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.

Iowa to receive grant money for EHR implementation

Iowa has become the first state in the nation to have its Medicaid program chosen to receive funds from the American Recovery and Reinvestment Act of 2009 to assess implementation of electronic health records and personal health records.

Iowa’s Medicaid program will receive a grant of $1.16 million in federal matching funds through the CMS, which is awarding grants to states to assess EHR readiness and awareness among their Medicaid providers. The money will go toward activities to plan for the adoption of EHRs, including efforts to promote interoperability and “meaningful use” of the records and identifying barriers to adoption. The stimulus law provides 90% of the funds needed to administer the grants to providers, including auditing.

The grant funding will also go toward assessing expectations for PHR technology. Unlike EHRs, which are maintained by providers, PHRs are managed directly by the consumer.

“While Iowa is the first state to receive approval of its plan for implementing the recovery act’s EHR incentive program, a number of other states have submitted plans as well,” said Cindy Mann, director of the CMS’ Center for Medicaid and State Operations, in a news release.

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.

E-prescribing 'could cut cost of human negligence'

Electronic prescribing systems that reduce the possibility of human error could cut clinical negligence claims by more than 70 per cent, according to US hospital chain Banner Health.

The company, which has worked with national IT programme supplier Cerner to evaluate the impact of its electronic prescribing system, said systems that reduced the possibility of human errors such as illegible handwriting or misrecorded doses had led to a 72 per cent reduction in the cost of clinical negligence claims at one of the group’s hospitals.

The National Patient Safety Agency has estimated that 9 per cent of patient safety incidents relate to medication errors, which together constitute some 20 per cent of all clinical negligence claims against the NHS.

In 2007-08, the NHS Litigation Authority paid out approximately £64m in damages for cases involving misprescribing.

Banner Health’s system director for care transformation Judy Van Norman told HSJ: “Some clinical leadership in the hospitals are interested and enthused about being involved but the resources at the individual hospital level to really lead the adoption of this is a frustration.”

Health IT execs meet to boost e-prescribing

Health and Human Services Department officials looked to spark the adoption of e-prescribing at a conference this week attended by some 1,400 health care professionals and industry representatives.

The meeting, held in Boston and sponsored by the Centers of Medicare and Medicaid Services, was put together in six weeks in preparation for the planned launch of the federal e-prescribing incentive program, set for January. Incentive payments for physicians who institute e-prescribing will initially be set at 2 percent.

We need to raise awareness in plenty of time to be ready for Jan. 1 said Kerry Weems, acting CMS administrator. We have a very short period of time to begin and end the education process.

The next milestone in the adoption push will come in November, when CMS plans to publish its final rule regarding incentive payments to providers. That rule will lay out definitive guidelines on what constitutes complete and successful e-prescribing, Weems explained. He said CMS continues to formulate that guidance and will use the conference to obtain feedback as it prepares the final rule.

Barry Straube, CMS chief medical officer, said the rule for qualifying for bonus payments is potentially reachable by many physicians’ offices.  He said the likelihood of qualifying is quite high for those offices obtaining an e-prescribing system.

HHS officials said they believe the bonus payments will provide the financial driver to accelerate adoption. There is a lot of money on the table here, said HHS Secretary Mike Leavitt.

Leavitt cited a $1 billion estimate as the dollar value of prescriptions that fall under the Medicare incentive.

Some physicians, however, remain skeptical of e-prescribing. Questioners during a conference session brought up the cost of adoption and the need for tort reform as issues affecting e-prescribing adoption.

Some anecdotal evidence, however, points to increased adoption.

Randy Boldyga, president and chief executive officer of RxNT, an e-prescribing vendor in Annapolis, Md., said 50 doctors implemented his company’s solution during one recent week, about double the usual number of installations. He said the Medicare incentives are playing a role in the increased activity.

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.

Chopra seeks outside advice on health IT standards

The Health IT Standards Committee today said today it would bring together experts from outside the healthcare field to share ideas about best ways to apply new workflow and information sharing standards across organizations.

Aneesh Chopra, the White House’s chief technology officer and chairman of the panel’s newly formed standards implementation group, said he wants to mine the lessons of other industries in using information handling standards successfully and then apply them broadly to healthcare.

“There is an interest in how other industries have adopted standards, and I think we’re going to take that feedback to heart,” Chopra said after the meeting. The panel will host a hearing on Oct. 29 to share best practices, Chopra said.

Additionally, Chopra will open a two-week online forum to seek feedback from a wider audience on a series of structured questions and information posts on standards usage. The implementation workgroup will report on its findings at the next standards committee meeting Nov. 19

Dr. David Blumenthal, the national health IT coordinator, cautioned against confusing the adoption of standards with the adoption of electronic health record technologies.

“This is not about the adoption of technology but the adoption of standards,” he said. Health IT vendors will be able to solve most of the technology problems, he said.

Standards are at the heart of healthcare reform, Blumenthal noted, as reform will depend on standards and infrastructure being available to exchange health information anytime.

“Congress might not know it or realize it, but you are at the center of their effort to improve the healthcare system,” Blumenthal said in praising the standards committee’s work.

Blumenthal also said the Nationwide Health Information Network project, a public-private sector project that has been in progress for years, is essentially a set of standards.

“The goal has always been not to develop a thing or a network that is closed or a physical representation of a network, but to create a resource in the form of protocols, standards and specifications that are available in the public domain, he said.

“They are available to anyone who wishes to use the Internet to exchange information in a private and secure and effective way.”

Blumenthal said his office has also been considering how to accelerate the availability of the standards, protocols and specifications that comprise the NHIN as well as how to provide consumers and small practices access to the NHIN toolset.

“We think [that] is a laudatory goal just as we think that individual physicians and small physician groups should” have access. Blumenthal said. “This is a public resource whose broadest use is our goal.”

In other areas, the Committee’s clinical quality workgroup said it would create a sub-group to focus on gaps in the transition of vocabulary standards along the health IT adoption path.

For instance, providers will have to migrate from using ICD-9 to ICD-10 to SNOMED CT by 2015 to record physician’s clinical observations in an electronic health record.

“We need to enable that conversion to the adoption process, and that’s where these gaps are,” said Jamie Ferguson, co-chairman of the work group and executive director of Kaiser Permanente’s health IT strategy and policy.