HHS issued two sets of much-anticipated federal regulations that significantly further the government's healthcare information technology adoption agenda. The first set of regulations lists the "meaningful use" criteria that healthcare providers must meet to qualify for federal IT subsidies based on how they use their electronic health records. The second set of regulations lays out the standards and certification criteria that those EHRs must meet for their users to collect the money.
The meaningful use regulations are proposed regulations subject to a 60-day public comment period after which HHS would issue final regulations. The EHR certification regulations are interim final regulations that take effect in 30 days with a 60-day public comment period. HHS said final regulations will be published in 2010.
Under the proposed meaningful use regulations, eligible healthcare providers must use their EHRs to: improve the quality, safety and efficiency of healthcare services; reduce healthcare disparities; engage patients and their families; improve the coordination of care; improve population and public health; and ensure the privacy and security of personal medical information.
Under the interim final EHR regulations, EHRs must be able to securely exchange information among providers and between providers and patients using standardized data elements and technologies. The regulations outline standardized formats for such things as clinical summaries; medical descriptions of clinical conditions and test results; and how that information is exchanged over the Internet.
Source: Modern Healthcare
Believe it or not, physicians really do support the idea of EMRs
. In one study of Massachusetts doctors, published in the Journal of the American Medical Informatics Association, 86 percent said health information exchange would improve the quality of care, while 70 percent were of the opinion HIE would cut healthcare costs and 76 percent said it would save time.
Alas, there is a downside, HealthDay reports. About 71 percent of the more than 1,000 respondents expressed concern about the potential for privacy breaches. And not even a single physician surveyed was willing to pay a suggested $150 HIE monthly fee. Half said they would not pay any fee.
In another study that also appears in the January edition of JAMIA, a group of 56 mental health professionals at an academic hospital generally believed that EMRs were clearer and more complete than paper records, if not necessarily more factual. That may be because 63 percent of the respondents were less willing to include "highly confidential" patient information in an EMR than in a paper chart. And if they were patients, 83 percent of the professionals would not want their mental health records routinely available to other healthcare providers.
Designers of future systems will need to enhance electronic file security and simultaneously maintain legitimate accessibility in order to preserve confidence in psychiatric and other EMR systems," the study says.
Read complete article here.
There is a push going on for push messaging, a likely first step in rolling out a proposed national health information network in time for healthcare organizations to use electronic health record systems in a "meaningful manner" and qualify for federal EHR subsidy payments under the American Recovery and Reinvestment Act of 2009. In late October, David Blumenthal, head of the Office of the National Coordinator for Health Information Technology at HHS called for pause in the planning of the NHIN.
Earlier this week, in testimony before a federal healthcare IT advisory panel, on blogs and postings to online discussions, what is beginning to emerge is the outline of what the healthcare IT world was put on hold to wait for, an outline of a "lighter" NHIN than has been the focus of much planning and development work in the past.
It is an NHIN still based on the Internet but with, in the short run at least, a reduced scope. The new, revised NHIN will focus on ready access and ease of use by healthcare providers who will be under the gun to purchase, implement and then "meaningfully" use by 2011 EHRs in time to receive the first subsidy payments under the Medicare portion of the program.
The stimulus law, defines meaningful use rather simply. To achieve meaningful use, providers must use a "certified" EHR for electronic prescribing, reporting quality-improvement measures and performing health information exchange "to improve the quality of healthcare, such as promoting care coordination."
Read full report here.
In a study published recently by "The Journal of the American Medical Informatics Association", computerized provider order entry (CPOE) has been shown to improve patient safety by reducing medication errors and subsequent
adverse drug events (ADEs).
Institute of Medicine (IOM) has long been a proponent of electronic health
records (EHRs), making the link between EHR implementation and potential
improvements in quality and safety.
CPOE systems are computer applications that allow direct,
electronic entry of orders for medications, laboratory, radiology, referral,
and procedures. CPOE systems for ordering medications are sometimes called
electronic prescribing (e-prescribing) systems. CPOE systems are often
implemented with clinical decision support (CDS) alerts to guide ordering. Early research demonstrated the benefits of
CPOE/CDS systems in reducing medication errors by as much as 55–86% and subsequent
adverse drug events (ADEs), although the latter occur less frequently and are
more difficult to identify.
Frequency of errors declined from 18.2% to 8.2%-a reduction in adjusted odds of 70% (OR: 0.30; 95% CI 0.23 to 0.40). The largest reductions were seen in adjusted odds of errors of illegibility (97%), use of inappropriate abbreviations (94%) and missing information (85%). There was a 57% reduction in adjusted odds of errors that did not cause harm (potential ADEs) (OR 0.43; 95% CI 0.38 to 0.49). The reduction in the number of errors that caused harm (preventable ADEs) was not statistically significant, perhaps due to few errors in this category.
A CIO believes that cost of EMRs is not the barrier to EMR adoption. He also says that Physicians in a community are paid on a pay-as-you go basis. So
anything that is perceived as a barrier to their daily productivity
directly effects their income.
He also believes that EMR Software does make Physicians marginally
faster, if they really know how to use them well. The systems have to
be usually customized to meet their style of practicing medicine.
Al Campanella who is the CIO at Virtua (a multi-hospital healthcare system headquartered in Marltom, NJ) was recently interviewed by Healthcare Informatics. He also believes that physicians aren't opposed to the concept of EMRs, they just don't want to make less money because of them.
While Physicians do agree fundamentally that structured data, and having electronic availability of data, is very valuable, but it's at the price of slower workflow for them. Al believes that it's really the effects on their personal workflow which is the biggest barrier.
According to Al, productivity will slow down anywhere from three weeks to three months, and then after that providers should be at least on par with pre-electronic days. Many physicians actually improve productivity by approximately 10 percent, to say nothing of all the off hours conveniences.
The federal definition and criteria for the "meaningful use" of electronic health-record systems seems to be getting delayed. It was due today, but that deadline passed today at noon.
Excerpts of an article from Modern Healthcare authored by Joseph Conn.
According to the author, the federally chartered Health Information Technology Policy Committee took the time Tuesday to parse some recommendations from one of its work groups on what to do about standards for electronic laboratory orders. The policy committee then hustled up a vote to accept the eleventh-hour recommendations so they still could be considered by rulemakers before the first round of meaningful-use criteria are published.
The American Recovery and Reinvestment Act of 2009 called for creation of the HIT Policy Committee to advise HHS' Office of the National Coordinator for Health Information Technology on a host of subjects. Committee members have spent a significant portion of their time since the group was launched in May dealing with meaningful-use recommendations. Earlier this year, the HIT Policy Committee made several suggestions to the ONC on the meaning of "meaningful use."
It recommended three tiers of increasingly more stringent criteria lasting for periods of two years each. The years 2011, 2013 and 2015 were chosen as the starting and ratcheting up dates to coincide with break points in the subsidy payment regime. The recommendations the HIT Policy Committee voted on Tuesday came from its information exchange work group and specified standards for use by providers when electronically ordering laboratory tests for a patient.
Work group Co-chairman Micky Tripathi of the Massachusetts eHealth Collaborative said 70% to 80% of lab transactions are not performed using EHR systems. The failure of the healthcare industry to come together on a common set of messaging standards and their implementation guides for labs is "in many ways, the Achilles' heel of meaningful use," he said.
"There are a lot of standards out there that are not used, and many standards that are used in various ways," Tripathi said. In addition to 5,200 commercial labs, there are 8,500 hospital laboratories, 400 public health laboratories and 115,000 small laboratories in physician offices and clinics, Tripathi said.
A lack of consensus on laboratory standards has remained an intractable barrier to interoperability for multiple reasons, Tripathi said. Large national reference laboratories control 25% of the market, he said, but are only part of a contingent of commercial laboratories, all of which are ineligible for EHR subsidy payments under the stimulus law. Thus, they won't receive direct incentives to respond if laboratory standards are included in the meaningful use criteria.
Commercial labs are covered under the federal Clinical Laboratory Improvements Amendments of 1988 or CLIA, but the law permits variance in regulation by the states. Many states require that lab results only be transmitted to the providers who ordered the tests, which precludes direct transmission to a patient through his or her personal health record, for example.
KLAS Enterprises LLC has issued its 2009 Best in KLAS Awards based on customer satisfaction with health information technology vendors and consultants.
The awards are based on survey data the Orem, Utah-based vendor research firm has collected during the past year from thousands of hospitals and physician practices.
Following is the highest scoring product and vendor in Ambulatory EMR and Practice Management Software category for the 2009 Best in KLAS rankings:
Ambulatory EMR Software
- 2-5 physicians : PrimeSuite Chart from Greenway Medical Technologies
- 6-25 physicians : PrimeSuite Chart from Greenway Medical Technologies
- 26-100 physicians : eClinicalWorks EMR from eClinicalWorks Inc.
- Over 100 physicians : EpicCare Ambulatory from Epic Systems Corp.
Practice Management Software
- 2-5 physicians : Athenahealth
- 6-25 physicians : PrimeSuite Practice from Greenway Medical Technologies
- 26-100 physicians : Horizon Practice Plus from McKesson Corp.
- Over 100 physicians : Resolute/Prelude/Cadence from Epic Systems Corp.
Source: Health Data Management
Physicians are more likely to report drug safety information when using an electronic health record
system, according to a recent survey.
The New York-based Pfizer pharmaceutical company released the survey, which was conducted by Ipsos, an independent market research company. The survey polled 300 primary care physicians in the United States who are categorized as basic EHR users, fully functional EHR users or paper health record users.Two-thirds of respondents used some form of an EHR system and one-third used a paper-based system.
Half of all respondents and 60 percent of fully-functional EHR users reported that they would be much more likely to submit information about adverse events using an EHR system. Of those still using paper-based systems, 80 percent cited cost as a deterrent to investing in an EHR system.
"Patient safety continues to be a top priority at Pfizer," said Freda Lewis-Hall, MD, Pfizer's chief medical officer. "This survey furthers our understanding about how we can best use electronic health records systems to collect critical information about the safe and appropriate use of our products so that we can improve patient safety."
Nearly 60 percent of physicians who responded to the survey said adverse event reporting through an EHR system would improve patient care.
Source: Healthcare IT News
David Blumenthal, M.D., national coordinator for health information technology, on December 7, 2009, posted a stimulus-related update on ONC's blog, called Health IT Buzz.
He announced that meaningful use criteria (from CMS) would be coming within weeks, with electronic health records certification plans in early 2010. Those rules had been expected along with meaningful use rules by the end of 2009.
Original Text from the Blog:
At ONC, we're making tremendous progress to achieve our goals and today, I wanted to provide a quick update and an important new announcement.
Although I'm often out front in communicating our goals and progress, there is an entire organization - plus numerous collaborating agencies, our federal advisory committees, and other stakeholders - behind me working harder, and faster than ever, to get the right pieces in place to meet very aggressive timelines.
You have seen evidence of that work already with our announcements of major grant programs to help establish health information exchange and grow the health IT workforce. And you'll see even more in the weeks and months ahead as we roll out new projects.
Already, we're on the way to getting the Regional Extension Centers and the State Health Information Exchange program established early in 2010. In fact, on a technical assistance call on Friday about the extension center program, we announced that, due to a strong response for applications, there will be approximately 30 extension center awards made in January and the remainder in March. This should assure support is in place for providers looking to become meaningful users of EHR systems leading up to 2011.
Of course, this isn't all we're doing. You will see meaningful use criteria (from CMS) in a matter of weeks. We also anticipate publishing in early 2010 our proposed plans for establishing a new certification program, which we believe will enable most vendors to have their products certified by 2011. And there will be a number of other awards and programs rolling out between now and the end of the first quarter. This past week's announcements of the Beacon Community Program and additional workforce training grants continue to build the needed foundation for electronic health records throughout the nation.
We're working hard and we're working fast, but we're also working smart and ensuring that the necessary programs and standards serve as a sound foundation.
At a policy conference sponsored by the National Committee for Quality Assurance in Washington, David Blumenthal, national coordinator for health information technology at HHS, said that a recent study of physician practices showed that 20% were using electronic health records
in 2008. Of those users, 90% said they were satisfied with the technology "and could point to quality improvements" as a result of using electronic records.
Even for those physicians who had complaints about using the technology, "it's clear that very few physicians would go back to paper-based records," he said.
Blumenthal reiterated his commitment to issue proposed rules on the so-called "meaningful use" of EHRs last month, as well as offer grants to establish 70 health IT regional extension centers nationwide that will offer technical assistance, guidance and information on best practices to support and accelerate providers' efforts to become meaningful users of EHRs.
Source: Modern Healthcare News
The Certification Commission for Health Information Technology has announced the first electronic health records
products certified under its 2011 criteria.
The Chicago-based organization has two programs for 2011 that include criteria to support proposed federal standards for qualifying for Medicare/Medicaid incentive payments under the American Recovery and Reinvestment Act. The government has not officially proposed standards. But based on some requirements in the law and recommendations from federal advisory committees, CCHIT has launched initial 2011 certification programs that it will modify if necessary.
The CCHIT Certified Comprehensive program is an update of the organization's traditional EHR certification service. The Preliminary ARRA certification program focuses on the standards for qualifying for the Medicare and Medicaid incentives for meaningful use of EHRs.
The initial EHR product certified under the Certified Comprehensive program is ABELMed EHR-EMR/PM, Version 11, from ABEL Medical Software Inc.
The initial EHR products certified under the Preliminary ARRA program are:
- eHealth Made EASY, Version 3, from eHealth Made EASY LLC. The product is certified for supporting two of 27 meaningful use objectives for eligible providers and 2 of 24 objectives for hospitals;
- KIS Track, Version 5.1, from Kaulkin Information Systems, supporting 2 of 27 objectives for eligible providers; and
- Medios, Version 4.5, from IOS Health Systems, supporting 27 of 27 objectives for eligible providers.
More information is available at cchit.org.
Author: Joseph Goedert
Source: Health Data Management
The Centers for Medicare and Medicaid Services soon will send a series of documents to state Medicaid agencies to assist them in developing health information technology plans, which include incentive payments to providers for meaningful use of electronic health records. The incentives are authorized under the American Recovery and Reinvestment Act.
CMS will send letters and templates for the State Medicaid HIT Plan, the Planning Advance Planning Document and the Implementation Advance Planning Document to make the documentation process as simple as possible, according to a notice published Nov. 30 in the Federal Register.
"This information is being requested in order that states can submit documentation to CMS for review and approval in order that states can implement the Medicaid program and draw down federal financial participation," according to the notice. It is available at gpoaccess.gov/fr/index.html.
Source: Health Data Management
In a blog published on 30th November, David Blumenthal, M.D., M.P.P. - National Coordinator for Health Information Technology writes that he believes that "policy should be based on the best available information, carefully analyzed and considered. However, recent studies raising questions about the benefits of EHRs are informative, but limited in their applicability to our HIT program. To the extent that they accurately capture past experience with EHRs, these studies illustrate something that the Congress and the President understand and have allowed for: namely, that having an EHR alone is not sufficient. Doctors and hospitals have to use this technology effectively, have to employ its extraordinary power to improve clinical decisions, in order to achieve its potential benefits. The federal government's new programs of incentives and penalties are totally focused on encouraging the meaningful use of EHRs. The resources set aside by the Congress to encourage the adoption of EHRs will go only to physicians, hospitals, and other providers who meet carefully designed new requirements for the use of EHRs that will translate into health improvements and cost reductions for the American people. And the plan passed by Congress includes new resources and support that will help make it possible for providers and hospitals to meet these requirements. We have already announced the availability of grants that will help providers adopt and use EHRs, and we will be making additional announcements in the weeks and months ahead."
Source: Health IT Buzz Blog on The Evidence for HIT