Electronic Health Record – Meaningful use rule ‘on target’ for end of year

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.

Social Security budgets $24M to exchange health data with hospitals, HIEs

The Social Security Administration has set aside $24 million to expand a program under which it contracts with hospitals and health information exchanges willing to electronically share electronic health data on patients seeking disability benefits.

Each year, SSA makes more than 15 million patient-authorized requests for medical information from treating providers, but most of this exchange is paper based and as such is very inefficient, SSA officials say. They’re hoping the use of health IT will greatly improve the process.

SSA is looking for a provider willing to link to the agency via local HIEs and the Nationwide Health Information Network. Contracts for the project, proposals for which are due Sept. 18, will be funded through the stimulus law.

Using the NHIN, providers will get a standardized electronic request for medical records along with a patient’s authorization. Providers will then be able to automatically respond to SSA requests with a standardized Continuity of Care Document.

To be eligible for the project, providers must use a certified electronic health record app and be able to demonstrate the technical ability to create a sample Continuity of Care Document with de-identified EMR information.

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.

Opinion: Electronic medical records improve quality of care

Patients in the Kaiser Permanente San Jose Hospital are seeing something new when a physician or nurse visits their rooms. The doctors and nurses themselves aren’t different; they continue to provide their patients with superior care and service.

But a piece of equipment they bring with them — a wheeled cart with a computer screen on top — is a significant difference, and it’s an example of what will help dramatically improve health care in America.

The cart-borne computer is wirelessly connected to a huge database containing the medical history of our members, as well as the latest recommended treatments for a wide range of medical conditions. The database contains all outpatient and inpatient visit information, diagnostic images such as X-rays and mammograms, allergies, specialists’ notes, lab tests and prescriptions. And it is all part of KP HealthConnect, the largest nongovernmental electronic medical record (EMR) system in the United States.

Electronic medical records are a cornerstone of President Barack Obama’s health reform effort, and as part of his effort to stimulate the economy, he has dedicated some $19 billion to make EMRs a national reality.

Why? Electronic medical records improve the quality of care. A fully functional EMR system gives physicians, nurses and technicians a patient’s comprehensive medical history at the point of care, whether it’s in the doctor’s office, the emergency room or in a skilled nursing facility. It is also remotely accessible for specialists and others who are on call, allowing them to make informed decisions that expedite patient care.

EMRs have the potential to increase efficiency and contain costs by reducing duplication and improving patient safety, and they do this by harnessing the incredible power of computers — their ability to calculate, to network, to automatically check facts and to provide targeted research results — and applying that power to medical care.

In health care systems with fully implemented electronic medical records, physicians and nurses no longer need to spend valuable time looking through several files for paper records that are often incomplete.

Now, for example, emergency department physicians with a fully functional EMR system can see a patient’s previous hospitalizations, medications and diagnoses when that patient shows up complaining of chest pains. That means treatment can begin more quickly and success is more likely.

Medication is safer, too: Prescriptions written by physicians using the EMR system are spell-checked and legible, and the computer automatically combs the patient’s history for potentially dangerous drug interactions and alerts the doctor.

In the hospital, medications are bar-coded and scanned at bedside to help ensure the right patient is getting the right drug in the right dose at the right time.

Of course, EMRs should not be a one-way street. In integrated health care systems, patients can use their home computers to increase convenience by making appointments online, ordering prescription refills that are delivered to their home, viewing their lab results through secure Web pages, and e-mailing their physicians — all at no additional cost.

Last year, thanks to these online tools tied to EMRs, Kaiser Permanente members had 6 million e-visits without using a gallon of gas.

Notes jotted on paper and placed in multiple files where doctors rarely see them are a remnant of a fragmented, inefficient model of medical care. In the 21st century, Americans expect — and deserve — more.