Using electronic health record systems for disease surveillance could help physicians determine when it is appropriate to prescribe antibiotics, according to a study published in the Annals of Internal Medicine, Reuters reports.
Study Details
For the study, researchers from NorthShore University HealthSystem in Evanston, Ill., used EHRs to review data on 28,000 patients.
Each of the patients saw one of 69 physicians at NorthShore clinics and hospitals during influenza seasons between 2006 and 2011.
Key Findings
According to the study, physicians on average prescribed antibiotics 45% of the time for patients complaining of a fever and cough or cold symptoms.
The rate of antibiotic prescriptions issued varied widely by physician, with doctors prescribing antibiotics between 18% and 84% of the time, the study found.
Researchers noted that physicians often prescribed antibiotics when they were uncertain whether a bacterial infection was causing an illness.
Researchers also identified patterns suggesting that context influenced physicians’ prescribing decisions. For example, antibiotic prescriptions decreased during flu “pandemic” periods, likely because doctors assumed that patients’ symptoms were caused by the flu virus.
Researchers Comment on Findings
Study author Ari Robicsek of NorthShore said the finding that physicians prescribed fewer antibiotics during flu pandemics shows that hospitals could do more to inform physicians about illnesses in the community.
Robicsek said that NorthShore is working to develop a tool that would help hospitals use EHR data to alert physicians about illnesses in their area (Pittman, Reuters, 8/6).
Source: iHealthBeat
On Tuesday, HHS sent to the Office of Management and Budget the final rule outlining standards and criteria for the certification of electronic health record systems under Stage 2 of the meaningful use program, Health Data Management reports (Goedert, Health Data Management, 8/1)
OMB review is one of the last steps before a rule is published in the Federal Register (Anderson, GovInfoSecurity, 8/1).
Background
Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health record systems can qualify for Medicaid and Medicare incentive payments.
Earlier this year, the Office of the National Coordinator for Health IT released a proposed rule on the standards and criteria for the certification of EHR systems under Stage 2 of the meaningful use program.
CMS also released a proposed rule outlining requirements for hospitals and health care providers seeking to attest to Stage 2 of the meaningful use program (iHealthBeat, 7/18). On July 16, CMS sent the Stage 2 final rule for health care providers to OMB for review.
Details on the Release
Federal officials previously said that the final versions of both Stage 2 rules would be released by the end of summer.
OMB typically takes between several weeks and many months to review rules (GovInfoSecurity, 8/1).
Source: iHealthBeat
Providing patients with online and mobile access to their health data can improve their satisfaction with health care organizations, according to a new report from PricewaterhouseCoopers’ Health Research Institute, FierceHealthcare reports (Cheung, FierceHealthcare, 7/26).
The findings are part of a nationwide PwC survey of 6,000 consumers across several industries (Parmar, MedCity News, 7/27).
When asked about the types of services they value in health care organizations:
When asked about the types of services they value from health insurers:
The report also noted that telehealth, mobile health, social media and retail clinics have led to increased consumer interest in “on-demand” health care (MedCity News, 7/27).
Source: iHealthBeat
More than 30,000 health care providers qualified for meaningful use incentive payments in 2011, but many clinicians still are uncertain about how to participate in the program, according to an article published in the Archives of Internal Medicine, MedPage Today reports.
National Coordinator for Health IT Farzad Mostashari, former CMS Administrator Donald Berwick and other health care leaders collaborated to write the article, titled, “Guide for Physicians to the EHR Incentive Programs.”
About the Incentive Program
Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health record systems can qualify for Medicaid and Medicare incentive payments.
In addition to outlining the requirements of the meaningful use program, the article provided links to websites where health care providers can:
According to the article, more than 172,000 clinicians were registered for the Medicare and Medicaid meaningful use programs as of Dec. 31, 2011.
Challenges to Participating
The authors acknowledged that many health care providers face challenges that are hindering their participation in the meaningful use program. They wrote, “Even the strongest enthusiasts for EHRs recognize that their adoption involves significant changes for physicians, with attendant dislocations in workflows, investments and habits of practice.”
They noted that the first years of the meaningful use program likely will be the most difficult, adding that the transition should become smoother as more sectors of the health care industry embrace health IT systems (Walker, MedPage Today, 5/15).
Source: iHealthBeat
CMS has started auditing health care providers who have received meaningful use incentive payments, according to an alert from the law firm Ober Kaler, FierceEMR reports.
Background
Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health record systems can qualify for Medicaid and Medicare incentive payments.
CMS is required to audit health care providers attesting to meaningful use, but until this point, the agency only has posted general information about the audits.
Details About the Audits
Accounting firm Figliozzi & Company — based in Garden City, N.Y. — is acting on behalf of CMS to conduct the audits. The firm has started sending letters asking health care providers to furnish documentation supporting their meaningful use attestation.
According to the Ober Kaler alert, the auditor is seeking four types of data:
Providers selected for the audits have two weeks to submit their documentation.
According to the Ober Kaler alert, the audits are not expected to involve site visits (Durben Hirsch, FierceEMR, 7/23).
Source: iHealthBeat
The South leads the rest of the U.S. in the number of health care providers who received Medicare meaningful use incentive payments in 2011, according to a new report from the Government Accountability Office, Modern Healthcare reports.
Background
Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health record systems can qualify for Medicaid and Medicare incentive payments.
The stimulus package also requires GAO to issue reports on health IT adoption (Conn, Modern Healthcare, 7/26).
Total Medicare Meaningful Use Payments
GAO’s latest report found that in 2011, the Medicare meaningful use program paid:
Key Findings About Hospitals
GAO found that of the hospitals that received Medicare meaningful use incentive payments in 2011, about:
The report also noted that about:
Key Findings About Eligible Professionals
Of the eligible professionals who received Medicare meaningful use payments in 2011, the report found that about:
The report also found that about:
Source: iHealthBeat
Older physicians are less likely to use an electronic health record system than their younger counterparts. A recent Health Affairs study found that in 2011 30.8% of physicians older than age 55 were using a basic EHR system, compared with 40% of doctors younger than age 40 and 35.5% of doctors ages 40 to 55.
There are several reasons for the lower EHR adoption rates among older physicians. Some older physicians might not be as technologically savvy as younger doctors and thus are reluctant to transition to an electronic-based workflow. In addition, older physicians are more likely to work in solo or small practices, which face greater financial barriers to EHR adoption. Further, some older physicians say they’ll be ready for retirement by the time they start to see any return on investment from EHR adoption.
Currently, older physicians who use a paper-based record system are not eligible for Medicare and Medicaid incentive payments under the meaningful use program. And, beginning in 2015, physicians who cannot demonstrate meaningful use of EHRs will be subject to a 1% reduction in Medicare payments. That penalty will increase by 1% in each subsequent year, eventually reaching 5%.
Push for a Hardship Exemption for Older Physicians
Arguing that older physicians face unique barriers when it comes to EHR adoption, some groups are pushing for CMS to include a hardship exemption category in the meaningful use program for doctors who are close to retirement.
In its comment letter to CMS on the proposed rule for Stage 2 of the meaningful use program, the American Medical Association called for an exemption for physicians who currently are eligible or will be eligible by 2014 for Social Security benefits.
AMA wrote, “It would be economically burdensome for physicians who intend to retire in the next several years to purchase, install and meaningfully use an EHR.” It added, “We are also concerned that many of these physicians may decide to close their Medicare fee-for-service panels or opt out of Medicare to avoid penalties during the end stage of their clinical careers, which would adversely affect access to care for our nation’s elderly and disabled.”
An AMA policy expert said that EHR adoption is a significant investment both in terms of cost and time and that older doctors likely won’t be practicing long enough to realize the benefits of health IT, such as improved patient care and efficiency.
She said that if a physician plans to retire within five years, it probably doesn’t make financial sense to invest in an EHR system.
Without a meaningful use exemption for older physicians, such doctors could close their practices prematurely or limit the number of Medicare beneficiaries they treat, according to the AMA policy expert.
Rep. Renee Ellmers (R-N.C.) — chair of the House Small Business Committee’s health care subcommittee — voiced similar concerns in a letter to CMS acting Administrator Marilyn Tavenner.
Ellmers — who worked as a nurse for nearly 20 years — wrote, “I believe that modern, well-equipped offices are vital to the practice of medicine, and that health information technology can help all health professionals to improve the delivery of care.” However, she said that she believes the goals in the proposed Stage 2 rule “may be too ambitious” for physicians nearing retirement age, as well as those in solo or small practices.
Ellmers urged CMS to allow hardship exemptions for physicians who are nearing retirement — those who are older than age 60 — and for physicians in practices with five or fewer physicians.
EHR Adoption Still Worthwhile for Some Older Doctors
A CMS policy expert acknowledged that there is a generational divide when it comes to EHR adoption and that older doctors typically are more reluctant to make the transition to health IT.
However, he said that CMS has been very encouraged by the number of doctors in the older age brackets who are adopting EHRs and attesting for meaningful use.
Reavis Eubanks — a solo-practice physician in western North Carolina — adopted an EHR system in January 2011, at the age of 64. He attested to meaningful use Stage 1 in June 2011 and received $18,000 in incentive payments.
Eubanks said ignorance was the main thing that prevented him from adopting an EHR system earlier in his career. He said, “I really did not realize that it could be done affordably, and I did not realize the vast advantages that it would give me as far as efficiency and communication.” Eubanks said, “If I knew what I know now, I would have done it a lot earlier.”
Eubanks said his experience using a server-based EHR system at a hospital in his area gave him “insight into the some of the problems that could arise if [he] had his own in-house system.” As a result, Eubanks selected a cloud-based EHR system from athenahealth.
One of the reasons Eubanks was attracted to athenahealth’s product is that the vendor offered a guarantee to meet Stage 1 meaningful use certification criteria. Another big selling point was the significantly lower upfront cost.
He said, “You can adopt a cloud-based system at a much, much [lower] upfront cost. The thing that always comes up is, ‘Yes, but you’re having to pay that percentage [fee] every month.’ But my retort to that is, ‘Yes, but you’re getting better and better services every month because the subscription-based company is not going to make any money unless the physician is making money.'”
Eubanks said EHR adoption “does have a learning curve and it does certainly have the potential of fairly adversely affecting the workflow,” but “it doesn’t have to be that way.”
He said it is important that the physician doesn’t “feel constrained to have to do it like the system tells him to do it, rather than the system being his servant and helping him accomplish things.” Eubanks also said he made great efforts to ensure that his new EHR system did not detract from his interactions with patients.
As a result of adopting an EHR system, Eubanks said he has seen significant improvements in claims processing, documentation and communication.
Eubanks said he would encourage older physicians who are on the fence about EHRs “to adopt electronic records even if they weren’t interested in meaningful use because of the benefits … particularly communication with other people, good documentation and the fact that when somebody gets your record, they can actually read it.” In fact, Eubanks said he would have adopted an EHR system even without the promise of meaningful use incentive payments.
Still, Eubanks sees a lot of value in the meaningful use program. He said the program “has asked us to do things that I believe any good physician should have been doing all along.” He added, “And therefore even outside of return on investment, the criteria for meaningful use would be beneficial to anybody that’s interested in providing good medical care.”
The CMS policy expert said that the meaningful use is about improving patient care through better care coordination, reducing unnecessary procedures and boosting patient safety. He said that doctors of all ages understand how important better patient care is.
Eubanks said he does not believe there should be a meaningful use program exemption for doctors who are close to retirement age, noting that such a statement is “unusual for a very conservative individual to say as far as a government mandate.” He said he believes the meaningful use program is trying to provide “good medical care … so therefore, I don’t think there should be an exemption.”
Likelihood of a Hardship Exemption for Older Doctors?
In its proposed rule for Stage 2 of meaningful use, CMS asked stakeholders to weigh in on proposed hardship exemptions, as well as offer other exemption categories that they believe should be added.
Because CMS is in a period of rulemaking, the agency could not comment on the likelihood of the inclusion of a hardship exemption for physicians close to retirement in the final rule.
An AMA policy expert said AMA believes its recommendation for such an exemption is reasonable and noted that CMS listened to some of the group’s feedback on Stage 1 of the program.
However, she said that AMA made similar hardship recommendations for CMS’ electronic prescribing incentive program that were not incorporated into the final rule.
Still, the AMA policy expert said there’s more at stake financially with the meaningful use program. She noted that EHR systems are significantly more expensive than stand-alone e-prescribing systems; the meaningful use program is long-lasting, while the e-prescribing incentive program ends in 2014; and the meaningful use penalties are more substantive than those in the e-prescribing program.
CMS plans to release its final rule for Stage 2 of the meaningful use program and detail the final exemption categories in late summer.
Source: iHealthBeat
Military and consumer robot maker iRobot recently unveiled RP-VITA, a robot that uses telehealth technology to connect remote physicians and other health care providers with hospital patients, the Boston Globe reports (Adams, Boston Globe, 7/24).
The Bedford, Mass.-based company, which developed the Roomba vacuum cleaner, last year invested in InTouch Health, which makes video-enabled, remote-controlled hospital service robots (Donnelly, Boston Business Journal, 7/24).
RP-VITA Details
RP-VITA is a 140-pound telehealth robot that allows physicians to virtually visit patients and take measurements in real time. It transmits video, audio and navigation instructions.
In addition, the robot is equipped with:
RP-VITA can be integrated with an electronic health record system and can connect to diagnostic devices (Boston Business Journal, 7/24).
Physicians, patients and hospital staff members can control RP-VITA using a special terminal or an iPad. Unlike many older telehealth robots, RP-VITA can navigate around the hospital on its own.
The robots are scheduled to become available to all hospitals later this year and will cost between $4,000 and $6,000 per month to lease.
Response to RP-VITA
Jason Knight — a pediatric emergency care physician at the Children’s Hospital of Orange County, one of two California hospitals testing RP-VITA — said the telehealth robot allows him to “get data I never had over the phone.”
Liz Boehm of ExperiaHealth, a patient experience consulting firm, said, “From the patient perspective, the advantage is the rapidity. The faster you get a diagnosis and treatment, the better your outcome” (Boston Globe, 7/24).
Source: iHealthBeat
The U.S. market for remote patient monitoring systems is expected to reach $20.9 billion by 2016, according to a report by Kalorama Information, InformationWeek reports (Lewis, InformationWeek, 7/25).
Report Findings
The report noted that the market for remote patient monitoring systems already has more than doubled from $3.9 billion in 2007 to $8.9 billion in 2011.
According to the report, factors contributing to the market growth include:
Report Predictions
In the report, Kalorama Information predicted that health care organizations increasingly will adopt remote patient monitoring devices like blood pressure monitors and glucose meters to exchange patient data between different locations over wireless networks.
Melissa Elder — author of the report and information analyst at Kalorama Information — said that many developers are launching new wireless health products that can do more than collect and send data. “Some of the challenges (at health care delivery organizations) can be somewhat offset by implementing newer patient monitoring technologies capable of not only monitoring patients, but sorting data and automatically updating patient records,” she said, adding, “This allows health staff to provide care more efficiently and also monitor patients in off-site locations” (InformationWeek, 7/25).
Source: iHealthBeat
On Monday, CMS sent to the Office of Management and Budget the final rule outlining requirements for hospitals and health care providers seeking to attest to Stage 2 of the meaningful use program, GovInfoSecurity reports (Kolbasuk McGee, GovInfoSecurity, 7/17).
OMB review is one of the last steps before a rule is published (Goedert, Health Data Management, 7/17).
Background
Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health record systems can qualify for Medicaid and Medicare incentive payments.
In February, CMS released a proposed rule outlining requirements for hospitals and health care providers seeking to attest to Stage 2 of the meaningful use program. The Office of the National Coordinator for Health IT also released a proposed rule outlining standards and criteria for the certification of EHR systems under Stage 2 of the meaningful use program (iHealthBeat, 5/9).
Details on the Release
The final rule on EHR certification criteria was not included in the list of regulations under review by OMB.
Federal officials previously said that the final versions of both Stage 2 rules would be released by the end of summer. OMB typically takes between several weeks and many months to review rules (GovInfoSecurity, 7/17).
Source: iHealthBeat
MGMA Supports ICD-10 Testing With Outside Organizations
July 30, 2013
Report: Many EHR Users Set To Replace Systems Within the Next Year
July 30, 2013
Providers, Vendors Urge Congress To Delay Meaningful Use Stage 2
July 30, 2013
Many Doctors May Find Meeting ‘Meaningful Use’ Requirements a Challenge
June 28, 2013
When it Comes to ICD-10 Physician Documentation: Collaborate and Educate
June 28, 2013
The Slow Crawl Toward Improved EHR Usability and Interoperability
June 28, 2013
Efficient Patient Communication and Engagement
June 13, 2013
ONC Issues Guidance on Stage 2 Transition of Care Requirements
May 31, 2013
Drugmakers Leverage Doctor, Patient Data To Market Their Products
May 31, 2013
Consumer Organizations Defend Meaningful Use Program
May 31, 2013
