CMS to test receiving quality data from electronic health records

The Centers for Medicare and Medicaid Services (CMS) plans to test its ability to accept selected clinical quality data directly from hospital electronic health record systems as early as July 2010.

CMS said it would seek volunteer hospitals to report stroke, blood clot and emergency department measures of care via EHR systems as part of the Reporting Hospital Quality Data for Annual Payment Update program, which provides higher Medicare payments to hospitals that report quality measures to the agency.

The agency detailed the plans in the Aug. 27 Federal Register in announcing changes to its rule for the Reporting Hospital Quality Data for Annual Payments Update. The program, a provision of 2003’s Medicare prescription drug legislation, required hospitals by 2010 to report on 42 quality measures to receive additional incentive payments.

Reporting to CMS is generally paper-based or through a mix of manual and automated systems.

Participating hospitals and their vendors will have to be able to transmit clinical EHR data that adhere to interoperability standards, such as cross document sharing, cross community access, clinical data architecture and Health Level 7 version 3, CMS said.

CMS has encouraged hospitals to adopt EHRs that can report quality data directly to a CMS data repository. Ideally, the use of EHR systems would improve the quality of care by providing physicians with pertinent clinical data as they were treating patients.

“The testing of EHR submission is an important and necessary step to establish the ability of EHRs to report clinical quality measures and the capacity of CMS to receive such data,” the agency said in the published interim rule.

The reporting of selected quality measures is also a key provision of the stimulus law. The Health IT Policy Committee, led by Dr. David Blumenthal, the national coordinator for health IT, has recommended that quality reporting be a part of the criteria providers must meet to demonstrate meaningful use of electronic health record systems, CMS said.

Blumenthal: Officials Working To Boost EHR Connectivity, Security

In an interview published in the New York Times’ “Pogue’s Posts,” National Coordinator for Health IT David Blumenthal discussed federal efforts to promote electronic health record interoperability and ensure the security of heath data.

Interoperability

Blumenthal said his office is undertaking efforts to help different EHR systems connect and share data. He said, ‘We’re gonna be helping states to create interoperability capability, capabilities to link records, to link institutions.”

In addition, Blumenthal said federal officials are developing nationwide standards and certification criteria that will support EHR interoperability. He added that the standards discussions “will all be a very open and transparent process.”

Privacy and Security

Blumenthal also addressed concerns about whether EHR systems would compromise the privacy and security of personal health data.

He said regulations are in place to ensure that any health data used for research purposes are stripped of all individually identifiable information.

Blumenthal also said his office plans to work with President Obama’s new cybersecurity initiative to ensure that EHR systems have advanced encryption capabilities and other data protections.

Electronic Health Record Systems Will Require 'Some Form of Oversight,' Government Advisor Says

As more healthcare providers move to implement electronic health records by 2011, the technologies for storing and managing these vast data sets will need to be regulated, an advisor to the federal government said at a conference here this week.

“There is some form of oversight necessary,” John Glaser, senior advisor of the Office of the National Coordinator for Health Information Technology, said at a colloquium on personalized medicine hosted by the American Association for the Advancement of Science. He acknowledged that a regulatory process would be necessary to handle the limitations of EHR systems and managing malfunction issues.

Glaser noted that ONC met with FDA this week to discuss regulation of EHR-related technologies. “Is it a formal device or not? I don’t know,” Glaser said, adding that he wasn’t sure whether regulation of EHR systems would necessarily fall under FDA oversight.

“However, to a large extent human aptitude plays a huge part in how well the software works,” said Glaser, who is also the chief information officer of Partners HealthCare System.

EHRs have been proposed as a key component of personalized healthcare, and Glaser noted at the meeting that they could be a powerful tool for picking up post-marketing drug risk information and relative risk data. At the meeting, other officials from government and academia outlined several efforts to use EHR systems to look for genes associated with disease predisposition and drug response

The Certification Commission for Healthcare Information Technology, a private organization, conducts one-day testing of EHR systems. But currently no federal oversight of EHR systems exists.

Earlier this year, an article titled “Finding a Cure: The Case for Regulation and Oversight of Electronic Health Record Systems,” published in the Harvard Journal of Law and Technology, advocated for federal oversight of EHR systems. Although the authors did not feel that oversight responsibilities should necessarily rest at the FDA, they recommended that EHR systems should be monitored for as long as they are operational so technical problems are detected and the system is continually improved.

The regulatory oversight for EHR systems is a looming question as hordes of healthcare providers will be moving to electronic record systems in the next five years, urged by the promise of federal funding. The stimulus package offers incentives to hospitals and physicians for the “meaningful” implementation of electronic health records. Glaser is helping the federal government implement its programs.

Physicians who accept Medicare and use EMRs can receive up to $44,000 over a five-year period between 2011 and 2016. Doctors who see more than 30 percent of patients receiving Medicaid benefits are eligible for up to $64,000 beginning in 2011 if they adopt the technology.

Furthermore, there are penalties proposed for non-adopters. Healthcare providers who have not shown “meaningful use” of a certified EHR system by 2014 can see a decrease of up to 1 percent in the Medicare fee schedule for 2015. The Medicare fee payment reductions will continue for every year of non-compliance. The deduction rate can go up to a maximum of 5 percent if total EHR adoption is under 75 percent of eligible providers by 2018.

In a recent study, researchers from the Harvard School of Public Health, Massachusetts General Hospital, and George Washington University found that less than 2 percent of hospitals had implemented comprehensive EHRs; and less than 8 percent had basic EHRs in place.