With the final rule on meaningful use of electronic health-record systems out, there’s one fewer item on the federal government’s checklist for implementing the EHR subsidy program under the American Recovery and Reinvestment Act of 2009.
One looming potential problem for health information technology executives, though, is the government’s long delay in establishing a procedure to recognize organizations to test and certify EHRs and their modular components.
The Office of the National Coordinator for Health Information Technology didn’t publish final rules on a first-round process to name “temporary” testing and certification programs until June 18 and didn’t start taking applications from organizations seeking to qualify as testing and certification organizations until July 1.
Certification is a “necessary evil,” given the multibillion-dollar public commitment to EHR subsidies, said Ray Scott, CEO of Axolotl Corp., a provider of EHR systems and health information exchange software and services. But at this stage of the program, he added, not having a single government-approved testing and certification authority in place and at the same time having hundreds of IT vendors needing to get their systems tested and certified under the new guidelines “might be a road block” to making certification happen.
Chad Greeno, managing director of the healthcare reform business unit at Cerner Corp., a developer of EHRs for hospitals and physician offices, concurred. “There is probably a bit of disappointment,” he said. “It has taken a lot longer than anyone, particularly someone as naive as me, thought it would take.”
Farzad Mostashari, deputy national coordinator for programs and policy within the ONC, said he has faith in the market the government has helped create to enable multiple providers of EHR testing and accreditation services as opposed to the de facto monopoly HHS created in the previous decade by anointing the not-for-profit Certification Commission for Health Information Technology.
“I believe in the market,” Mostashari said. “One thing we did was to create a competitive marketplace for certification. It’s an open field.” Providers, he said, can compete on service, speed and costs.
“We have gotten a lot of interest, a lot of requests for applications; we’re committed that within 30 days of receiving an application we will render a decision and those organizations will be open for business,” he added. “I don’t think we have a complete application yet. By the end of the summer, I expect we’ll have more than one.”
Scott suggested that providers talk to their vendors to ensure that they will receive latest-edition software needed to meet the new meaningful-use criteria. “If they can’t meet all of the meaningful-use requirements, get them to suggest how you can,” he said.
With modular certification of EHR components, it might be possible for providers to back-fill functions needed for meaningful use missing from their systems with software from other vendors.
Source: ModernHealthcare.com
Health IT stakeholders are applauding some elements of the newly released final “meaningful use” rules and raising concerns over others, Healthcare IT News reports (Manos, Healthcare IT News, 7/14).
Background
Yesterday, federal officials released the final rule defining how health care providers can demonstrate meaningful use of electronic health records to qualify for federal incentive payments made available through the 2009 federal economic stimulus package.
The final rule for the first stage of the incentive program stipulates that physicians must meet 15 core objectives and hospitals must meet 14. In addition, doctors and hospitals must comply with five additional objectives out of a “menu” of 10 options (Lillis, The Hill, 7/13).
Officials also released the final rule describing the required standards and certification criteria for EHR technology (AHA News, 7/13).
The rules were finalized following a three-month public comment period during which HHS received more than 2,000 recommendations about the regulations (Mearian, ComputerWorld, 7/14).
Praise for Rules
On Tuesday, Senate Finance Committee Chair Max Baucus (D-Mont.) and Senate Health, Education, Labor and Pensions Committee Chair Tom Harkin (D-Iowa) said the new rules will help the U.S. health care system improve care, reduce costs and curb medical errors (Lillis [1], “Healthwatch,” The Hill, 7/13).
William Jessee, president and CEO of the Medical Group Management Association, said his organization was pleased that the final meaningful use rule reflects some changes that MGMA sought in earlier proposals. He said the final rule incorporates MGMA’s recommendations for scaled-back requirements on electronic prescribing, administrative transactions, computerized physician order entry and other criteria (Healthcare IT News, 7/14).
Steven Findlay, a policy expert with Consumers Union, said the final rule “strikes the balance that was needed.” He added that the requirements “give doctors the financial support to promote electronic records adoption without undue burdens. But they also hold doctors accountable for actually improving care and the health status of their patients” (Alonso-Zaldivar, AP/Atlanta Journal-Constitution, 7/13).
Ralph Brindis, president of the American College of Cardiology, said the changes “will make it easier for physicians to comply and encourages practices to begin implementation” (The Hill, 7/13).
Lingering Issues
The American Hospital Association had numerous concerns with the final meaningful use rule. In a statement, the group said the rule could:
Chip Kahn, president and CEO of the Federation of American Hospitals, said he supported the meaningful use rule but also echoed some of AHA’s concerns about individual hospitals operating in multicampus systems. He said “it is essential that Congress clarifies the definition of an eligible hospital to put all hospitals on a level playing field for the distribution of incentive payments” (Adams, CQ HealthBeat, 7/13).
Chair of the House Ways and Means Committee Rep. Sandy Levin (D-Mich.) and Chair of the panel’s Subcommittee on Health Rep. Pete Stark (D-Calif.) praised the overall rule but also expressed concern about hospitals in multicampus systems.
Stark said he would hold a subcommittee hearing next Tuesday to evaluate how Congress could address the multicampus issue (Lillis [2], “Healthwatch,” The Hill, 7/13).
Steven Stack, board member of the American Medical Association, in a statement said he is unsure whether most physicians will be able to benefit from the first stage of the incentive program. He said, “Physicians recognize the potential for health IT and want to adopt new technologies, but costly [EHR] systems are out of reach for many physicians” (CQ HealthBeat, 7/13).
AMA said it is withholding final judgment while it continues to examine the regulation (AP/Atlanta Journal-Constitution, 7/13).
Many Organizations Continue To Review Regulations
The Markle Foundation, the Center for American Progress and Brookings Institution’s Engelberg Center for Health Care Reform issued a joint statement backing health IT adoption incentives. The groups said they are continuing to review the rule in detail.
Leaders of the Healthcare Information and Management Systems Society said they expect to release an initial reaction to the rule sometime Wednesday and create an in-depth analysis soon after.
The College of Healthcare Information Management Executives also said it is actively reviewing the meaningful use rule (Healthcare IT News, 7/14).
Source: iHealthBeat
On Thursday, HHS proposed modifications to the 1996 HIPAA privacy and security rules to incorporate changes Congress included in the 2009 federal economic stimulus package, Modern Healthcare reports.
Proposed Adjustments
The draft rule would allow patients to restrict certain disclosures to health plans and prohibit personal information from being sold without their consent (Conn, Modern Healthcare, 7/8).
The rule also proposes treating billing companies, customer service contractors and other businesses the same as physicians, hospitals and insurers, which would subject them to fines and penalties if they violate privacy regulations.
Earlier this year, HHS significantly increased the maximum penalty for HIPAA violations, to $50,000 per violation and $1.5 million annually (Lentz, Reuters, 7/8).
The proposed rule also would:
Reasoning Behind Rule; Next Steps
The proposed changes were mandated by the HITECH Act, which was included in the economic stimulus package and designed to encourage hospitals and physicians to adopt electronic health records (Reuters, 7/8).
According to a statement released by National Coordinator for Health IT David Blumenthal and OCR Director Georgina Verdugo, “This rulemaking will strengthen the privacy and security of health information, and is an integral piece of the administration’s efforts to broaden the use of health information technology in health care today” (Gruenwald, “Tech Daily Dose,” CongressDaily, 7/8).
The Office of the National Coordinator for Health IT is developing a final regulation to ensure that electronic health records are capable of complying with the new HIPAA privacy and security requirements (Robinson, Government Health IT, 7/8).
The draft rule is open for public comment for 60 days, beginning July 14 (Modern Healthcare, 7/8).
Source: iHealthBeat
Individuals who e-mailed their physicians experienced better outcomes on management of two chronic diseases than people who did not e-mail, according to a new study of Kaiser Permanente patients, the Sacramento Bee reports (Peyton Dahlberg, Sacramento Bee, 7/7).
The study, published in the July edition of Health Affairs, examined 35,423 Kaiser patients in Southern California who have diabetes, high blood pressure or both. Researchers reviewed about 556,000 e-mail threads containing more than 630,000 e-mail messages (Kaiser Permanente release, 7/7).
The study was conducted between 2005 and 2008 (Sacramento Bee, 7/7).
Study Results
The study found that patients initiated 85% of the e-mail exchanges (Kaiser Permanente release, 7/7).
Eighty-eight percent of patients with diabetes who e-mailed their physicians had control of their blood sugar levels at the end of 2008, compared with 83% of diabetics who did not e-mail.
The study also found that 73% of patients who e-mailed received screenings for retinopathy — an eye problem associated with diabetes — compared with 70% of patients who did not e-mail (Sacramento Bee, 7/7).
Among patients who e-mailed their physicians, the study authors also recorded improvements in cholesterol control and screening, blood pressure levels and screening for kidney disease. The more frequently e-mails were exchanged, the greater the health improvements, researchers noted (Gardner, HealthDay, 7/7).
Takeaways
E-mailing may help strengthen the relationship between patients and physicians, the authors suggested. They also noted that patients who are likely to e-mail their physicians might be more inclined to better manage their own care (Sacramento Bee, 7/7).
Source: iHealthBeat
On Tuesday, federal officials announced the release of the final rule defining how hospitals and health care providers can demonstrate “meaningful use” of electronic health records to qualify for federal incentive payments, Reuters reports (Lentz, Reuters, 7/13).
Officials also released the final rule describing the required standards and certification criteria for EHR technology. The new regulation updates the interim final rule on EHR certification that ONC released in January (Mosquera, Government Health IT, 7/13).
Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHRs will qualify for incentive payments through Medicaid and Medicare.
HHS Secretary Kathleen Sebelius, new CMS Administrator Donald Berwick, National Coordinator for Health IT David Blumenthal and Surgeon General Regina Benjamin announced the rules during a news conference (Health Imaging & IT, 7/13).
Core Meaningful Use Objectives
Blumenthal said the final meaningful use rule offers health care providers more flexibility than the proposed regulations released in January.
The final rule requires physicians to meet a set of 15 core objectives during the first stage of the incentive program. Hospitals are required to meet 14 core objectives for Stage 1. In addition, all health care providers will need to comply with five objectives out of a “menu” of 10 options (Manos, Healthcare IT News, 7/13).
The earlier proposed rule included 25 objectives for physicians and 23 objectives for hospitals.
One of the core objectives requires health care providers to transmit 40% of prescriptions electronically. The requirement was relaxed from the earlier proposed regulations, which called for a 75% electronic prescribing rate.
Health care providers also will need to enact a single measure to meet the clinical decision support requirement, down from five measures in the previous proposal.
In addition, CMS reduced the number of quality measures that health care providers must report on, deferring some measures to Stage 2 meaningful use requirements (Versel, FierceEMR, 7/13).
Another core objective requires hospitals and physicians to use computerized physician order entry systems to capture at least 30% of medication orders. Under the earlier regulations, hospitals would need to use CPOE systems for 10% of medication, laboratory and diagnostic orders, while doctors would need to use the systems for 80% of such orders (Robeznieks, Modern Healthcare, 7/13).
‘Menu’ of Additional Options
In addition to the core objectives, the final rule requires doctors and hospitals to comply with five objectives out of the menu of 10 options. Health care providers will need to comply with the remaining objectives as part of Stage 2 meaningful use requirements (Healthcare IT News, 7/13).
One of the new objectives in the menu calls for health care providers to offer patients condition-specific educational resources.
Clarifications on Eligibility
The final meaningful use rule defines a hospital-based eligible professional as someone who performs nearly all services in an inpatient hospital setting or emergency department.
The rule also expands the definition of acute-care hospital to include designated Critical Access Hospitals for the Medicaid incentive program (Health Imaging & IT, 7/13).
Additional Information in NEJM Piece
Blumenthal and Marilyn Tavenner, principal deputy administrator of CMS, offered additional explanations of the final meaningful use rule in a New England Journal of Medicine perspective piece.
In the perspective piece, Blumenthal and Tavenner explain that HHS weighed 2,000 outside comments before deciding on “significant changes” to the earlier meaningful use regulations.
The piece also includes a full list of the core objectives and the menu of options for the new final rule (Hobson, “Health Blog,” Wall Street Journal, 7/13).
In addition, Benjamin authored a companion piece that also appeared in the journal (FierceEMR, 7/13).
Next Steps
In January 2011, eligible health care providers and hospitals can begin registering for the EHR incentive program. CMS will manage the registration for both the Medicaid and Medicare incentive programs from one virtual location.
Federal officials expect to release additional information on the Stage 2 and Stage 3 meaningful use requirements over the next few years (Mearian, ComputerWorld, 7/13).
Source: iHealthBeat
As the number of health-related smartphone applications continues to grow, some doctors are expressing concern about the reliability of the information provided and the impact it could have on patients, the Los Angeles Times reports.
According to a mobihealthnews review published in March, there are nearly 6,000 health-related applications for smartphone devices such as the iPhone, Blackberry and Android.
About 80% of the health applications are available through Apple, while Android has about 500 programs, the review found.
Consumers typically can download the applications at no-cost or for less than $10.
Examples of Medical Apps
Smartphone applications cover a wide range of health topics. For example, Medic ID stores patients’ emergency medical information and allows medical personnel to access the data in case of an emergency.
Another application called MedWatcher receives FDA alerts and news stories about new medications, side effects and recalls.
Growing Concerns
Despite the potential usefulness of consumer health applications, some physicians are concerned about reliability because the programs are not required to undergo a formal review process.
Some doctors also are concerned that patients will follow advice from smartphone applications rather than seek medical care.
Kevin Patrick — editor of the American Journal of Preventive Medicine and a professor at the University of California-San Diego — said the medical smartphone application market “is still a very immature market,” and that many programs have not undergone clinical trials to demonstrate their efficacy (Kritz, Los Angeles Times, 7/12).
Source: iHealthBeat
Last week, HHS awarded a total of $390.5 million in hospital preparedness and emergency response grants to help hospitals improve their medical surge capability in the event of a public health emergency, such as an act of terrorism, disease outbreak or natural disaster, Modern Healthcare reports (Rhea, Modern Healthcare, 7/12).
Specifically, the grants will be used to develop:
The grants also will help facilities develop processes for hospital evacuation and sheltering, fatality management and forming community health care partnerships (Commins, HealthLeaders Media, 7/8).
Regional Awards
The grants were awarded to all states and territories (Goedert, Health Data Management, 7/8). HHS allotted additional funding to Chicago, Los Angeles County, New York City and Washington, D.C., to ensure the cities have adequate resources if a catastrophe should occur.
California received the largest grant, at almost $32 million, while Los Angeles County received an additional $12.3 million (Modern Healthcare, 7/12).
Source: iHealthBeat
Seventy-eight percent of U.S. adults said their physicians should have access to information included in their electronic health records — the same percentage as 2009, according to a new HealthDay/Harris Interactive survey.
Thirty percent of respondents said their insurers should have access to information contained in their EHRs, down slightly from 33% in 2009.
Twenty-eight percent of U.S. adults said their primary care physician uses an EHR, while 17% said their primary care physician does not use an EHR. Forty-two percent of survey respondents said they were not sure whether their primary care physician uses an EHR system, and 12% said they do not have a primary care physician.
Results are based on an online survey of 2,035 U.S. adults conducted from June 8 to June 10.
Source: HealthDay/Harris Interactive, “Few Americans Using ‘E-‘Medical Records”
The total market for handheld devices in health care is expected to reach $8.8 billion in 2010, up by 7% from 2009, according to a report published last week by health care market research firm Kalorama Information, InformationWeek reports.
The report — titled “Handhelds in Healthcare: The World Market for PDAs, Tablet PCs, Handheld Monitors, & Scanners” — considered all handheld devices and made predictions for certain health care categories.
For example, the report found that total sales for patient-monitoring products reached $5.3 billion in 2009, accounting for 64% of the market share for handheld devices.
It also found that the administrative devices market — which includes PDAs, smart phones, tablet PCs and inventory/medication scanners — generated about $3 billion in 2009 for a market share of 36%.
The report identified several drivers of handheld device growth in the health care market, including:
The report also predicted that incentives from the 2009 federal stimulus package will continue to drive increased sales of handheld devices in the health care sector, noting that the incentives “are getting health care organizations to think about IT purchases, and they are helping to make the argument for better electronic data entry” (Byers, CMIO, 7/1).
Source: iHealthBeat
Thirty-six percent of health IT professionals surveyed said that the ability to improve patient safety and/or reduce medical errors is the most critical influencer for the use of radio frequency identification applications in health care organizations, according to a recent Healthcare Information and Management Systems Society survey.
Twenty percent of survey respondents said inventory management/asset control is the most critical influencer of RFID use, while 19% cited hospital operation improvements.
Another 17% of respondents said patient and workflow improvement is the most critical influencer for the use of RFID tools in health care organizations, according to the survey.
Results are based on a May 2010 online survey of 222 health IT professionals.
Source: HIMSS, “Use of RFID Technology”
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