitals can be found here.


Our column in Government Health IT on RECs and HIT contracts

Government Health IT published a column by Steve Fox and yours truly on the critical role Regional Extension Centers (RECs) can and should play in distributing best practices regarding contracting for health IT systems, including EHRs.  Via Government Health IT:

RECs have the potential to serve as a valuable resource, especially for remote and underserved paper-based primary practices. However, RECs could be doing a disservice to physicians by failing to advise or provide them with essential EMR contract negotiation skills.

With HITECH Act incentives expiring in just a few years, healthcare providers will likely get only one chance to qualify for the full amount of the incentive payments. Thus, successful implementation and operation of an EMR system by the selected health IT vendor becomes critical to each healthcare organization trying to achieve “meaningful use” and take advantage of the incentive program.

In this environment, strong and effective contracts between healthcare providers and health IT vendors is especially significant, because such agreements can provide adequate protections, safeguards and other rights for the provider-customer, in the event a vendor defaults or otherwise fails to perform to the provider’s satisfaction.

You can read the full column by clicking here.


CCHIT certifies 19 complete EHRs and 14 EHR modules

On October 1, 2010, CCHIT announced certifications of 19 "complete" EHR products, including, for example, Epic products for both hospitals and eligible professionals, and Allscripts and GE Centricity products for eligible professionals.  

CCHIT also certified 14 "module" EHR products, from vendors which applied for certification of their products as complete EHRs "but testing could not be completed on a small number of criteria (such as electronic prescribing) because planned updates to the test procedures by NIST were not available at the time of testing." Such "EHR Module" certified products may seek certification as a complete EHRs in the near future.  Via Healthcare IT News:

The Certification Commission for Health Information Technology announced Oct. 1 that it has tested and certified 33 Electronic Health Record products under the ONC-ATCB program.

CCHIT is one of three Approved Testing and Certification Bodies, designated by the Office of the National Coordinator (ONC). The other two are the Drummond Group and InfoGard Laboratories, Inc.

The ATCBs certify that the EHRs are capable of meeting the 2011/2012 criteria supporting Stage 1 meaningful use. Certification is required to qualify eligible providers and hospitals for funding under the American Recovery and Reinvestment Act (ARRA).

The CCHIT certifications include 19 Complete EHRs, which meet all of the 2011/2012 criteria for either eligible provider or hospital technology, and 14 EHR Modules, which meet one or more – but not all – of the criteria.

"CCHIT announces 33 certifications," Healthcare IT News (October 1, 2010).


Steve Fox interviewed by InformationWeek about EHR contracts

Our own Steve Fox was interviewed by InformationWeek regarding the essential protections healthcare providers should include in their EHR contracts with health IT  vendors.  In particular, Steve warned providers against simply accepting vendor agreements without carefully reviewing and negotiating the key provision therein. Via InformationWeek:

"Many health IT vendors offer online contacts that prompt the physician to click the 'agree' button. Unfortunately some of these agreements have no warranties and in fact disclaim many standard warranties, so the vendors are selling their products 'as is,' which means if something goes wrong they are not responsible," Fox told InformationWeek after his presentation. "Some contracts even go further and say if a third party, for example the patient, would sue as a result of a problem with the EHR, the physician has to indemnify and defend the vendor even if it was the vendor that caused the problem."

You can read more after the jump, or by clicking here.


Steve also opined on the reluctance of vendors to promise meeting future regulatory requirements, including the upcoming standards for Stages 2 and 3 of meaningful use:

"We do know there will be new meaningful use requirements for Stage 2 and 3, and it's a moving target. Many vendors are unwilling to agree to future, unknown regulations, saying 'We don't know what we don't know,' but vendors need to remember that providers are paying them a lot of money for support and maintenance to meet those requirements. This is a big area of tension between providers and vendors right now," Fox said.

Finally, Steve offered a few suggestions on some of the critical provisions relating to data access and ownership, as well as safeguarding the privacy and security of protected data:

For those providers adopting software-as-a-service models to outsource their EHRs, Fox recommends that providers restrict vendors from holding data "hostage" and ensure unfettered access to customer data, including protected health information (PHI), on vendors' systems.

He also said providers should insist that vendors routinely back-up data and mandate the return of customer data upon termination of the contract as well as ensure security of data and access to such data if the vendor goes out of business.

With regard to security, Fox said providers need to stress confidentiality of PHI and make clear who owns the data and establish guidelines for the use of data by a vendor. Healthcare providers should also negotiate agreements that include intellectual property issues, obligations of nondisclosure, remedies for breach of patient information, and indemnification obligations.

"Health IT Contracts Offer Little Protection For Buyers," InformationWeek (August 24, 2010).


In the news: Senators request easing of meaningful use requirements; HHS releases over $267M for RECs; and more

  • A group of 37 U.S. Senators sent a letter to HHS Secretary Kathleen Sebelius expressing concern regarding the current definition of meaningful use.  The senators urged the Secretary to "allow providers to 'temporarily defer a limited set of IT goals' without otherwise changing the ultimate timeline or requirements of the program."  The senators also sought to change the eligibility determination based on Medicare provider numbers, considering many healthcare providers have multiple medical campuses under one such Medicare number.  According to Sen. Max Baucus (D-MT), such changes would "improve the guidelines HHS has set in way that will encourage widespread use of basic, functional IT tools and improve patient care.”
  • HHS released over $267 million from the stimulus funds to help 28 non-profit Regional Extension Centers (RECs).  This latest award brought the total of stimulus-funded RECs to 60, and is expected to support 100,000 primary care and hospitals within 2 years.  According to Secretary Sebelius, these 28 awards "represent [HHS's] ongoing commitment to make sure that health providers have the necessary support within their communities to maximize the use of health IT to improve the care they provide to their patients."  
  • Thomson Reuters released its annual study identifying the 100 top U.S. hospitals based on their overall organizational performance. The 10 areas measured are: mortality, medical complications, patient safety, average length of stay, expenses, profitability, patient satisfaction, adherence to clinical standards of care, and post-discharge mortality and readmission rates for acute myocardial infarction, heart failure, and pneumonia. The study has been conducted annually since 1993. Is your hospital one of the 100 Top Performing Hospitals? Find out here.
  • According to the Baltimore Business Journal, a proposed Maryland law could change how primary care providers do business, by creating a patient-centric primary care delivery system whereby insurance companies would financially reward primary care providers for better outcomes.  However, the new law would also ease patient privacy rules by allowing greater sharing of patient information among medical practices and insurance companies. The law will likely pass with little or no opposition.


Slides from webinar on negotiating "must-have" provisions in HIT contracts

Last Thursday, March 18, 2010, from 1:00PM to 2:00PM (EDT), Post & Schell hosted the second webinar in a series examining the effects of meaningful use and other HITECH Act regulations on the healthcare industry. 

The webinar focused on identifying and negotiating the essential elements of HIT agreements, particularly in light of the HITECH Act and related HHS regulations regarding "meaningful use" of "certified EHR technology." Post & Schell's Steve Fox and Vadim Schick, along with Jim Oakes, Principal at Health Care Information Consultants, discussed:

  • Warranty, limitation of liability and privacy and security provisions in HIT contracts
  • Structuring payments to correspond with certain achievement milestones
  • Acceptance testing procedures
  • Provisions specific to vendor-financing transactions
  • ASP / SaaS models of software licensing

If you missed the presentation, you can listen to the podcast here. You can also view the slides from our presentation here.

This webinar was the second in a series devoted to structuring vendor-provider agreements in the post-HITECH Act world. If you missed our first webinar, A Lawyer's Take on "Meaningful Use," you can still view the slides from that presentation


Steve Fox Interviewed on Negotiating EHR Agreements

As if foreshadowing our upcoming webinar on negotiating EHR license agreements in the post-HITECH world, For the Record interviewed our own Steve Fox on this very subject in its February 15, 2010 cover story:

Steve Fox, senior partner and chair of the IT group at the law firm Post & Schell, says such strategies will be critical to an implementation’s ultimate success. For instance, he says vendors’ guarantees that their platform will meet meaningful use thresholds should be discounted.

“I’d be surprised if [satisfying] the final regulations will be achieved by a vendor doing anything,” he says. “Ultimately, it will be up to individual physicians’ offices or provider organization to achieve meaningful use, and in order to do it, they will need that vendor’s help. I have to laugh when I see those guarantees, ‘If you buy our product, you’ll achieve meaningful use,’ because nobody can make that claim. On the other hand, the failure of the vendor’s product can cause you to fail to achieve meaningful use. That’s why it is so important that you have tight provisions in the contract saying that whatever you want that vendor’s product to achieve, it will meet those particular objectives.

“Many vendors use the phrase ‘We don’t know what we don’t know’ as a way to say they can’t try to comply with future regulations, but our position is if you are in the HIT arena, you have to agree up front to comply with whatever they are,” he adds.


You can read the full article here.

"IT Vendor Negotiations in the ARRA Era," For the Record (February 15, 2010).

Free Webinar: Negotiating "Must-Have" Provisions in HIT Contracts

On Thursday, March 18, 2010, from 1:00PM to 2:00PM (EDT), Post & Schell will host the next webinar in a series examining the effects of meaningful use and other HITECH Act regulations on the healthcare industry. 

This webinar will focus on identifying and negotiating the essential elements of HIT agreements, particularly in light of the HITECH Act and related HHS regulations regarding "meaningful use" of "certified EHR technology." Post & Schell's Steve Fox and Vadim Schick, along with Jim Oakes, Principal at Health Care Information Consultants, will discuss:

  • Warranty, limitation of liability and privacy and security provisions in HIT contracts
  • Structuring payments to correspond with certain achievement milestones
  • Acceptance testing procedures
  • Provisions specific to vendor-financing transactions
  • ASP / SaaS models of software licensing

You may view this presentation at your desk. There is no charge or limit to the number of people who may listen to the presentation on the same line. Click here to register. After registering, you will receive log-in information by e-mail.

This webinar is second in a series devoted to structuring vendor-provider agreements in the post-HITECH Act world. If you missed our first webinar, A Lawyer's Take on "Meaningful Use," you can still view the slides from that presentation


Breaking: ONC releases NPRM on certification programs

ONC announced release of the much-anticipated Notice of Proposed Rulemaking (NPRM) on certification programs.  Via ONC Press Release:

Certification of Health IT will provide assurance to purchasers and other users that an EHR system, or other relevant technology, offers the necessary technological capability, functionality, and security to help them meet the meaningful use criteria established for a given phase. Providers and patients must also be confident that the electronic health IT products and systems they use are secure, can maintain data confidentially, and can work with other systems to share information. Confidence in health IT systems is an important part of advancing health IT system adoption and allowing for the realization of the benefits of improved patient care.

Eligible professionals and eligible hospitals who seek to qualify for incentive payments under the Medicare and Medicaid EHR Incentive Programs are required by statute to use Certified EHR Technology. Once certified, Complete EHRs and EHR Modules would be able to be used by eligible professionals and eligible hospitals, or be combined, to meet the statutory requirement for Certified EHR Technology.


To this end, an NPRM proposing the establishment of certification programs for purposes of testing and certifying health information technology was issued in March 2010 with a request for comments. The NPRM proposes:

* A temporary certification program to assure the availability of Certified EHR Technology prior to the date on which health care providers seeking the incentive payments would begin to report demonstrable meaningful use of Certified EHR Technology.

* A permanent certification program to replace the temporary certification program.

You can learn more about this new NPRM here.

You can find the full text of the NPRM here.


Thursday: Free Webinar on "Meaningful Use"

On Thursday, February 25, 2010 from 1:00PM to 2:00PM (EST), Steve Fox and yours truly will host a free webinar, the first in a series, which will focus on the critical definition of "meaningful use" of "certified EHR technology," as described in proposed regulations released and published by CMS pursuant to the HITECH Act on January 13, 2009.  We will discuss:

  • Key policy goals and objectives behind meaningful use
  • Measures required to achieve meaningful use
  • Structure of incentive payments under Medicare and Medicaid
  • Eligibility requirements for professionals and hospitals

You may view each of these presentations at your desk. There is no charge or limit to the number of people who may listen to each presentation on the same line. Click here to register. After registering, you will receive log-in information by e-mail.

Our next webinar, to be held on Thursday March 18, 2010, from 1:00 to 2:00 PM, will focus on how to negotiate software and EHR licensing agreements and other transactional issues with respect to dealing with health IT vendors.

For more information, please contact me at or 202-661-6945.


Updated: Meaningful Use Definition Released in the Federal Register

CMS released a proposed rule pursuant to the HITECH Act which includes the much-anticipated definition of Meaningful Use of Certified EHR technology.  You can find the full text here.*

HHS has also released an interim final rule with a request for comments to adopt an initial set of standards, implementation specifications, and certification criteria, as required by section 3004(b)(1) of the Public Health Service Act. This interim final rule represents the first step in an incremental approach to adopting standards, implementation specifications, and certification criteria to enhance the interoperability, functionality, utility, and security of health information technology and to support its meaningful use. The certification criteria adopted in this initial set establish the capabilities and related standards that certified electronic health record (EHR) technology will need to include in order to, at a minimum, support the achievement of the proposed meaningful use Stage 1 (beginning in 2011) by eligible professionals and eligible hospitals under the Medicare and Medicaid EHR Incentive Programs.  You can find this interim rule here.*


* These are links to PDF versions of the NPRM and IFR published on January 13, 2010 in the Federal Register.

ALERT: CMS and ONC to Discuss Next Steps in EHR Programs Today

Today the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) will announce two regulations that lay a foundation for improving quality, efficiency, and safety through meaningful use of electronic health record (EHR) technology.

The regulations will help implement the EHR incentive programs enacted under the Health Information Technology for Clinical and Economic Health (HITECH) Act, which was part of the American Recovery and Reinvestment Act of 2009. Public comments on both regulations are encouraged.

Join today’s call; details are listed below:

--David Blumenthal, MD, MPP, national coordinator for health information technology
--Jonathan Blum, director, Center for Medicare Management
--Cindy Mann, director, Center for Medicaid and State Operations

Briefing for HITECH Partners and Stakeholders – Providers, HIT Industry Organizations

Today, Wednesday, Dec. 30, 2009, 5:15 p.m. – 6:00 p.m. Eastern Time

Toll-Free Dial: (800) 837-1935
Conference ID: 49047605
Pass Code: HITECH

Stay tuned for more updates and information on the HIMSS Meaningful Use Web site at . HIMSS will be posting a statement tomorrow.

GE and Siemens provide new financing options for Health IT purchases

On the eve of HHS releasing the much-anticipated definition of "meaningful use," health IT divisions of GE and Siemens revealed new financing options for purchases of their EMR and other HIT products.

On December 16, 2009, Siemens followed IBM and GE in offering "a series of flexible financing solutions to help healthcare providers pursue meaningful use objectives and meet [HITECH Act] deadlines <...>  Featuring zero-percent interest terms for qualified customers, the solutions enable organizations to defer up-front payments associated with their technology investment while meeting criteria for future government incentive monies."

According to Fierce Healthcare:

To provide the greatest possible range of choices for customers, Siemens offers solutions from Siemens Financial Services, Inc. as well as from selected partners, including IBM Global Financing and 3-D Financial Services. These options allow customers to choose a customized financing solution that matches their individual technology acquisition roadmaps, business strategies, financial profiles, and technology needs. <...>

By bridging the gap between the project implementation and the receipt of ARRA incentive, Siemens will be providing its customers an option which allows them to optimize their cash flow while maximizing return on investment.

Back in June of 2009, GE announced its $2 billion commitment as part of its Stimulus Simplicity program. According to the Wall Street Journal, GE, through its GE Capital division, “expects to offer $100 million in interim financing to hospitals and health-care providers for projects that are expected to qualify for funds from the U.S. government's economic-stimulus package. GE said the move offers doctors, community health clinics and hospitals a bridge to qualify for stimulus funds and faster access to electronic medical records.” While the “meaningful use” definition and the EHR certification are not yet finalized, GE guarantees that its EHRs will meet the upcoming requirements, regardless of the details of the final rule. Like IBM’s program, GE’s financing is also restricted specifically for GE Centricity, GE’s EHR product.

On December 24, 2009, GE extended the financing terms available for its Centricity EMR software to other health IT products, including Centricity Enterprise and Centricity Business, a financial and administrative tool for providers.  According to Healthcare IT News:

GE executives say they have seen strong interest in the program, with demand exceeding $140 million in sales opportunities.

In the current economic environment, vendor financing may be the best (if not the only) option for healthcare providers seeking to qualify for incentive payments under ARRA.  However, such  providers should be aware of the many potential pitfalls and related issues inherent in vendor-financed deals, including: (1) additional pressure from vendors to accept standard contractual terms and conditions; (2) failing to obtain necessary warranties from vendors that their systems will comply with all relevant requirements under ARRA and the HITECH Act and will permit the provider to achieve meaningful use; (3) dealing with problems that may arise if either the vendors’ products fail to achieve certification, or the provider fails to achieve “meaningful use” in a timely manner, as well as a host of other issues. 

These issues are subject of an upcoming article by yours truly, in the Journal of Health Information Management.  We will link to the article when it becomes available online.

"Siemens Unveils Flexible Financing Solutions to Help Providers Achieve Meaningful Use," Fierce Healthcare (December 16, 2009).

"GE expands healthcare IT loan program," Healthcare IT News (December 24, 2009).

"GE Unit Offers Interim Loans to Hospitals, Health-Care Providers" The Wall Street Journal (June 16, 2009), B3.

"G.E. Offers Loans for E-Health Record Purchases," New York Times Bits Blog (June 15, 2009).

ONC names 17 members of the privacy and security workgroup

The Office of National Coordinator for Health IT named 17 members of the newly formed privacy and security workgroup of the HIT Policy Committee.  According to Government Health IT:

The work group will be co-chaired by Deven McGraw, director of the Health Privacy Project at the Center for Democracy and Technology, and Rachel Block, executive director of the New York eHealth Collaborative and deputy commissioner for health IT transformation at the New York State Department of Health.

Their team will advise the Policy Committee on such matters as how safeguards for the exchange of health information should fit into the “meaningful use” test for health IT incentives that ONC has been working on.

The ONC has previously announced the establishment of a separate workgroup devoted to creation of a national health information network, which, of course, will have to deal with its own set of privacy and security concerns.  There is also a privacy and security workgroup under the HIT Standards Committee.

Government Health IT provides a list of the other members of the workgroup:

Some of the privacy and security work group members named today already sit on its parent Policy Committee. They are: are Dixie Baker, SAIC; Paul Egerman, consultant; Judy Faulkner, Epic Inc.; Gayle Harrell, a consumer representative with the state of Florida; Dr. Mike Klag, Johns Hopkins University School of Public Health; Latanya Sweeney, Carnegie Mellon University; and Paul Tang, Palo Alto Medical Foundation and Policy Committee vice chairman.

New members who are not current members of the Policy Committee are: Dr. Peter Basch; a healthcare practitioner, Dr. A. John Blair, a practitioner; Marianna Bledsoe, the National Institutes for Health; Joyce DuBow, AARP; Justine Handelman, Blue Cross Blue Shield; John Houston, University of Pittsburgh Medical Center; Terri Shaw, Children’s Partnership; and Paul Uhrig, SureScripts. Jodi Daniel and Sarah Wattenberg will represent the Office of the National Coordinator for Health IT on the workgroup.

"ONC names privacy, security workgroup members," Government Health IT (December 8, 2009).

Timely advice: Begin preparations for "meaningful use" now

Our collaborator and friend James Oakes, a Principal at Health Care Information Consultants, LLC in Baltimore, Md., authored a wise and timely call for action for healthcare providers hoping to capitalize on the incentive payments for meaningful use of certified EHR technology included in the HITECH Act. 

The article, appearing in BNA's Health IT Law & Industry Report, argues that even though the HHS has yet to produce final regulations defining such key HITECH Act terms as "meaningful use" and "certified EHR technology," healthcare providers should not wait any longer to begin planning for the transition from paper to digital records, or the likely required updates to existing EHR systems:

Given the uncertainty surrounding these issues, a number of providers have elected to delay any action towards selecting and implementing an electronic health record (EHR) for their institution until answers are made available, reasoning that they want to know as much as possible before committing to a direction. However, providers who take this path may put themselves at risk for forfeiting eligibility for ARRA funds at all, given the time to execute and implement systems.


Oakes suggests several initial steps to EHR implementation:

  1. Gain a high-level understanding of the basic provisions of ARRA and the HITECH Act.
  2. Develop a realistic plan for your institution based on your assessment of the level of automation that is right for your circumstances, environment, and budget.
  3. Discuss the implementation, transition and any relevant software changes with your current health IT vendor.  Considering the huge increase in demand in HIT services, it is important to secure your vendor's support and involvement early on, so that your organization does not end up at the end of the line.
  4. Know the health IT market because your organization will benefit from having the most customized solution (as opposed to, e.g.,  the most expensive or feature-rich), at the right price.

"Get started!" urges Oakes:

Going through all of these steps will not be accomplished overnight. Indeed, past experience suggests that if a hospital has not started these steps already, it will take from 24 months to 48 months for a mid-sized hospital to transition from planning to live operation, including full use of clinical capabilities. Given that ARRA incentives start phasing down in FY 2013 for physicians (2014 for hospitals), it is not beyond the realm of possibility that an institution that waits too long to start could find itself shut out of maximum incentive payments.

You can find the full article, courtesy of BNA's Health IT Law and Industry Report, here.

In the news: Blumenthal on "meaningful use," new health information management jobs, etc.

Dr. David Blumenthal, the National Coordinator for Health IT, gave an update on the Obama Administration's efforts to define "meaningful use" and to further adoption of EHRs nationwide.  Blumenthal did not reveal any new details regarding the upcoming regulations on meaningful use, reminding his audience of the upcoming "notice of proposed rulemaking in late 2009 with a public comment period in early 2010."

Meanwhile, according to Government HealthIT, the next meeting of the HIT Policy Committee, which will meet on October 27 and 28, will focus on how to map meaningful use objectives to medical specialties as well as small practices and hospitals.

Speaking at the 81st annual American Health Information Management Association convention in Grapevine, Texas, Dr. Blumenthal stated that he expects 50,000 health information management (HIM) jobs to be created as the U.S. moves from the paper-based to the digital system of healthcare.  AHIMA's CEO, Linda Kloss, noted that the interest in HIM careers has "exploded" during the last year.

Much more news after the jump.


  • American Medical News reported on the staffing changes for healthcare organizations necessitated by the nationwide switch to electronic health records. According to the article:

There are some assumptions about staff changes that are easy to make, experts say. Any job that was strictly paper-based prior to implementation, for example, will need to be overhauled or eliminated.

Other changes are not so easy to predict, and could depend on how willing your employees are to adapt and learn new skills.

  • According to Crain's Detroit Business, urban hospitals lag behind rural hospitals and physicians' practices in joining health information exchanges (HIE's) because such HIE's pose a combination of monetary, strategic, and technological challenges.
  • Washington Post reported on a pilot project in Ohio aimed at streamlining the cost of healthcare administration.  The state's eight major health insurers - representing 91% of the patients - have signed on to participate in this initiative.  The Post described the program as:

a single Web portal [that the participants] believe will reduce duplication, miscommunication, and confusion between doctors and insurance companies. That will mean quicker office and hospital service, more time for patient care, and, ultimately, cost savings, participants said.

  • Healthcare IT News reported that -- according to e-prescribing company Surescripts -- "the number of physicians using electronic prescribing will have more than doubled in 2009 and that "more than 140,000 – 23 percent of all office-based physicians, nurse practitioners and physician assistants in the United States – are e-prescribing today."
  • USA Today reported on the various hardships and setbacks to widespread implementation of EHRs.  The article ended on a somewhat hopeful note, with a great quote by Stephanie Reel, the CIO of Johns Hopkins University:

We've been saying that we're five years away from electronic medical records for the past 40 years ... Now maybe we really are only five years away.

"Meaningful" Progress Toward Electronic Health Information Exchange, David Blumenthal, MD (October 1, 2009).

"Specialists, primary care providers differ in meaningful use," Government HealthIT (October 6, 2009).

"Health IT effort to create thousands of new jobs, says Blumenthal," Healthcare IT News (October 6, 2009).

"How electronic medical records affect staffing," (October 5, 2009).

"Slow with the flow: Hospitals lag in joining health info exchanges," Crain's Detroit Business (October 4, 2009).

"Paperwork angst drives Ohio doctor, insurer effort," The Washington Post (October 5, 2009).

"More than 140,000 physicians on growing list of e-prescribers," Healthcare IT News (October 5, 2009).

"High-tech 'scribes' help transfer medical records into electronic form, " USA Today (October 7, 2009).



Regional Extension Program: Important Updates and Links from HHS

Via HHS e-mail update:

The Office of the National Coordinator for Health Information Technology (ONC) is pleased to announce the availability of materials that are of immediate interest and use to stakeholders and potential applicants for the Health Information Technology Extension Program: Regional Centers Cooperative Agreement Program, and that are new or updated since the August 27, 2009 technical assistance telephone and web conference.

REVISED – Preliminary Application Template (Attachment I to the Funding Opportunity Announcement):  As discussed on the August 27th technical assistance public conference, the suggested template for applicants’ use in compiling and presenting the information required for the Preliminary Application has been updated to include the complete requirements established in the funding opportunity announcement and is now available from and the Extension Program section of ONC’s website at

NEW – A complete transcript of the August 27th technical assistance conference is available for download from the Extension Program section of ONC’s website.  Please visit to access detailed information about the conference, including the transcript and the presentation slides used during the call.

NEW/REVISED – Program-specific Frequently Asked Questions (FAQs) are now available on the Extension Program section of ONC’s website.  New FAQs are posted frequently, so potential applicants and other interested parties are encouraged to visit often.  Please visit then scroll down and click on “Frequently Asked Questions”.

On the HIT Extension Program site, you can find the Funding Opportunity Announcement / Application Instructions document,  as well as a large FAQ section and the "Facts-At-A-Glance" summary. 

You can find the August 27th, 2009 presentation (PPT) here, and the transcript of that same presentation here.

"Health Information Technology Extension Program: Regional Centers Cooperative Agreement Program Update," HHS e-mail update (September 3, 2009).

Government Health IT: CCHIT to serve temporarily as sole EHR certifier

Via Government Health IT:

The federal Health IT Policy Committee today endorsed recommendations that would leave the Certification Commission for Health IT in the short term as the sole organization authorized to certify health IT systems that qualified for funding under the economic stimulus plan. More certifying organizations would be added later.

Certification of electronic health record systems that met federal criteria for “meaningful use” of health IT could start as early as October, members of the Department of Health and Human Services’ Health IT Policy Committee said at the August 14th meeting.

Under the plan, CCHIT would provide a preliminary stamp of approval that health IT systems were HHS-qualified or certified until a final meaningful use regulation is published at the end of the year, said Marc Probst, chief information office of Intermountain Healthcare and co-chairman of the Committee’s certification work group.

Preliminary certification is meant to give providers and vendors enough certainty to proceed with planning, designing and purchasing systems in 2010. The HHS certification-qualification would mean that a provider purchasing the systems would be eligible for Medicare and Medicaid incentive payments under the stimulus law beginning in 2011.

"CCHIT will be sole health IT certifier, for now," Government Health IT (August 14, 2009).

HIT Policy Committee Reveals "Meaningful Use" Proposal

Via Healthcare-Informatics:

By 2011, at least 10 percent of all orders processed in a hospital must be entered through CPOE to qualify that institution for CMS incentives under the HITECH Act, according to a proposed matrix of meaningful use released today by ONC’s HIT Policy Committee.

Other 2011 hospital requirement are:

  • implementation of drug-drug, drug-allergy, and drug-formulary checks
  • maintenance of up-to-date problem lists of current and active diagnoses based on ICD-9 or SNOMED
  • incorporation of lab-test results into EHR as structured data
  • reporting of hospital quality measures to CMS
  • implementation of one clinical decision rule related to a high-priority hospital condition
  • providing of patients with an e-copy of their health information
  • capability to exchange key clinical information (eg. discharge summary, procedures, problem lists, medication lists, allergies, test results) among providers of care

In another major development, the committee recommended that incentives be paid according to an ‘adoption year’ timeframe rather than a calendar year timeframe. “Under this scenario, qualifying for the first-year incentive payment would be assessed using the 2011 Measures. The payment rate and phaseout of payments would follow the calendar dates in the statute, but qualifying for incentives would use the ‘adoption-year’ approach,” the committee stated.

Here is the link to the matrix.

Stay tuned for more on meaningful use definition.

HIT and the practice of medicine in Texas

While we anxiously await ONC's preliminary definition of "meaningful use" (due to be published on Thursday of this week), let us consider the future of American healthcare through the prism of recent industry analysis and new developments in Texas.

The New York Times Bits blog had a posting today about "an ambitious experiment" at the Cook Children's Health Care System in Ft. Worth, Texas.  Cook Children's is implementing a new EHR technology system (see details after the jump) which the administration hopes "will help the clinic improve care management and curb costs."  This outcome-oriented approach is also consistent with the payment and reimbursement structure at the clinic: "a capitated payment -- a set annual payment for each patient, instead of the standard fee-for-service system of American health care."

This development reminded me of Atul Gawande's fascinating article in The New Yorker last month about the bottom line-driven culture of hospitals and medical practices in McAllen, TX, which, according to his analysis, may lead to significantly higher cost of health care, while showing no real improvement in the quality of care.  The article contrasts the McAllen model with an outcome-oriented, collaborative model of practice of medicine in such healthcare enterprises as the Mayo Clinic in Minnesota and Grand Junction in Colorado, which produce better quality of care while significantly lowering costs.

According to the the Bits blog:

[Cook Children's] plans to install Web-based electronic health records and data integration technology at its 60 offices and clinics throughout Texas. It is also offering personal health records, controlled by the families of its young patients, that can follow them throughout their lifetimes.

The Web-based health records will be supplied by AthenaHealth, while the data integration software and personal health records will come from Microsoft.

The most intriguing thing Cook Children’s has planned is probably its prototype Innovation Clinic. It will be a small physician office, with two or three doctors. Small practices are the biggest challenge for electronic health-record adoption, since they cannot afford full-time technical helpers. The 2,000 to 3,000 patients will be from Medicaid families — lower-income homes where chronic health problems are most common.

The clinic, said Ryan Champlin, vice president of operations for Cook Children’s, will emphasize family engagement and preventive care.

Is outcome-oriented practice of medicine the answer to some of the major problems of the U.S. healthcare system? Will the final health reform bill, if passed, incentivize or address these issues?  While the answers to such questions remain uncertain, it is clear that health IT will play a crucial role in the future of healthcare in the U.S., and is absolutely essential to the collaborative medicine model adopted by providers like Cook Children's.

Atul Gawande, "The Cost Conundrum," The New Yorker (June 1, 2009).
"Electronic Health Records: A Texas Model," The Bits Blog (July 13, 2009).

HIT Policy Committee workgroup presents preliminary definition for Meaningful Use

On June 16, 2009, the Workgroup on Meaningful Use presented its findings to the HIT Policy Committee.  The findings include two parts:  the preamble and the matrix.   The matrix consists of goals to be achieved by 2011, 2013, and 2015, and the metrics for such goals to evaluate hospital and clinician progress in meeting them.

We will have much more analysis on this preliminary definition later, so stay tuned for our updates.  Meanwhile, our favorite "geek doctor" John Halamka stated the following on his blog:

Now that the initial definition of meaningful use is available, the HIT Standards Committee workgroups and HITSP will work through the month of July to ensure the matrix is populated with the most up to date standards and implementation guide detail.

Hospitals and Clinician offices now know what is expected for 2011, so the time is now to begin your software implementations.

"Meaningful Use has Arrived", Life as a Healthcare CIO (June 16, 2009).