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IT effect on patients, providers most vital: Blumenthal

By Rebecca Vesely / HITS staff writer

Proposed rules on the meaningful use of electronic health records will be made public by the end of the year or perhaps sooner, said David Blumenthal, national coordinator for health information technology at HHS.

In a speech before the American Medical Informatics Association’s annual symposium in San Francisco, Blumenthal stressed that health IT must be focused on the goal of making the healthcare system work better for patients and providers.

It’s not the technology that’s important, but its effect,” Blumenthal said. “That’s the purpose of the stimulus bill.”

The American Recovery and Reinvestment Act of 2009 included Medicare and Medicaid incentives to eligible providers such as physicians and hospitals to boost adoption of EHRs. To receive the incentive payments, providers must demonstrate “meaningful use” of a certified EHR. The CMS, in conjunction with Blumenthal’s office, is developing the proposed rule that provides greater detail on the incentive program and a definition of meaningful use. The stimulus law, enacted in February, appropriated $2 billion to Blumenthal’s office to create the infrastructure for meaningful use.

After a comment period, the final rule on meaningful use will be released in the spring, Blumenthal said.

While Blumenthal declined to give a specific definition of meaningful use, he offered some hints. People working in health IT should think about EHRs “not as a technology project, but as a change-management project,” he said. Components of meaningful use include sociology, psychology, behavior change and the “mobilization of levers to change complex systems and improve their performance,” he added.

Through the stimulus law, Congress mandated that meaningful use become more focused over time, with yearly benchmarks. There has been a “lively discussion” in the Obama administration of that timetable in the proposed rulemaking of meaningful use, Blumenthal said.

“We will be looking for your feedback,” Blumenthal told the assembled association of nearly 2,000 members who attended the conference held at the Hilton San Francisco Union Square this week. “Rulemaking is not the end of the conversation.”

Privacy and security are absolutely critical to the widespread adoption of health IT, Bluementhal said, adding that this is also on top of his agenda. “Without the trust of the public, we will not be successful in getting everything out of the potential of health informatics.”

In the next few months, his office will convene a working group on privacy and security to look at what else is necessary to ensure the public’s trust beyond what is instructed by Congress in the stimulus law, he said.

“We need to be extremely vigilant and aggressive in terms of developing standards around privacy and security,” Blumenthal said.

And his office is moving forward with its first grant programs under the stimulus law. Last summer, Blumenthal announced two grant programs mandated by the stimulus law. The first is $700 million in grants to establish up to 70 health IT regional extension centers nationwide, which will offer technical assistance, guidance and information on best practices to support and accelerate providers’ efforts to become meaningful users of EHRs. The second program offers $560 million in grants to states to develop health information exchange capacities among providers.

The first round of grant recipients will be announced soon, Blumenthal said. HHS received about 90 applications for the first 20 slots in the health IT regional extension center program, he said, adding that he was encouraged by the volume and quality of the grant applications.

“The grants to states, we believe, are another good bet,” he said.

Blumenthal also gave some hints on his office’s plans to develop and announce programs to increase the supply of trained health IT workers.

“The skills needed are not necessarily what our teenage children have,” Blumenthal said, which brought laughter from the crowd.

Specifically, the nation needs professionals who understand meaningful use and improved processes of care, the ability to redesign workplaces to integrate the new technology and to help providers use the technology to its full potential, he said.

“The training needed is well beyond the installation of information technology,” he said.

Blumenthal expressed great confidence that health IT can be a foundation for fundamental change in the healthcare system.

“I believe it will be a short time before EHRs are as common in medicine as the stethoscope, the cardiogram, the MRI and other core tools,” he said. “I think we’re already moving in that direction.”

Above article published on http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20091117/REG/311179986/1134 

December 1, 2009 
 
Electronic Health Record - Meaningful use rule ‘on target’ for end of year

By Brian Robinson,

The Centers for Medicare and Medicaid Services is still on target to publish by the end of the year a proposed rule on the meaningful use of electronic health records, despite growing fears from industry about the possible impact of the regulation.

Tony Trenkle, director of the Office of e-Health Standards and Services at CMS, said he had been spending a lot of time with health industry folks who have expressed “concerns and fears” about what will be in the regulation.

Those include how high the bar will be set for meeting meaningful use targets during the first year of implementation, and whether the industry will be able to meet them, he told a meeting today of National Committee on Vital and Health Statistics (NCVHS).

Other concerns include whether hospitals outpatient clinics would be eligible to receive separate payments, whether quality measures will disadvantage specialty health providers, and worries particularly by the states about whether CMS would be able to harmonize Medicare and Medicaid requirements.

Under the HITECH Act, a part of the American Recovery and Reinvestment Act, health care providers can receive payments from both the Medicare and Medicaid programs if they can demonstrate meaningful use of certified EHRs. Payments are due to begin in 2011.

One of the major outcomes of the Nov. 19-20 NCVHS meeting is expected be a letter setting out recommendations to the Secretary of the Health and Human Services for measures that can be applied to decide on just what meaningful use is.

They include commissioning a “fast track” study from the Institute of Medicine on a national strategy for quality measurement development, to begin a process to identify essential data elements, to require EHR vendors to use defined quality data elements, and to require that any certified EHR be able to add data elements that may be defined in the future.

The NCVHS expects to release the final version of the letter at the Nov. 20 conclusion of its meeting.

Above article published on http://www.govhealthit.com/newsitem.aspx?tid=10&nid=72449

November 30, 2009
 
Government Defined Meaningful Use Results in Meaningful Dollars

A Map to Your Money

By Steven Kraus, DC, DIBCN, CCSP, FASA

Say it once, they hear you. Say it twice, they understand you. Say it three times, they take action. Maybe you’re aware of the philosophy that you have to communicate a message at least three times - and perhaps in different ways - in order to create an actionable response.

That’s precisely what the government is doing regarding meaningful use of electronic health records (EHR), and each time they communicate, they get more specific. So, although I’ve talked in broader terms about meaningful use, I’m following the government’s lead and breaking down what they’re saying (the how and the when) to create an actionable response from you - before it’s too late to cash in on $44,000. Doctors of chiropractic, start your engines.

Leader of the Pack

The Health and Human Services (HHS) Office of the National Coordinator for Health Information Technology’s HIT Policy Committee is in charge of defining the parameters of EHRs qualifying for stimulus plan dollars - up to $44,000, depending on when you adopt the technology. The HIT organization recently sent me a communication that outlines the latest draft of requirements. I don’t have the space to inform you of every one of them, but I want to take this opportunity to drill it down. Because the regulations are well-defined, complying should not be difficult. Here’s a quick summary:

Your EHR must be qualified through forthcoming certification by the Certification Commission for Health Information Technology (CCHIT).
You will be required to employ “meaningful use” of your EHR.
You must report on calculated measures as defined by the Center for Medicare & Medicaid Services, such as outcome and pain assessment for region, quality and intensity of pain.

Stipulations one and three are pretty straightforward, but truly, what the heck is meaningful use? What’s meaningful to you might not be meaningful to me and vice versa. But we don’t get to define that; the government does. The fact is, if you have the right software partner - one who is aware of the guidelines, automatically and continuously updating your software, and showing you how to use the technology - you should have little concern. Put the responsibility squarely on the shoulders of your vendor. If broad enough, they will shoulder the burden for you.

Another important announcement from the HIT Policy Committee (in August) indicated that the only current certifying body shall be the CCHIT, which will verify whether your EHR meets the standards required by the HIT Policy Committee for the $44,000 incentive payments. Additionally, they will likely blend some of the rules of meaningful use and reporting into certification approval so your EHR can properly assist you in achieving meaningful use.

The Green Flag

Here’s an eye opener: If you don’t have a meaningfully used qualified EHR in place during the next several months (by the end of first quarter of next year), you may miss up to $18,000 - the first year’s eligible payments for 2011. But that’s just the first year. Over the following four (through 2015), the HIT Policy Committee will continue to increase its requirements every two years. If you get on board in early 2010, not only will you be eligible for stimulus funds, but you also will have to meet fewer requirements than those who adopt the technology later.

For example, in 2013, the qualifying criteria will likely be doubled from what they were in 2011; by 2015, tripled. Scary? Maybe. But not really for those who are prepared. In the first two years of eligibility (2011 and 2012), a chiropractic physician can receive up to $30,000. It makes sense not only to start your engines, but also to step on the gas and go.

Three-Way Tie for First Place

Although you may not have guessed it, the HIT Policy Committee developed its guidelines for three-way benefit: payers, doctors and patients. Now ultimately, it’s the patients who will benefit most from your adopting - and meaningfully using - a qualified EHR, but the benefits for you are obvious, too. Your office will run more efficiently, records will be quicker to access, information will be easier to gather and report; and, then there’s the whole matter of the $44,000 incentive.

According to several estimates, the average cost for one medical doctor to introduce an electronic health record system plus hardware is $40,000 to $60,000. The cost for one doctor of chiropractic to purchase true EHR software is $12,000 (plus any hardware you may require). Take that however you’d like, but the fact of the matter is, in our profession, we are poised to not only get fully reimbursed for adopting, but also to have a little pocket change left over for all the hardware and training you would ever need.

You know there is a caveat, however. The longer you wait, the less money you’ll get, based on the incentive schedule of payments. And, if you don’t adopt at all, you’ll get financially penalized - in the form of lesser Medicare claims reimbursement. Ouch.

What’s Under the Hood?

Here’s a look at a few of the elements that make up the HIT Policy Committee’s upcoming requirements for your EHR. In order to qualify, you must do the following:

provide access to patient-specific education resources before 2011;
provide patients with an electronic copy of their health information before 2011;
incorporate lab-test results into your EHR before 2011;
send preference-based reminders to patients for preventative/follow-up care before 2011;
record clinical documentation in your EHR in 2013;
use evidence-based order sets in 2013; and
provide clinical decision support at point of care (reminders, alerts, etc.) in 2013.

Many of you may already be taking measures to meet these criteria. If you’re not, it’s not too late, but you’ll want to get off the starting blocks quickly.

Drive With Purpose

Let’s go back to the concept of meaningful use. When you’re looking at an EHR system, don’t buy it just to qualify for stimulus money. Make sure it’s interoperable, easy to use and allows you to report on predetermined measures as well as demonstrate meaningful use. Although meaningful use has different definitions from person to person, the HIT Policy Committee’s definition is becoming clearer. However, there is still some fine-tuning, and we should expect to see results published by December of this year.

Winning the Race

At this point, it’s a race against the clock. Although you don’t have to be the first one to reach the checkered flag (adoption, installation, implementation, understanding and meaningful use of a qualified EHR), you do have to reach it without hesitation if you want to qualify for the bigger payouts in the first two years of government incentive payments.

Should that sound overwhelming, take the pressure off. Keeping your software up-to-date in accordance with government guidelines (this includes criteria on federally defined meaningful use) means keeping reimbursements coming over the years. Otherwise, you might qualify for stimulus plan dollars now, but fail to do so through 2015. Some DCs won’t qualify at all because their EHR vendor does not have the capacity or infrastructure to meet all of the criteria for development of a true EHR. This becomes even more problematic, as other entities such as Medicare and insurers will likely require the same government certification in the coming years in order to participate in their panels of providers or to participate in reimbursement programs.

I’ve previously asked, “Why wait?” when it comes to adopting technology. Now, it’s not a question of why; that’s established - because the federal government is driving the technology (the “what”) in order to comply with changing regulations and to achieve cost savings across all avenues of health care. The “when” is also in place - by early 2010, in order to qualify for the first available annual payments totaling up to $44,000 for each doctor (the “where”) in your office. The “how” is by choosing the right EHR and support structure to assist you in being the clinic of the future rather than the clinic of the past - to call on experts and partners to help you meet the criteria smoothly, efficiently and effectively. “Who?” That’s you.

Above article published on http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=54297
 
November 5, 2009 
 
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